M.D. Confidential: It's All Very Hush-Hush

THE HISTORY OF MENTAL ILLNESS

The history of mental illness reveals that the mentally ill have always been shunned in all societies throughout history. They have always been with us, and will be for a long time to come.

Such disorders were well-documented by the early Greeks, Romans, and Egyptians thousands of years ago. Those who hallucinated, heard voices, and expressed fear of others (that is, they were delusional), were considered to be very special and have the ability to see into the future. They were revered as extraordinary due to their psychotic manifestations.

Several hundreds of years ago, it was decided that the public had to be protected from such deranged individuals, but also that they required protection from the abusive public. Thus they were housed in mental institutions.

The first written knowledge of such intuitions came from the Arab Islamic states, as explained by travelers to those areas. Cairo had such a hospital in the 9th century for the care of the insane and employed compassion, support, and music therapy as treatment.

In medieval Europe, the insane were housed in some monasteries, small villages, and in city towers called fools’ towers. The hospital in Paris, Hotel-Dieu, had a few cells in the basement solely for lunatics. Also, the Teutonic Knights had hospitals with small attached madhouses.

In 1285, a treatise by Sheppard, Development of Mental Health Law and Practice, described a case of a frantic and mad individual due to the instigation of the devil. Thus, such illness was then associated with Satan.

Spain had many institutions, and in London, England, The Priory of Saint Mary of Bethlehem was built in 1247—later known as the famous Bedlam.

Much later, throughout England and Europe, the parish authorities assisted families both financially and with nursing care for their mentally disabled. Such a parish might further help by housing a mentally ill family member in a private madhouse or board them out with other caring families. Some charitable institutions, supported by religious groups, were available, such as Bedlam.

In the early 18th century, many cities throughout England had private institutions. Unfortunately, there are recordings of some institutions selling or renting out their patients in the form of slavery. Such individuals served as serfs in various workhouses, mills, and mines. In the early 19th century, the College of Physicians in England put a stop to that practice.

Privately-run asylums developed in the 1600s, and in 1632 the Bethlem Royal Hospital in London recorded that in the lower levels there was a parlor, a kitchen, larders, and several rooms where distracted people were held. Those who were violent were chained, but all others could roam about and even had access to the public areas close by.

When King George III had a remission of his mental disorder in 1789, such disorders were finally seen to be treatable and curative.

Moral and compassionate treatments prevailed with the French physician, Philippe Pinel, in 1792 at the Bicêtre Hospital near Paris. Pinel and others freed patients of chains and dark dungeons were abandoned. It was agreed that such illness was the result of social and psychological stress, hereditary tendencies, or the result of physiological damage. Attendants and other nursing personnel were taught to be compassionate, supportive, and humane. Patients were encouraged to work in the hospitals and on discharge were assisted within the public workplace.

In England particularly, cottage-like homes developed to house those requiring less supervision. Such cottages held 50-70 patients, and it produced a familial environment, where patients were encouraged to perform chores to allow a sense of contribution. They were rewarded with Christmas, Easter, or other holiday incentives.

I and my wife, a nurse, had the opportunity to work in such humane and modern cottage hospitals at the Runwell Hospital in Wickford, Essex and St. Ebba’s Hospital in Epsom, Surrey in the early 1960s. I was surprised that at Easter, Christmas, and other festive occasions the women received a small glass of sherry and the men a small tankard of beer at mealtime. They were light-years ahead of the huge, red brick, four-story monstrosities that held four to five thousand patients in Canada and throughout the United States.

In the USA, the first psychiatric institution opened in 1773 in Virginia: the Eastern State Hospital. Later, in the early 19th century, many such hospitals opened throughout the States.

In Canada, every province had immense, three-to four-story ornate hospitals. Each building was fronted by magnificent Corinthian columns, and some contained grand staircases. However, a few levels had bars on the windows, and many had padded cells. Each was a community within itself, and in the 1960s they became more civilized with beauty parlors, cafeterias, movie houses, game rooms, private showers on each ward, and overnight sleeping rooms for families from afar who came to visit their relatives.

I myself worked at the Weyburn Mental Hospital in Saskatchewan in the summer of 1951, the Brandon Mental Hospital in Manitoba in 1956, and then at Essondale, later called Riverview, in British Columbia in 1958 and again in 1961 and 1964. I was impressed with the caring, supportive, and considerate attitude of all nursing, medical, and personnel ancillary care.

In the 70s and early 80s, there was an international movement to decentralize such large institutions and move patients into their communities to be with their families. Thus, group homes were established. Patients were encouraged to be treated at home with therapists visiting close by. Outpatient units were attached to every medical facility in the area.

