‘Up the pole’ was commonly used at Oakwood Hospital in 1978 and I don’t think I’ve heard it again since then. Maybe it was peculiar to that hospital or maybe it was swept away in the asylum closure programme of the 1980s. ‘Floridly psychotic’ was the clinical alternative to ‘up the pole’, although it’s a mystery to me how medicine adopted the word ‘florid’. The idea of a botanical psychosis is appealing and if there is such a thing, I hope it’s called Blodeuwedd Syndrome after the character composed of flowers in the Mabinogion. A better alternative to both ‘up the pole’ and ‘floridly psychotic’ is ‘turbulence’, a word preferred by one patient I knew to describe his moments of madness: ‘Brace! Brace!’
According to my Google research, ‘up the pole’ can also mean pregnant, but only in Ireland. At Tooting Bec, a no-nonsense, straight-talking senior nurse rudely greeted news of Eira’s second pregnancy with ‘up the fucking duff again’. Honest at least. By this time we were actively looking for ways to move to Wales, a decision confirmed one Saturday afternoon when a real life ‘up the pole’ event occurred on the Deaf Unit.
To cut a long story short, he had an Andrew Tate type personality, although his faults could be excused by his age (18) and life experience (trauma and a childhood in care). He wore the brittle protective shell suit of a dominant alpha male, spending too much time lifting weights, checking his biceps and trying to wind people up. His communication in sign language was slick and articulate and he easily and often insulted, mocked and ridiculed other patients, using graphic signs and imagery that were surprisingly innovative and grossly offensive. There was nothing pathological about this in a strictly medical sense and indeed it probably fell within the normal limits for a certain subset of adolescent lads. On the other hand, it was certainly debatable whether the Deaf Unit was the right environment for him. Essentially, he represented the disadvantaged side of the more privileged Trump/Johnson/Tory donor coin.
This particular Saturday afternoon I felt compelled to have a word with him about another episode of signed abuse. His response was a well-delivered left hook to my eye, worthy of Henry Cooper in his prime. Luckily I’m not a trained boxer; if I were, I imagine my instinctual response would have been an immediate upper cut followed by instant dismissal. In fact, he instantly dismissed himself by fleeing outside, climbing a telegraph pole and refusing to come down. Following a quick risk assessment (what if he fell? Imagine the paperwork…) I dialled 999. Possibly the first time the Police had been called to Springfield Hospital. These days I understand they are regularly called to acute units around the country. Everything’s gone up the pole.
Part 20. A Stitch in Time: the Case of Language Deprivation.
The Garden of Earthly Delights (detail). Hieronymous Bosch.
Arriving to work at the London Deaf Mental Health Unit in the late 80s and early 90s often felt like walking into an Hieronymous Bosch hellscape. The worst Deaf Club ever. The problem was unintentionally caused by well-meaning staff who were suffering from a mild case of Hearing Saviour Complex. In the early years their search and rescue missions had enjoyed some success, extracting a small number of deaf patients from one of Surrey’s learning disability hospitals and bringing them back to a semi-natural habitat in the microcosmic deaf world of the Deaf Unit. At the same time, a number of people, usually young adults, with actual neurodivergent or developmental issues joined them in this one-size-fits-all mental health laboratory. A kind of recreation of Oliver Sacks’ Awakenings in which exposure to BSL stirs people into life. Later, the Unit became a stopover for forensic patients from Rampton as part of their Home Office supervised journey back into the community. Routemaster 37/41 (Mental Health Act 1983), one slip and you find yourself recalled. On paper, these patients were ‘mentally disordered offenders’, but many had been deemed unfit to plead due to language and intellectual limitations rather than clear mental disorder. Often they had dangerously low levels of impulse control and explosive emotional dysregulation. The Unit was also home to an adolescent on the autistic spectrum; unusual, if not illegal, even for those times. This was his home in the sense that there was nowhere else to go and his family home was even more unsafe than this one. The common denominators for all these groups of patients were deafness and trauma. One of the problems was a lack of alternative placements for deaf people with developmental, intellectual, behavioural, emotional or psychiatric problems. But there was also a tension created by the Unit’s impulse to do the right thing and the precarious status of the Unit: the moral imperative to help was sometimes compromised by the economic imperative to accept any referral as long as the person was deaf. Although an NHS service, the Deaf Unit relied on supra-regional funding and therefore had to justify both its usefulness and its value for money. The Unit had a monopoly on deaf mental health services south of Birmingham, not by design but simply because there were no other providers. This was an accidental monopoly caused by generalised neglect of deaf people’s needs at local levels and not the kind of monopoly enjoyed by water companies, who literally shit on their customers with total impunity. The Deaf Unit was a sole provider in an unpredictable market, relying on the continuing goodwill of hard-pressed regional health authorities to cough up funding. One consequence of this was the drift towards accepting the most complex cases, resulting in a volatile patient mix. The unspoken belief was that a deaf environment would be an effective intervention in itself when in fact some patients needed much more specific help than we were equipped to offer. Just Being There was not enough for all those Awakenings.
