Schizophrenia - how we treat it

The demise of the asylum and the rise of care in the community

The treatment of the mentally ill measures the health of any society

Henry Cockburn was diagnosed with schizophrenia in 2002. Before that he was a heavy cannabis user.

His father, Patrick Cockburn, The Independent’s award-winning foreign correspondent, has seen – at first hand – the  dramatic changes in the way we treat the mentally ill over recent decades. Today, in the second of his groundbreaking four-part series, he explains how psychiatric care in Britain went wrong – while Henry reveals his experiences as a schizophrenic marooned in the system.

---

The treatment of the mentally ill measures the health of any society because they are the most vulnerable and the least able to defend themselves against cruelty and neglect. It is an issue that affects the lives of a large part of the population. At any one time some seven million people in England and Wales over the age of 16 – one in six of the adult population – are suffering from a significant psychiatric problem. At least one-third of all families have a member who will at some stage be mentally ill.

Mental illness may be pervasive but it remains a largely hidden plague. Despite significant progress over the past decade, knowledge of psychiatric disorders lags far behind that of physical illnesses. Neat-sounding categories such as schizophrenia, bi-polar depression and schizoid-affective are not distinct diseases like TB or polio, but names given to a psychosis on the basis of symptoms evident when a patient sees a psychiatrist. As these symptoms change – as they often do – so does the diagnosis.

In the 1950s medications were discovered that could control, but not cure, mental disorders, and it is still not known exactly how they work. Only last month it was revealed that big pharmaceutical companies have largely stopped the search for new drugs to treat mental illnesses after spending billions of dollars in the search. They had found that not enough was known about the human brain and its ills for them to have a reasonable prospect of success.

Given the uncertainty about the nature of mental illness, it is extraordinary that governments in Britain and across the world should have revolutionised the treatment of those suffering from it. In the years since the mental asylums created by the Victorians were first denounced in the UK as relics of a past era – by Enoch Powell as Minister of Health in 1962 – the great majority of them have been closed. Between the 1950s and today the number of beds available for psychiatric patients in Britain has declined spectacularly from 150,000 to 27,000.

The asylums were supposed to be replaced by “Care in the Community”, a cuddly-sounding approach that one Labour minister derided as “couldn’t care less in the community”. The crime novelist P D James, who worked as an administrator in the NHS and whose husband was a long-term patient in a mental hospital, commented bitterly that community care “could be described more accurately as the absence of care in a community still largely resentful or frightened of mental illness”.

Half a century ago every British city had at least one mental asylum on its outskirts, but these were rapidly closed down and sold off, often to become luxury flats or the site of a supermarket. It was one of the most radical changes in the British institutional landscape since the dissolution of the monasteries in the 16th century. As with the monasteries, the motives leading to the demise of the asylums combined a genuine belief that the system was wrong with an ideological hostility to their existence and a keen sense of the financial advantages stemming from their demise.

The psychiatric hospitals were caught in a pincer movement from right and left. The left saw the asylums as being like prisons, whose inhabitants were primarily the victims of an authoritarian system. Films like One Flew Over the Cuckoo’s Nest propagated this attitude. On the right, such views were welcome because they provided respectable reasons for spending less money on the mentally ill and reduced the role of public welfare.

What followed this revolutionary change is still a subject of angry dispute among doctors and former patients. Many things were wrong with the old asylums, which could be brutal and uncaring, but they were also a place of refuge for people who desperately needed one and had nowhere else to go. Barbara Taylor, a historian who spent time as a patient in the late 1980s in the Friern mental hospital in north-east London, formerly known as Colney Hatch, recalls in an essay that “for me Friern was truly an asylum. I entered it on my knees: I could no longer do ordinary life, and giving up the struggle was an incalculable relief. My home in the hospital was a locked acute ward with a deservedly violent reputation: a Dickensian barrack of crumbled brickwork and peeling walls, reeking of fag smoke and teeming with ghosts; but for me it was sanctuary.”

The end of the asylums came not just in Britain but across the world and is still going on. In the United States the number of beds available for psychiatric patients fell from 558,000 in 1955 to 53,000 in 2005.

Some of the slogans of the anti-asylum movement in Britain and the US are chilling in their covert or unintentional cruelty. One of them was “de-institutionalisation”, as if healthy people, and not just the mentally ill, are not themselves dependent on institutions where they work, such as a school or an office. The institutional needs of the mentally ill are often very simple, described by one social worker as being “a place where you can go and sit and chat and have a cuppa, and lunch”.

But even this is sometimes denied them on the grounds that it makes them part of a “dependency culture”. A carer, lamenting the closure of a day centre in Wales, says “often people are very withdrawn, lonely or low, or in another world, others have lost most of their personality and are referred to as being burnt out. These people don’t want or need anything very demanding, just coming to the centre and getting out of the house is enough, and a blessing for carers.”