However, many patients were unable to adapt since they had been uneducated, unemployed and had no training whatsoever. There has been an outcry by the public, since many such patients have been seen to be on the streets, addicted to drugs and alcohol, and sleeping in store fronts, parks, or alleys. The prisons now house many mentally ill individuals. Housing for the poor, the destitute, the indigent, and the mentally ill is obviously wholly inadequate.

It is important to realize that institutionalized patients before the 1970s were generally very well cared for. Prior to their hospitalization, many mentally ill were unemployed, uneducated, shunned, isolated, rejected, abused, exploited, or addicted to drugs and alcohol, and upon their discharge, many unfortunately returned to their old habits.

With hospitalization, they received good medical attention, proper hygiene, adequate nutrition, and companionship. Many worked in the kitchens, laundry, libraries, and farms, or as gardeners, aides to mechanics, assistants to the nurses and medical staff, cleaners, barbers, and hair stylists. They formed close, lasting bonds with the staff and with each other, and often had supportive family visitation, occupational therapies, and regular religious spiritual assistance.

Such hospitals often had festive nights with food, music, and even dances, especially during special occasions. Once weekly, a hospital had a movie night held in large auditoriums, and occasionally such patients were entertained by outside groups of performers.

With the progressive drive to close such hospitals throughout the world in the 70s, all such patients returned to receive treatment in the community, and were moved into halfway houses or to be with their families. As to treatment, they saw a counselor, nurse, or a psychiatrist once per month for fifteen minutes to readjust their medication. They remained poorly prepared for life outside of the institution: unemployed, shunned and isolated in the community, and left on social welfare.

Many became the homeless on the streets: addicted to drugs and alcohol, behaving in anti-social activities, prostitution, and often subsequently suffering imprisonment. Change requires a large amount of funding for rehabilitation, re-education, close supervision by counselors and therapists, treatment facilities, and better housing. Such change requires greater advocacy, raising the profile of mental illness and the need for open public discussion by individuals and community groups.

Nobody escapes being wounded. We are all wounded people, whether physically, emotionally, mentally, or spiritually. The main question is not, 'How can we hide our wounds?' so we don't have to be embarrassed, but 'How can we put our woundedness in the service of others?' When our wounds cease to be a source of shame, and become a source of healing, we have become wounded healers.

– Henri Jozef Machiel Nouwen

ADDICTED ALLISON

Hey, Simon. That bitch daughter of yours, Allison, has taken our new clock radio, my good pillowcases, and my brand-new suitcase out of her room, Adele, Allison’s step-mother, shouted down from the second-floor landing.

Damn, I never even heard her get up and leave, Adele. We shouldn’t have taken those sleeping pills last night, Simon shouted back as he made coffee for the three of them that morning.

Adele came into the kitchen frothing at the mouth. No point making her coffee, Simon. She’ll sell my good cases and my radio on the street to get more coke. She’ll be drinking that rot-gut on Sherbourne Street. Or shooting up on Queen, Dundas, George, or in Regent Park with that no-good Nazi bum of hers. You know, that coke head, Vongrubber.

It’s Gunther. Her boyfriend, Gunther.

Simon poured a coffee for Adele and tried to calm her down. December is a cold month, Adele. At least she has Gunther to help her sometimes. I’m afraid she’ll end up with pneumonia again, like when she almost died last year in hospital. I’ll go look for her tomorrow, since it’s the weekend.

Adele sat down, sipping her coffee but pounding her fist on the table. You shouldn’t have given her that money, dummy. She’ll just shoot up with that German fucker of hers and peddle her ass on the weekends. You’re just enabling her by giving her money. He takes it off her to buy more smack to shove up his arms or snort more snow up his nose.

Simon knew that was the way it was. Well, she’s my daughter, Adele. I have to try and find her, and at least get her and Gunther into an addiction clinic. You know: some good therapy.

Adele stomped out of the kitchen and yelled out from the hallway, Yeah, well, she should get a life, Simon. Pull herself together, get a proper job, and stop wasting our and the government’s money every time the police pick her up or the ambulance takes her to the hospital. You know, to clean her up. She slammed the door to the kitchen but had a parting shot. She doesn’t have a pot to piss in, Simon … my God, and she’s piss-poor. You keep giving her money. Simon, the enabler!

Simon followed Adele out of the room, trying to placate her. You keep saying she’s piss-poor, Adele. Where does that saying you use so often come from?