Language deprivation was at the heart of many of the behavioural problems we were trying to contain. The most challenging patients had either been deprived of sign language as children or had some form of language disorder related to an intellectual disability. It only takes a moment’s reflection to realise the multitude of consequences for a child deprived of language. Recent research points to a critical period for first language acquisition between birth and 5 years old and that missing this milestone has an enduring limiting effect on brain development. The challenge of working with language deprivation is huge and yet the answer is obvious: focus on that critical period and make learning sign language affordable and accessible for hearing parents of deaf children.
Somewhere in Scotland in the early 1980s an asylum held an unusual experiment in user-led services. Experts by experience were placed in key roles in pharmacotherapy; specifically, they were responsible for the syrups dispensed from the sticky bottles of Largactil and Melleril to patients who couldn’t be trusted to swallow their tablets. On a forgotten back ward, a trusted patient held a 10ml plastic beaker at eye level and filled it to its brim. ‘Bill needs a bit extra, he’s not well today,’ he said to the nurse nominally in charge of the medicine trolley.
This is not entirely true, but the syrup patient did exist and the nurse was indeed my old flatmate Neil. Neil and his syrup story came down together from Scotland and he went to work on the locked ward at Tooting Bec, known as RS1. I briefly worked on the admission ward above him, RS2, after qualifying, and on the top floor was RS3, better known as the DDU, (Drug Dependency Unit). The anonymous ‘names’ of those wards epitomise the dehumanising effects of institutional care at that time, as people were turned into medical classifications in human warehouses. The DDU was slightly different, as its focus was mostly on stopping illicit substances getting in while staff dished out the legitimate stuff in the form of the vivid green syrup. And we’re not talking absinthe.
On Saturday evenings the DDU staff prepared meals for themselves, sometimes with a dash of booze if Joe, the senior nursing officer, was in attendance. This was completely normalised professional misconduct, akin to parking on double yellows while the traffic warden keeps an eye on your car as you pop to the shops. When the old regime, including Joe, was swept aside by the iconoclast Ray Rowden – who wrote the manual on closing asylums- the alphabetical ward names went too, to be rechristened as trees. RS1 became Sycamore and RS2 became Rowan, although K1, one of the dementia wards, bizarrely became Krypton ward. I didn’t hang around to find out if the name changes had a humanising effect on the place, but I doubt it.
Joe had a psychopathic relative living in the nurses’ home who worked at the DDU. One night, after a heavy session in the social club, he went to the unit with a replica pistol and held it to a patient’s head. The next day Ray Rowden sent a memo to everyone in the nurses’ home to say he was banned from all parts of the hospital except the route from his room to the front gate, literally his dismissal pathway. A map was included to avoid confusion. Many years later, I met this man in the lobby of our inpatient unit in north Wales. In that moment of shocked mutual recognition I saw the look of someone whose past had caught up with him, similar to a concentration camp guard being greeted by Nazi hunters after 30 years under a false name in Argentina. In fact, he’d been working at Broadmoor Hospital and I presumed that even they wanted rid of him. He said he was here for a job interview so I promptly gave the interviewing panel my character assassination and he was never seen again.
