Mental Health Services and Community Care. Cummins, Ian
prestige developments (Chaplin and Peters, 2003), with the substantial grounds being a bonus. These luxury housing developments use a language of sanctuary that has echoes of the asylum narrative. The development is a private space that offers an escape from the pressures of the city but convenient access to it. This is, of course, required as the buyers will need to work in lucratively paid jobs to afford such an exclusive property. Chaplin and Peters (2003) note that the advertising for such developments uses terms such as ‘seclusion’ that had generally negative overtones when the space was an asylum. The authors found that there were few explicit references to the fact that these developments were on the sites of former asylums. The stigma attached to the asylum lingers on, even after the institution itself has physically disappeared. However, as Chaplin and Peters conclude, ‘paradoxically, asylum can now be bought in an ideal self-contained community, with security to keep society out’ (Chaplin and Peters, 2003: 228).
Leary (2011) outlines what he calls ‘ruin pornography’, by this he means the stylish and artistic photographs and media representations of once great industrial cities. He terms this trend Detroitism, as the city has gone from being a metonym for post war growth to one for deindustrialisation. As he points out, it is possible to buy art house coffee table books of ruined and neglected buildings that were once the heartbeat of US post war industrial economic boom. What these photographs cannot capture is the dynamism of a booming economy or what that meant for working class people. The stylised photographs and images obviously cannot capture the reality of these areas as working environments – the heat, the noise and the physical effort required to keep up with industrial processes are all missing. In a rather similar vein, there is a thriving interest in neglected and abandoned asylums. These photographs are used, in a similar way, to capture the essence of the former institutions. These haunting photographs of abandoned wards, strange equipment used in treatments and images of neglected patients all add to the Gothic reputation of the asylum. ‘Asylumism’ thus acts as a metonym for the management and treatment of mental illness before the advent of community care. In doing so, it collapses the end of the asylum as an institution into its whole history.
Van der Velde (2016) published Abandoned Asylums – a series of photographs that promises readers ‘an unrestricted visual journey inside America’s abandoned state hospitals, asylums and psychiatric facilities, the institutions where countless stories and personal dramas played out behind locked doors and out of public sight’. It also promises images of hospitals that treated the famous and infamous, including Marilyn Monroe and Charles Manson. The abandoned and decaying institutions act as magnets for so-called ‘urban explorers’, such as Keïtaï, who enter abandoned sites and post photographs of what they find. Alongside a series of photographs, the following is an entry from Keïtaï’s blog about a visit to the former West Park Asylum in Epsom Surrey.
We were able to see more of the place; the padded cell, the main hall, the post office and the children’s creche. The padded cell was our main goal like many others who venture there. It was smaller then [sic] I expected and harder too. (Keïtaï, 2011)
This is not the only approach to the complex history of the asylum. For example, ‘The lives they left behind: Suitcases from a state hospital attic’ (Community Consortium, 2015) is an exhibition based on a suitcases found in an abandoned building when the Willard Psychiatric Center in New York’s Finger Lakes closed in 1995. The exhibition paints a complex portrait of the individual lives of the patients before they entered the asylum. This approach forces the reader to ask fundamental questions such as ‘why were these individuals admitted to the institution, how were they treated and why were patients for such long periods?’ Raymond Depardon produced a series of superb photographs of the Gorizia asylum where Basaglia (Foot, 2015) enacted his reforms. These photographs document the need for the reform, as Depardon in discussing how he came to take the photographs states:
I often went back to the old hospital in Trieste, the place called the ‘manicomio’, the ‘lunatic asylum’. One day, I followed this group coming out of the canteen. What was it about the patients that struck me: the way they looked, the clothes they wore, the way they walked? I was drawn to them. I found myself in a very old ‘reparto;’ the door of the ward closed behind me, there wasn’t a nurse in sight. With the noise and the decrepitude of the place, I confess that for a moment I took fright. I started taking photographs, very quietly. (Raymond Depardon, quoted in Howard, 2018)
The development of mental health policy is a history of space and place, seclusion and exclusion. In examining this history, it is vital to consider the symbolic value that is placed on particular spaces and places. Bedlam comes to be representative of institutionalised care. In the US, conscientious objectors in the Second World War were sent to work as hospital orderlies in asylums. Parsons (2018) highlights that these individuals were appalled by what they saw and became committed to reform. This initially involved fighting racial segregation. Conscientious objectors working at the Philadelphia State Hospital at Byberry took their concerns to two journalists Alfred Deutsch and Albert Maisel. This resulted, in 1946, in the publication of an expose in Life magazine, which reached millions of US citizens – the modern equivalent of a prime time documentary or viral video. The expose compared the hospital to prisons. The article also included a photograph, entitled Despair, of an emaciated, naked patient (Parsons, 2018). For readers, who the previous year had seen newsreels of the liberation of Belsen, the link was an obvious one. Later, in 1960s Italy, Basaglia, who was heavily influenced by the work of the Holocaust survivor Primo Levy, made a similar link between the camp and the asylum (Foot, 2015). This was a link that Levy did not think stood up to scrutiny (Cummins, 2018).
The French historian Pierre Nora considers public memory and sites of commemoration, He noted that there is a ‘rapid slippage of the present into a historical past that is gone for good’ (Nora, 1989: 7). He argued that we respond to this by focusing on memories of physical spaces. Thus, the modern world becomes obsessed with a socially constructed version of history that can replace previous collective memories (Nora, 1989). He coined the term lieux de mémoire for sites of remembrance. Nora (1989) sees memory and history as being in opposition with each other. He states: ‘History’s goal and ambition is not to exact but to annihilate what has in reality taken place’ (Nora, 1989: 9). He uses the battlefields of Verdun. The site has become a national monument to the Fallen. In creating the memorials, the horror and carnage has been removed. In its place, there is a grandeur and solemnity totally at odds with the battle that the site commemorates. One possible way to approach asylums is to see them as lieux de mémoire where the memories are still contested.
Community
As previously outlined, the asylum was an institution set apart both physically and psychology from the wider society. This exclusion also reflected the way that psychiatry was a discipline apart from others in medicine. One of the drivers of community care was to tackle this social isolation of the psychiatric patient. There was an implicit assumption that the ills of institutionalisation would be overcome by community based services. Community is one of Raymond Williams’ Keywords (2014). Keywords (Williams, 2014) is an exploration of the changing meanings of the words and terms that are used in discussions of culture and cultural ideas. It consists of 110 short essays on terms including bourgeois, culture and hegemony. He published a revised version in 1983, and added 21 new words.
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