Ray (1964-67)

Aura

It was a strange place it was, at the best of times. It had a sort of aura about it. Scientifically, we can say the full moon doesn’t make any difference, but walking up that drive, getting closer to home, on a full moon you can almost sense something prickly in the air, you know. If only I felt it, I don’t know. So many people used to feel it. It’s funny; I never actually felt it when I was inside the place. I mean you came of duty late at night and walk down the corridors. You think how long those corridors are, you know? Low lighting at night and you’d walk from one end to another, from the admission block, you’d come from Wren, at the far end and you’d have to walk down, it was a long walk you know. That never used to feel strange. But outside sometimes you’d get these little… I don’t know whether the darkness makes it more primitive, you know, but yeah, it was weird. I never felt threatened on the inside.

Patient Attacks

I was attacked: twice while I was there. Both times by people who were hallucinating. On one occasion, a guy was actually saving me, as I’d got a dragon on my shoulder! So he was punching! To get it off my shoulder; to protect me! I was just like Whoa! Steady down!

And the other time, a guy just came over the top of a table accusing me of saying things about his mother. I wouldn’t say it was a particularly violent place. There were moments like that, but the fact they stand out suggests it probably wasn’t that violent most of the time. But, yeah, I mean there were, in all honesty, but the violent incidents that stick out more was staff rather than patients!

Institution and a workplace

You have to view it with some sort of context – What is cruel now was cruel 40 years ago. A lot of the staff there in ’64, only 20 years from the end of the war, so most of the men in their late 30s, 40s, actually fought in the war, and the guards depot was right across the valley in Caterham. It was rumoured that they’d be discharged at Caterham, take a sharp right, march across the valley and appear at Cane Hill and sign up. If you’re institutionalised to start with, then it’s another institution.

Institutions are pretty interchangeable, if you fitted within them. For them, they’d gone from a sort of disciplined, uniformed existence to another disciplined and uniformed one, certainly at that time. And the people of the 60s, say late 50s, 60s, top of the pile, had other reasons. A lot of them had started before the war, towards the end of the depression. I’ve had some of the charge nurses say it was a good job; it was dry, indoors, with a pension, relative job security. You know, there were families there; they had hospital housing down at the bottom, in Coulsdon. And yeah, there were some multigenerational links, a mini village within Coulsdon. It was a community in it’s own right.

Care in the Community

My experience goes from there through to working at the high end of Care in the Community, assisted living. I’ve been involved with that sort of thing since 1968, 69, so before Care in the Community came in. I’ve been involved in Supported Living, so I’ve always worked from that viewpoint, that direction, ever since I left Cane Hill. The reason being is that for a hell of a lot of people, it was entirely the wrong place! No need for them to be there, especially with modern medicines that could enable the more florid symptoms to be controlled, without controlling the person. Yes, excellent! I’ve seen people living good, productive enjoyable lives in the community. I’ve also seen some people who just couldn’t hack it. The community wasn’t for them because they had more florid symptoms, or because the symptoms of their particular illness conflicted with society. So society always rejected them, including living in a house with 3 other people, or on their own, it’s not going to make any difference to that! You know, society still isn’t going to want them sitting on the bus next to them, or working in the same place. It wasn’t for the benefit of patients in the hospitals; it was largely economic.

Development

That’s why Thatcher was the patron saint of Care in the Community, if you like. She saw that you could sell off the land, get rid of these bloody patients because they’re a bit of a nuisance. Knock down all these old bins; it’s all on prime development land, because when the original asylums were built, they were built way out of the cities. There’d be countryside in between, so you’d got that problem away from the city. Suburbs have grown and grown and grown and suddenly here is prime commuter land, so from a purely economic point of view, if you can start building mass density housing on that 80, 100, 200 acres, whatever they were taking up, these old places, you’re quid’s in, you know!  One of them problems is that all the planning authorities went along with this theory, and some of them turned round and said “Ok, you can develop, but only on the original footprint, on the existing buildings. Suddenly it all went tits up, all the income that’s supposed to be coming back from selling all this very valuable land went out the window! There may be dozens left, but quite an awful lot that still haven’t maximised the density of building required to make a feasible contribution to the coffers, to pay for Care in the Community. So Care in the Community always had that albatross round its neck, that it didn’t generate income. They were bloody poor at generating income, these places, and when you release them into the community, you’ve lost them, and they’re a drain on society. So basically, the whole thing went tits up!