The three wards shared a panic alarm. An ear-piercing klaxon with an indicator board by the entrance to each ward telling you where the disturbance was. The panic alarm successfully created panic, acting like a starting pistol for staff to charge blindly on to the staircase before checking the board. Having run back and checked, there would be a chorus of ‘It’s RS1!’ In and out like a human cuckoo clock stuck in the cuckoo’s nest.
Clockwise: Ben Ferencz, Otto Ohlendorf, Joseph Weits.
Two TV documentaries and a couple of local council decisions have triggered some thoughts on social engineering. Gwynedd council’s consultation on holiday homes ended this week, so maybe some respite from the complaints of the pro-2nd home lobby who view any state interference in our daily lives as a form of social engineering: 20mph speed limits; limits on selling houses; limits on planning permission; limits on cars in Ultra Low Emission Zones; limits on jetskis; limits on doing whatever we bloody well want. There’s no limit to their opposition to limits. I suspect they make an exception in the case of refugees whose freedoms they definitely would like to limit, including the freedom to be alive. Unlike these faux-outraged victims of the nanny state, most refugees are actual victims of actual social engineering in the shape of ethnic cleansing and genocide.
With the same potential for a positive community impact in the long term, but considerably lower key than its holiday home policy, is Gwynedd’s proposal to de-couple social workers from their NHS colleagues in Community Mental Health Teams, breaking away from the orthodoxy of the Partnership model of working. I thought I’d make an FOI request about this, because I’ve got nothing better to do, and now I’m wondering about social work and social engineering.
In the midst of all this worrying, this week I’ve watched two documentaries on extreme social engineering: Ordinary People investigating how ordinary Germans recruited to the Einsatzgruppen mobile killing units found themselves executing Jews across eastern Europe and Blue Box exploring Joseph Weits’ role in expanding Israel’s borders at the expense of Palestinian Arabs. It’s easy to draw the obvious conclusions and highlight the sad ironies, but beyond these I noticed some less obvious common threads. In Ordinary People the extraordinary Chief Prosecutor at Nuremberg, Ben Ferencz, notes the two mistakes made by the Nazis: keeping detailed records and letting him find them. Over in Palestine Joseph Weits was also keeping a record, but of his own thoughts in his personal diaries. No one in his family had properly read them until his great granddaughter, the maker of the documentary, came along and did. We hear the objection ‘I’m not comfortable with this’ repeated as she questions her family about grandpa Weits’ role in the expropriation of Arab properties and land. She has become grandpa’s Chief Prosecutor. Perversely, we see in these two documentaries individuals acting in ways they believe to be justified: Ohlendorf, well-educated, likeable and ideologically deranged, believes Jews are Marxists and enemies of the Third Reich whose children must also be killed to prevent their revengeful future threat to the regime; Weits, methodical and opportunistic, uses business ethics to rationalise the appropriation of Arab property, defending it in terms of a financial transaction, a purchase for which the other parties are properly compensated. He is celebrated as The Father of the Forest for his grand tree planting programme, less so as The Architect of the Transfer of Arabs to refugee camps. Ohlendorf goes to the gallows without a shred of doubt about his actions but we learn from Weits’ journals that he fears that among all the trees he planted are the seeds of a neverending conflict with his Arab neighbours.
