Background
to the
Research
- In the residential and day
care facilities of NIAMH former patients and retired staff frequently
recalled their memories of life in Northern Irish psychiatric hospitals.
It was thought to be important to record these experiences of hospital
life in the 1950s and NIAMH approached the authors to undertake this
research.
Research
Approach
- The research was carried out in the autumn
of 1994 and into early 1995 and included all psychiatric hospitals in
Northern Ireland. The research was divided into two stages, stage one
consisted of a set of unstructured group discussions and stage two used
the 'Critical Incidence Technique' - where participants were asked to
recall particular experiences or incidents. In all, a range of interviews
were carried out with nurses, doctors, social workers and former patients.
The results were reported in the form of nineteen themes that emerged
during the discussions and interviews.
Main Findings
Friendship
- This theme was frequently mentioned by
former patients, many of whom had lived in hospital for a generation
and who valued the social network within the hospital.
Security
- The daily structured routine of life in
the institution, with three meals a day and a set of rules to live by,
provided a safe and secure environment for many patients and staff.
The Social Organisation of the Hospital
- The hospitals of the 1950s had all the
features of institutions, however the better ones offered a regular
range of activities such as dancing, films, inter-war competitions (involving
staff and patients) and various forms of work. In some hospitals, all
the wards were locked and only opened when patients were lined up to
go to the dining room. Many former patients and nurses commented that
senior nursing staff were 'ex-service' and life was regimented.
Brutality
- Mental and physical abuse of patients was
common-place in the 1950s and paraldehyde was used to sedate patients.
However, some former patients reported that there was no abuse.
Climate of Optimism and Change
- This theme was mainly mentioned by retired
doctors, some retired nurses and one or two former patients. Changes
were influenced by enlightened staff and the introduction of the major
tranquillisers. Outside the hospitals, lack of understanding of mental
illness and stigma were very prevalent.
Indifference and Resistance to Change
- In many institutions, care was often of
a custodial nature. Nurses wore white coats and were called wardens.
Some nurses and doctors were very resistant to reforms and new forms
of treatment.
Electro Convulsive Treatment
- Nurses and patients found this treatment
very disturbing and their memories of it were still vivid.
The Farm
- Most psychiatric hospitals in Northern
Ireland in the 1950s had a farm, and former staff and patients reported
positive experiences of the work carried out on the farms.
Bathing
- Bathing was usually communal, with patients
lined up for their bath and having to share the same bath and bath water.
Smells
- Former patients and staff have vivid recollections
of the smells within the hospital, usually these were of stale urine,
rotten food, and wax and paraffin from the polished floors.
Clothing
- Up until the mid-1950s, patients wore hospital
clothing which were bought in bulk and communal, often the clothes did
not fit the person. By the end of the 1950s, patients were beginning
to be allowed to have their own clothes.
Sexual Exploitation
- Some patients and some young female student
nurses were exploited and these incidents were covered up.
Privacy
- Patients had no privacy, with few windows
having curtains. During the 1950s, the population of hospitals was relatively
large and hospitals were often overcrowded giving little privacy.
Psychiatric Hospitals as a Place of
Safety for the Vulnerable Sane
- Some people were in hospital in the 1950s
because they were vulnerable and had nowhere else to go. Once incarcerated,
it was difficult for these patients to leave, and many became institutionalised.
Typical Daily Tasks for Female Patients
- Women worked in the laundry, the kitchen,
swept floors, knitted dishcloths and carried out general cleaning.
The Bedridden Population
- A high number of patients were bedridden
in most hospitals, this was based on an ethos of easy management and
social control rather than on medical grounds.
Glimpses of Social Workers
- Social workers promoted community alternatives
to hospital and brought an emphasis on social therapy to the work of
nurses and doctors in the hospitals.
Suicide
- Many participants recollected suicides
within the precincts of the hospitals, the two most common forms were
hanging and drowning.
Containment of Disturbed Patients
- The disturbed wards tended to be noisy
and strident with an atmosphere of violence. Patients were frequently
restrained by the use of straight jackets.
Conclusions
- The recollections of participants paint
a disturbing and shocking picture of the care of those with mental health
problems in the 1950s, despite the period being one in which progress
was made with the establishment of the National Health Service and the
Welfare State.
- Despite the impact of the drugs revolution
and the beginnings of real change, the chronic asylum culture was resilient.
- Patients in the 1950s were powerless,
vulnerable and depersonalised. They lacked privacy, wore hospital clothes
and their lives were very regimented. However, some hospitals offered
security, safety, companionship and acts of kindness.
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