Class and Mental illness

There’s not a place for large institutions, what there is a place for is asylum. And using the other connotations of the word, a place that’s safe, secure, a refuge. One of the big advantages of the old asylums is that you’d got masses of space, so if somebody wanted to walk around and howl at the moon, it wasn’t upsetting the neighbours, and things like the horses. So what? Who cares, that’s his bag. Howling at the moon every Thursday! My underlying theory about mental illness is that it’s class based. It’s all to do with the amount of space that you can purchase. So the working classes are mad, because they live on the streets, cheek by jowl, with everybody else, so any aberration within that community impinges on another communities. The middle classes are neurotic. They can actually afford to take them to a nice therapist somewhere, that’s traditional talking therapy. “Lets try this now, Ooooh, there’s another chap who thinks helium gas is good for you; we’ll try it. And rub some of this in!” So they can tolerate a lot more abnormality within this area of society because they’ve got the funds and the network to be able to cope with a lot of these things. And the rich? The aristocracy, are just eccentric! Aunt Mellie’s up in the East Wing being a vampire, because that’s alright, got nobody else but the staff, that’s all right!

Catchment area and recruitment

The catchment area was South London including within it Clarkenwell, and was the successor to the poor houses, and reception centre. That was a lovely euphemism, wasn’t it? The Camberwell Reception Centre, the CRC, you’d see an awful lot of people coming in from CRC to Cane Hill, it was almost a transit cap. People who’d hit the bottom, hit the skids, fallen through the social networks, it was quite like, especially in those days, it still is sadly, they’d end up somewhere like Camberwell Reception Centre, where if you were lucky, they’d be de-loused, but in all probability, they weren’t in any way behaving disruptively. They were going to be shipped out, up to Cane Hill. So it was almost like a recruiting station for Cane Hill! Ironically, I did some research for a couple of years looking at replacing the old reception units and trying to get more throughput so people of that way of life could move on to sheltered housing, eventually to a stage of independent living. So I started off at Cane Hill receiving people from Camberwell Reception Centre and ended up working years later, on how to get rid of these places.

Closure

In all honesty, I don’t really know if I knew Cane Hill had closed. I probably hadn’t really thought about it to any great extent until I suppose, the nineties, and computers, and the web, all that came in more.

Change and lack of it

So many things have changed over the years, in the timescale since I started. So many things haven’t changed! Society’s attitudes haven’t got that much better. Political will isn’t much stronger than it ever was; it’s always going to be a poor relation. I can remember looking at patient’s notes when I was there. They’d been there, back in the twenties, since the turn of the century, you know. Christ, it was barbaric! Luckily a penny dropped. I thought, “in 50 years time somebody is going to be looking back here and thinking ‘what you’re doing is barbaric'”, so first, do no harm. We set ourselves on the right road.

ECT

With ECT, it developed out of insulin shock treatment, they’d administer insulin shocks, which were pretty damned dramatic. And that had a similar effect in terms of fitting, and confusion and that… That, in all probability, developed out of giving people cold baths, as a punishment, which was a hell of a shock to the system. “Hang on! Through that he’s a bit more lucid. What’s going on?” and out of all these various, terrible happenings, every now and then something would appear and you’d think, god, I wish you hadn’t come from them, but at least you’re worth having, so you’d learnt something. ECT, I think in about the 30s? It started with a “Ah, this is better than insulin, it’s more controllable, you turn a switch and it’s a time when electricity was the big thing! You used to have parties where people would all link hands and somebody would crank a handle on a generator and it really did freak people out to start with, like having a laser show in your back garden.