Closer to home, Gwynedd’s Health and Wellbeing Department responded at length to my FOI about removing its social workers from CMHTs. They cited evidence that partnership working has essentially been a fudge with unrealistic ambitions and unclear outcomes. Their proposal is to focus on a preventative wellbeing social pathway across the continuum of care, leaving medical and clinical care with the Health Board. What exactly that might mean in practice isn’t clear but it’s a surprisingly bold move and if they’re ambitious enough I think it’s potential is profound and totally congruent with what I understand to be social work’s purpose and values. An opinion piece in the Psychiatric Bulletin by Rob Poole and Peter Huxley supports the view that both social care and social interventions to tackle the origins of mental ill health have slowly been eroded as mental health care has become decontextualised. The social workers that impressed me most were those who valued community work as much as casework, who were engaged politically and socially with community projects like housing and employment. They understood networks and often intervened at that level. In a sense they were social engineers, servicing the mechanics of social inclusion. A well-oiled society is a healthy society and offers protection against breakdowns. That kind of benevolent social engineering deserves a second chance.
I’ve stumbled into thinking about mental health and deafness again (it never goes away, quietly lurking in the canyons of my mind https://youtu.be/3hcZ4s9cvpw ). Out of the blue I was asked if I had data on mental health service use by deaf people. Needless to say, this isn’t the sort of thing I’m privy to since bidding farewell to the NHS all those years ago. The question triggered a flashback to the Excel client activity spreadsheet that I stoically kept up to date and reminded me that, on the whole, the organisation took a benignly indifferent approach to my work with deaf adults, except when I sent in funding referrals for specialist deaf interventions; at that point the organisation knee-jerked into major incident mode and invoked the IPFR (Individual Patient Funding Request) committee to extinguish this apparent existential threat to the Health Board’s finances. To be fair, the IPFR squad were usually called in to approve exceptional cases requiring novel treatments or out of area specialist care, so they and I were often puzzled by the need for their approval to get a deaf person some straightforward EMDR treatment from a deaf therapist. The process was slow and cumbersome and involved justifying exceptionality on the basis of deafness, not clinical need, leaving me feeling like a conspirator in the medicalisation of deafness despite my repeated attempts to summarise the cultural model of deafness for the committee. These are the kinds of institutional barriers a BSL Bill ought to be able to dismantle.
The data enquiry was in the context of current murmurings about a Welsh BSL Bill and so I started to think about BSL deprivation as an obvious social determinant of deaf mental health problems, visualising it as one of those upstream issues you see in health promotion diagrams: the one that shows people falling (or being pushed) upstream into a river and drowning as they are drawn across the rapids and over the fast flowing waterfall downstream. At the edges of the river are doctors and nurses throwing in lifebelts and dragging out the bodies and asking themselves ‘Isn’t there something we can do to stop them falling in?’ Remembering Tryweryn and Milan1880, the drowning souls call back (in Welsh & BSL): ‘We didn’t fall and we weren’t pushed. A committee far, far away flushed us away.’
“Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.”
In this context, upstream means intervening at the very source of the river – at the spring, the mountain peak, or, in the case of deafness, at the newborn screening clinic. Imagine if it were the norm, even a legal requirement, that newborn hearing assessment clinics were equipped with bespoke packages of information, advice and support for the deaf child and its parents, promoting the benefits of BSL. Not doing so at this crucial moment – more or less the present status quo – contributes to language deprivation, restricting access to BSL and the richness of deaf culture and putting at risk the child’s future language and cognitive development; setting the scene for all the problematic consequences that follow, including the better known social determinants of health and illness that flow from language deprivation. A BSL Bill has the potential to put a stop to this.