The disastrous impact of “care in the community” was being recognised in the 1990s and more sophisticated community care became available such as the Early Intervention in Psychosis units that aim to help young people suffering their first psychosis by detecting and treating it in its early stages. But the closure of so many mental asylums in the past continues to have a negative impact because almost all those now inside are there by compulsion. Psychiatrists say they are becoming increasingly like an 18th-century Bedlam, with locked rooms like cells and an emphasis on preventing escape. Dr Humphrey Needham-Bennet, a consultant psychiatrist, says “they are more like a prison than a hospital”.

Paradoxically, mental health care in Britain  since the closure of the asylums has moved in two different and contradictory directions. One, motivated by media and public fears, is to treat mentally ill people as potential axe murderers to be closely incarcerated. The other approach, equally exaggerated, is to understate the gravity of a chronic mental illness and pretend sufferers can live “in the community” as if they were not ill.

Schizophrenia: The shame of silence, the relief of disclosure

Henry Cockburn: If I say I'm schizophrenic people reply, 'So you've got a split personality'

The stigma of the hidden schizophrenia epidemic

Editorial: We are failing sufferers of mental illness

Henry Cockburn: I like to be liked – and finally I’ve found friends who really like me

Is this the 'tobacco moment' for cannabis?

Henry Cockburn: 'I can hear what other people can't'

Fashion advice from the shrink’s sofa

Henry Cockburn: I was trying to listen to my shoes. I thought I was going to be put in a straitjacket

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Account Manager

    £20000 - £35000 per annum: Recruitment Genius: This full service social media ...

    Recruitment Genius: Data Analyst - Online Marketing

    £24000 - £35000 per annum: Recruitment Genius: We are 'Changemakers in retail'...

    Austen Lloyd: Senior Residential Conveyancer

    Very Competitive: Austen Lloyd: Senior Conveyancer - South West We are see...

    Austen Lloyd: Residential / Commercial Property Solicitor

    Excellent Salary: Austen Lloyd: DORSET MARKET TOWN - SENIOR PROPERTY SOLICITOR...

    Day In a Page

    Isis in Iraq: Yazidi girls killing themselves to escape rape and imprisonment by militants

    'Jilan killed herself in the bathroom. She cut her wrists and hanged herself'

    Yazidi girls killing themselves to escape rape and imprisonment
    Ed Balls interview: 'If I think about the deficit when I'm playing the piano, it all goes wrong'

    Ed Balls interview

    'If I think about the deficit when I'm playing the piano, it all goes wrong'
    He's behind you, dude!

    US stars in UK panto

    From David Hasselhoff to Jerry Hall
    Grace Dent's Christmas Quiz: What are you – a festive curmudgeon or top of the tree?

    Grace Dent's Christmas Quiz

    What are you – a festive curmudgeon or top of the tree?
    Nasa planning to build cloud cities in airships above Venus

    Nasa planning to build cloud cities in airships above Venus

    Planet’s surface is inhospitable to humans but 30 miles above it is almost perfect
    Surrounded by high-rise flats is a little house filled with Lebanon’s history - clocks, rifles, frogmen’s uniforms and colonial helmets

    Clocks, rifles, swords, frogmen’s uniforms

    Surrounded by high-rise flats is a little house filled with Lebanon’s history
    Return to Gaza: Four months on, the wounds left by Israel's bombardment have not yet healed

    Four months after the bombardment, Gaza’s wounds are yet to heal

    Kim Sengupta is reunited with a man whose plight mirrors the suffering of the Palestinian people
    Gastric surgery: Is it really the answer to the UK's obesity epidemic?

    Is gastric surgery really the answer to the UK's obesity epidemic?

    Critics argue that it’s crazy to operate on healthy people just to stop them eating
    Homeless Veterans appeal: Christmas charity auction Part 2 - now LIVE

    Homeless Veterans appeal: Christmas charity auction

    Bid on original art, or trips of a lifetime to Africa or the 'Corrie' set, and help Homeless Veterans
    Pantomime rings the changes to welcome autistic theatre-goers

    Autism-friendly theatre

    Pantomime leads the pack in quest to welcome all
    The week Hollywood got scared and had to grow up a bit

    The week Hollywood got scared and had to grow up a bit

    Sony suffered a chorus of disapproval after it withdrew 'The Interview', but it's not too late for it to take a stand, says Joan Smith
    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?

    Panto dames: before and after

    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?
    Thirties murder mystery novel is surprise runaway Christmas hit

    Thirties murder mystery novel is surprise runaway Christmas hit

    Booksellers say readers are turning away from dark modern thrillers and back to the golden age of crime writing
    Anne-Marie Huby: 'Charities deserve the best,' says founder of JustGiving

    Anne-Marie Huby: 'Charities deserve the best'

    Ten million of us have used the JustGiving website to donate to good causes. Its co-founder says that being dynamic is as important as being kind
    The botanist who hunts for giant trees at Kew Gardens

    The man who hunts giants

    A Kew Gardens botanist has found 25 new large tree species - and he's sure there are more out there