Adele smiled for the first time. She was on stage again, with her university degrees plastered all over the kitchen walls and her part-time acting career. Now listen up, Simon. In ye olde England, some had a metal pot under their bed. There were no toilets or bathrooms, so they pissed into those pots all day and all night. When the pot was full, they took it to the leather tannery factories in the city.

Simon clapped his hands as he recalled. Aha. Yes, England was awash with beaver and other hides from America, and the uric acid in urine was needed to tan the hides into leather.

That’s right. They sold their urine for a few pennies or florins. However, if they were very poor and couldn’t even afford to buy a pot, then they didn’t have a pot to piss in and were really piss-poor."

Simon thanked Adele for the lecture, but she still berated him as he left. Simon left his third wife at home and finished his day working as an accountant that Friday, but he had to travel to Ottawa that week to do some contract work for the government.

On the next weekend he got into his car, turned on the wipers to clear the sleet coming down, and headed for Regent Park in Toronto. This is where I usually find her. Pray to God she’s there, he said to the radio announcer talking about a snowstorm hitting the east.

After two hours of circling the park he gave up. There, I see her friend, Gunther, he suddenly shouted out as he rounded a corner onto Dundas.

Gunther was negotiating with two men in black windbreaker jackets and hoods pulled over their heads. Simon recognized Adele’s clock radio held by one of the scruffy characters.

He stopped his car on the busy street. Hey, Gunther, where’s Allison? Have you seen her? I’m looking for her."

Gunther came over to the open window. He was unshaven, wearing a dirty toque pulled down over his sad, grubby face, and his breath stank. Yeah, yeah. She’s upstairs. In number six. She’s okay, I think. She needs a fifty. I’ll give it to her, he said, showing Simon the dollar bills and hiding the syringe and needle with his other hand behind his back. He smelled of booze.

Simon looked up at the seedy rooming house with a body sleeping on the open doorstep. Cars were honking for him to move on.

I’ll be right back, Gunther. Tell her I’ll help her. He started his car and drove around the block to find a car park. That took an hour. He paid the attendant and walked back to look for Allison at the The Swank Rooming House on Dundas.

He stepped over the body at the door that was ajar and pulled back the thin sheet, praying that it wasn’t his daughter lying there. It wasn’t, but the body had a cardboard sign next to it. A few pennies for Penny, please. He threw some coins into the empty jam jar.

He waited for some response from Penny. When he got none, he called 911 and reported the body. No, she’s alive, he said and left.

He walked into the The Swank. A hooker approached him and asked him if he’d like a good time. He brushed her aside, held his nose from the stink of cheap perfume, and walked up two flights of stairs to find number six.

The door was slightly open. Simon walked in, not sure what he would find.

There she was. Allison was sitting on a chair, just barely conscious, swathed in the two pillowcases and a ragged, filthy, moth- eaten blanket. The room was small, cold, and stank of marijuana and stale cigarette smoke. The one small window was covered in sheets of old newspaper, and the only table held an old, grimy, dog-eared bible. There was an old electric heater in the corner sitting idle. He walked over, plugged it in, and turned it on full blast. It spluttered and died.

He came back to his daughter. Allison. Are you all right? What are you doing?

She sat in a soiled, white plastic chair and was trying to work on her laptop, which was propped up on a yellow card table that was badly stained with cigarette burns. Simon was appalled to see her so tired-looking and indifferent.

Hey, pops. You found us. Doing design work for the movie company in town, working on the blue screen for a backdrop. Good job, pops. Good job. Pay’s good, she answered not looking up.

Some time ago, Simon had told Adele that he was proud of the fact that Allison had graduated from her graphic design course last year at the local college. It was after he had last rescued her from hooking on the streets. As usual, Adele had chided him for bringing her home and cleaning her up again. You spent all that money for her design courses and what did it get you? Nothing but more trouble.

At that time, Allison had told Adele and her father that Gunther was a graphic artist in Frankfurt, and together they hoped to find work. Adele had just laughed out loud. Simon knew that Allison was also a very talented artist but that talent was never used.

Simon looked about the room at The Swank. The walls were covered in sheets of sceneries of old Toronto painted by Gunther. Gunther was snoring on the floor in the corner on a frayed mattress. He had vomited and stale urine filled his pant leg.

Simon put his hand on his daughter’s shoulder. She winced. Come home, dear. It’s almost Christmas. It will be warm for you, her father said kindly. He looked over at Gunther and cautiously added, Maybe bring him when he’s off drugs, and both of you can see a counselor. Come home, you know, for some turkey.

Allison brushed her father aside. Naw, pops. He’s got some good work now and cleaning up. I’m off all that junk, and Gunther found us a nice, clean place to live. Somewhere over there, she said and pointed