On a bit of a roll and in a moment of involuntary and uncontrollable activity I slipped out of retirement and into the world of Google Scholar. I found a lot of papers and also this:
Someone’s already done the work…
I didn’t buy the book because I’m retired. If anyone out there reading this owns it or might buy it, you know where I am. Neil Glickman has also written a very helpful book describing adapted CBT for deaf people with limited or deprived language. I did buy that one and gave it away when I retired. Just so you know. As for the concept of social determinants of mental health, everyone’s known about them since well before Karl and Emile coined the terms ‘alienation’ and ‘anomie’. We’re still waiting for the kind of large-scale social restructuring envisaged by Karl that would address these persistent social determinants. Poverty, racism, discrimination, exclusion and marginalisation are not recently discovered phenomena and neither are Adverse Childhood Experiences (ACEs), but it is only relatively recently that they have been absorbed into the mainstream via trauma-informed services. None of this is a surprise to social workers ofcourse – that venerable journal, Sociology of Health and Illness was first published in 1979 after all. With a few notable exceptions, psychiatrists, clinical psychologists and nurses have been latecomers to this particular party. Looking at ACEs, typically traumatic experiences of abuse, neglect & deprivation, it seems clear to me that a deaf child’s exposure to audism & oralism is clearly an example of an ACE. A BSL Bill could protect deaf children from such adverse experiences.
The sequelae of limited or no access to sign language during childhood are considerable and comparable to those seen with other types of ACEs in terms of lifelong mental health problems. Added to this, poorly developed language competence will make therapy & treatment more challenging for deaf people. There is accumulating evidence that language deprivation in deaf children can lead to delays in theory of mind (empathy related) skills and working memory (essential in reasoning tasks & closely linked with children’s academic achievement). These are avoidable downstream problems whose source is located in the lack of early access to BSL and which in themselves place deaf children at risk for future mental health problems. A BSL Bill could reduce these risks at a stroke.
An ambitious Welsh BSL Bill which is both prescriptive (pro-BSL) and proscriptive (anti-audism) and which gives BSL due prominence in the emotional & social development of deaf children, would be a significant upstream intervention in mental health promotion for deaf children and adults.
I don’t remember why I named this website after the two-line poem by Catullus, Odi et Amo (I Hate and I Love). The poem is a remnant of schooldays and must have had some emotional salience at the time, associated with a traumatic dumping I expect. From my mental filing cabinet labelled ‘Hate’ I’ve retrieved another document: Hate in the Countertransference by DW Winnicott. We read this for the psychotherapy course at Springfield Hospital. Simultaneous hating and loving are implied in Winnicott’s 1949 paper, although hate and the ‘psychotic’ is his explicit subject. Written pre-Largactil and before psychosis went off limits to psychotherapy, it’s not exactly an easy read for anyone like me not familiar with the complexities of psychoanalytic theory. If only he could have said it all in two lines like Catullus. I remember it because it indirectly gives permission to hate your patient, not usually a core competence in therapy training. The important thing ofcourse is to be aware of your hatred, otherwise you end up like Tony’s grotesque therapist in After Life. Deep breath: the gist of Winnicott’s paper is that the therapist-patient relationship reproduces the mother-baby relationship wherein the mother may hate her baby and must conceal this hatred from baby and to some extent herself. And breathe out. Baby too is prone to hate when the good breast is replaced by the bad breast. All very alarming when you have a newborn of your own at home. As an aside, I’d like to say that my wife and I never understood the directive to leave your baby crying alone in his or her room. Using the object relations defence won’t justify that particular manifestation of countertransference.
Institute of Group Analysis
The group analysis was included in the psychotherapy training package so that we could have the experience of being hated – sorry, of being a patient. Three of us, two ward managers and a CPN, drove across London (you could do that in 1990) and joined the other one hundred fellow participants at the IGA. Each week there was a lecture followed by group analysis. Once each term we all sat in concentric circles, the group ‘conductors’ in the middle, for the large group experience. The term conductor, rather than facilitator or even analyst, was coined by SH Foulkes who set up the Institute after the war. As the quotation below suggests, the conductor and the orchestra have no score but do share an expectation that some kind of music will be created. However, because this is a form of analysis where transference is crucial to the process, the conductor offers no direction and remains inscrutable. The group sessions were one and a half hours long. Quite often in my group the orchestra didn’t start playing for at least half an hour. That amount of silence can induce an awful lot of anxiety. Then we’d drive back to Tooting, sworn to confidentiality but dropping general hints about our respective groups.
