Thursday, June 2, 2011

Innovation without Change

This is the title of a book written 20 years ago by David Brandon (see portrait) to argue for radical improvements in what were described then as 'our extraordinarily impoverished mental health services'. Much of the content of this posting is drawn from Brandon's writings, interspersed by comments of my own on the current scandal exposed by the BBC's Panorama programme at a privately operated mental health facility for people with learning diability and autism near Bristol.

John Perceval was the son of a British Prime Minister assassinated by a psychotic man in the House of Commons in 1812. Perceval himself became 'deranged' in 1831, and he was admitted at the request of his mother and brother to an institution run by Dr Fox in Brislington, Gloucestershire. He was transferred in 1832 to a private madhouse in Suffolk where he remained until early 1834. A year later he married and went to Paris where he wrote about his experiences, publishing two volumes in 1838 and 1840 of 'A Narrative of The Treatment Experienced By A Gentleman, During A State of Mental Derangement.'

He describes in careful detail the physical abuse that took place in Dr Fox's madhouse: beatings, excessive restraints, forced cold baths and forced medical treatment. Perceval beautifully summarises the extensive differences between his needs and what was provided:

"I needed quiet, I needed tranquillity, I needed security, I needed even at times seclusion. I could not obtain them. My will, my wishes, my repugnancies, my habits, my delicacy, my inclinations, my necessities were never once consulted.....Then I hated, I despised, I was enraged, I became hardened, I was brutalised......I will be bound to say that the greatest part of the violence that occurs in lunatic asylums is to be attributed to the conduct of those who are dealing with the disease, not the disease itself.....Because I did not respect myself, they disrespected me, whereas they should have brought me to my senses by greater reserve and respect."

John Perceval was the first English 'lunatic reformer' His Narrative is a serious work of protest. Early in the first volume Perceval asks readers, "In the name of humanity, then, in the name of modesty, in the name of wisdom, I intreeat you to place yourselves in the position of those whose sufferings I describe". Over the next twenty years Perceval worked tirelessly to bring to the attention of legislators in Parliament and elsewhere the needs of the mentally ill in asylums and outside them, and to champion reform. According to Brandon,'if anyone should receive acknowledgement as the father of the mental health reform movement, it is Perceval'.

Well, isn't it a funny old world? If not a perverse, brutally savage, refractory and enraging as-well-as-funny-old-world? John Perceval's account of his treatment in Dr Fox's madhouse almost two hundred years ago replicates almost exactly the account given by the under-cover Panorama reporter at Winterbourne View; of needs for care, respect, tenderness and sensibility being met with Abu Ghraib-style torture, at the hands of men and women - young, well-fed twenty-first century men and women - unfit, it seems to me, to transact with any life-form at all, let alone some of the most the most vulnerable, and already-wounded of our kind.

So the grisly mental welfare wheel still churns to mangle more victims as it did in Perceval's day, and their cries (and the pleas of those who speak out for them to authority and power) are at best unheard, and at worst ignored - for it's my sense, born of fifty-three years as a nurse in several environments set up to care for the mentally ill or disabled, that managers and regulatory functionaries do sometimes wilfully ignore the whistleblower; they want the whistleblower to stop whistling; they want the whistleblower to shut up and go away; they want a quiet unproblematic life; they want promotion to a sinecure position in the quangocracy; they want a consultancy or a non-executive directorship on the board of a private care-provider; they want a 'gong' or a knighthood, or a damehood; they want whatever's going; and by Golly they usually get it.

I can't be sad about what's happened, I feel enraged, and that's more appropriate. Apologies from corporate or political suits, glib mendacious nonsense about 'lessons being learned', and 'never again' set my teeth on edge, expose raw nerves in me. I've seen it over and over, this scandalous bullying, this dehumanising criminality, and it seems to be spawned by the institutions themselves, as if there is some intrinsic flaw to them, as I believe there is. And I've tried for five decades to exorcise it from within, to keep myself free of it, to mitigate its worst effects, through training, through writing, through whistle-blowing, through personal example, and I've paid a price for those efforts; with the currency of capitulation, of craven cowardice, of self-doubt, even - there have been times - although it's an agony to admit it - of complicity and concealment to protect my self-interest: in a career, a salary, a tied-house, the security of my family, the well-being of our youngest son, whose own mental afflictions, psychiatric neglect and ill-treatment I have sometimes - God help me! - interpreted as retribution for my personal weakness and folly. So shame, and remorse - and that's appropriate too. But I don't know that it supplies any kind of solution, and I don't know what can.

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