The large group inevitably transported people back to first days at school, memories of feeling lost and alone among strangers, finding your way and looking for guidance. Unexpectedly, a Holocaust survivor recalled his story, the ultimate terrible large group experience. I couldn’t see him from my seat, he was poignantly lost in the ripple of concentric circles. In my small group I experienced intense anxiety until the silence was eventually broken. At one level I put it down to natural shyness, a fear of being the focus of attention and ultimately being negatively judged – a form of mild social anxiety. At a deeper level, I wondered if its origins were in my CODA heritage, tangled up with language, culture, and shame. Shame is the most corrosive emotion of all. My first conscious contact with shame came at one of the first, perhaps the first, UK CODA meetings in Brighton a year earlier. All of us had felt varying degrees of shame growing up with deaf parents and some were quite bitter about it. I wasn’t in that camp and neither was Ben Steiner. I knew Ben through his interpreting work at the Deaf Unit. He was the perfect antidote to shame, very securely attached to his CODA identity through his close bond with his mother who had signed onto his hands and body in the dark when he was a child. He told this story to the CODA group and I took it away in my heart. I later summoned the courage to share it with my small group in that north London suburb. The group conductor remained inscrutable but I didn’t mind too much, it didn’t matter if he judged me or even hated me, I was playing my own tune now.
I need to start with that random reading list from Part 1, specifically the newspapers. Just in case I’d given the impression that I was some kind of precocious Jacob Rees Mogg monster child, reviewing the stockmarkets or pruriently enjoying rural vicar sex scandals, I feel I should explain. The Daily Telegraph and Sunday Express were delivered to our house throughout my childhood. Every week, or perhaps fortnight, there was the bonus of Pogle’s Wood and Shoot!. In those days, The Telegraph hired excellent Sports writers and I didn’t pay too much attention to the actual news coverage. Noel’s family must have been Telegraph readers too, as I remember the two of us sharing the report of Norman Hunter’s shorts ‘bifurcating’ during some mud-soaked mid-seventies football match on the bus to school. It will come as no surprise that this is the first time in over forty years that I’ve had the opportunity to use that word. Noel’s family was definitely more Telegraph than mine, evidenced by his obvious pleasure in eating a Mother’s Pride sandwich whenever he came to our house. He also had an impressive collection of Sobranie cigarettes from the tobacconist on Week Street. Over time, I moved on to the Telegraph’s Arts pages which were helpful to a teenager who rarely left the suburbs. Once I had moved out, however, I never looked at it again. Many years later I was checking in to a conference hotel behind a well-known Professor of Mental Health Nursing and he requested the Telegraph for his room, immediately casting into doubt his moral compass and two decades of peer-reviewed scholarship. At least it wasn’t The Mail I suppose. The Sunday Express is and always has been a rag.
Which newspaper you read, what bread you eat and which brand of cigarettes you smoke are all functions of the presentation of self in everyday life, if you’re a symbolic interactionist. Or products of your relationship to the means of production if you’re a dialectical materialist. I learned this at The Lanch. I went to Coventry (Lanchester) Polytechnic in 1978 and left in 1981 (still none the wiser about those brackets). I arrived at a good time: the following year Thatcher won her first General Election, providing years of material for a generation of sociologists and political scientists; the Ska revival was just rising to its peak with Coventry as its unlikely epicentre; and the Social Science department was enjoying the rigour and enthusiasm being generated by two or three progressive, fresh-faced academics at the start of their careers. Thatcher had already snatched the children’s milk and would later announce that there was no such thing as society. About as anti-sociological as you can get. It was going to be an uphill struggle for the social work department. The Applied Social Science course had a built-in route to the CQSW for aspiring social workers, which involved placements during the summer breaks and an extra year at the Poly. Students had to opt into this pathway at the end of the first year. That was the plan, but here’s a clue: 1978 – 1981, three years.
Rejected by Maidstone College of Art, I’d reconciled myself to the next best thing: History of Art and French at Bristol University, on the basis that if you can’t join them, write about them in French. If I’m honest, I wasn’t confident about my potential as an artist or indeed as a linguist. I was never going to challenge the bio of yet-to-be-discovered Maidstone alumnus Tracey Emin and I could never master the French subjunctive. In 1977, on the evening of our A Level results, I was in the Duke of Edinburgh, which stood opposite Oakwood Hospital’s perimeter wall, celebrating with my friend Noel over a few pints of Shepherd Neame and a game of bar billiards. Unexpectedly and in unusually high spirits, his dad burst through the door and announced that our headmaster (MA DPhil – MAD Phil – first name Philip and Lord Longford lookalike) had phoned recommending that Noel return to school and prepare for the Oxbridge entrance exam. This proved to be a turning point for both of us. He went on to study at Oxford and I bottled out of Bristol. How did that happen?
Lord Longford
I’ve never had a plan. Once I’d learned to read I didn’t stop until I was eleven. I read everything in front of me, from Capt WE Johns, HG Wells, Isaac Asimov and the The Daily Telegraph. Back issues of The Readers Digest, Woman’s Realm, Ray Bradbury, Dennnis Wheatley and The Sunday Express. It was random. At eleven I went to the Grammar School and reading became homework. Random suited me better than order. I didn’t know where this was heading but Mr Newcombe (English) wrote in my first school report that I should go to university. He seemed to have a plan but it felt unintelligibly long-term to a twelve year old. By the Fifth Form things seemed to be following someone else’s plan when Mr Harvey (Maths) described me as ‘insouciant’, a word wasted on my parents. He obviously hadn’t done his homework on them. Or maybe he was a master of reverse psychology. I proved him wrong (maybe he proved himself right) and got a B, still treasured as a minor triumph in my life. I went into the Sixth Form, where things were slightly less ordered and rediscovered the joy of reading. The rest is history. Actually, sociology (see Part 2).
Once I’d ditched the idea of becoming a francophile art historian, my hiatus needed filling. For no obvious reason that I can remember, I took up a post as a Nursing Assistant at Oakwood Hospital. The place was physically almost invisible, hidden behind high walls. The very grand admin block could be seen at the end of a long drive from the main gates and parts of a two-storey ward block could be seen from either the Tonbridge Road or the top deck of the Banky Meadow bus going down Queen’s Road (evidence, I’m afraid, of my low-level hooligan nights at Maidstone United’s Athletic Ground). The hospital’s resemblance to a prison was no coincidence as it was designed by John Whichcord, the architect of Maidstone prison. A fine early example of BOGOF. Opened as the Kent County Lunatic Asylum in 1833, it has now mostly disappeared with the exception of some Grade II listed buildings that have been converted into apartments. The stigma has disappeared too, to be replaced by a few coveted addresses.
I was sent to work on a male ‘psychogeriatric’ ward. Much of the hospital was devoted to caring for this group of patients. The terms senile and pre-senile dementia were still commonly used, although it was around this time in the late 1970s that the diagnosis of Alzheimer’s disease started to gain currency. There was no induction programme for me, no formal training, definitely no mandatory training and no expectation that I might need to know more than how to wash, dress and feed our patients, give them medication, or strip and make beds and run errands. Risk assessment, manual handling, Deprivation of Liberty Safeguards and advance directives were unknown concepts from a future universe and the only documentation I saw was the bath book. No doubt there was some form of nursing record, just as there was probably a psychiatrist somewhere, but I never saw either of them. Acetylcholinesterase inhibitors? Don’t be silly. A pink tablet seemed to be given most frequently. I later realised this was Haloperidol and the primary cause of the restless agitation displayed by many of the patients. The management of iatrogenic restlessness was the Buxton Chair, later outlawed, as was Haloperidol (or at least it should be).
But this is now and that was then. In the absence of precognition and with an open mind, I didn’t ask any questions. Six months later, I thought I might like a career in the helping professions and found a course in Applied Social Science that included the option to qualify as a…social worker. How did that not happen?
Odi et amo 