ECT had come along and it was the consultants that would see a patient… “Yes…Definitely a bad case of depression, yes… ECT, we’ve got this now! This wonder-drug! I prescribe 25 sessions!” and literally, there would be prescriptions for it in the twenties, or more! After one or two the person would perhaps have made quite a startling improvement. It did actually used to have a very positive effect. Hold that thought. You’ve got a positive effect, the person is now talking and eating, and doing more things than perhaps a couple of weeks previously. Mute, lying in bed, withdrawn from the world. Except that the prescription said 25 sessions! So six more, and the person is now going burr-urrgh-urgh! Another few sessions and they may be hitting an up point, so for years it was a period of people being written off as successfully treated, or unsuccessfully treated by ECT, depending on where they were at the end of the cycle, of X number of shots!

Eventually people started questioning this, thinking, “Hang on! Now there are definitely some signs, of effects noticeable and a significant number of people make this worthwhile, but it’s only happening after the first two or three, five maybe max. And from that point on, people start honing in and saying “well ok, lets see if we can do some good through this, and started zapping everything in sight with our new toy! Initially, it was unmodified, which meant there was no sedative or tranquilliser or anaesthetic, the person was just taken, held down on the bed, or strapped on, electrodes on and when they went into a fit, they’d break arms, legs, physically break arms! The sudden muscle spasms struck you and if you broke an arm….. It wasn’t a way to keep people in the hospital, it was just simple ignorance, “We’ve got a good thing here, a lot of it must be better” It happened with Largactyl, and that’s when I was actually at Cane Hill. A patient might be on, say, 100 mg of Largactyl 3 times a day, that would be quite a hefty dose! A couple of doctors down in London, who were working on the “small bit good, big bit better” philosophy, were prescribing thousands of milligrams of Largactyl a day to people. Totally zombied! Plus they’d get fried to a crisp if they went out in the sunshine. One of the terribly side effects of Largactyl was it made you terribly photosensitive, which is why you see a lot of the old asylum photographs from the forties, fifties and sixties, a lot of them wearing straw hats, because the effects of the sun on Largactyl.

Freedom of patients

The time the patients spent outside varied. Bearing in mind there were still locked wards when I started. In 64, the majority I think were locked. By the end of 67, they’d started unlocking a few, that didn’t need to be locked. Mainly because they were the old refractory wards, Wesley and Vanbrugh, all round the back. And they were for the burnt out patients.

They didn’t move the older patients towards the back towards the mortuary; it didn’t take much to wheel somebody. It was a day out! For the porter, I mean, not the deceased!

Admittances

One lady died, just after I started, who’d actually been there since the place opened in 1883, she’d been admitted as a twelve year old who was morally defective, possibly become sexually promiscuous or whatever, and if she was poor, then a young girl got pregnant, they’d take the child off straight away and sling her off to the bin! The actual thinking behind the asylum movement initially was good, positive, and it was to say we should give these people the best conditions we can, in healthy surroundings, out in the countryside where it was fresh, and would build in farms, so they could be, to a certain extent, self-sufficient, and get good, fresh produce. Thinking about the conditions in London at the time, this was a great thing to have! in the late 19th century, living you know, was hard to do, let alone living well! So in actual fact, it was probably for a lot of these people, the first time they’d had three square meals a day. And have the health service.

Early Philosophy

The underlying philosophy was good. Then they thought “right, hmmm, dealing with large numbers, I guess hospitals are a good model to work on” If you’ve got a clean slate and you’ve never had an asylum before, and you had these tens of thousands of people to deal with, you’d just have to start building big, you know! There weren’t any modifying medications, if you were mad, you were bloody mad, 24-7! And you were out of it, whatever the symptoms were, you were there day in, day out. There was no controllability factor that medication brings, whether that’s good, bad or indifferent, it’s a factor of that time! If you have all these people and they howl at the moon, chase around wearing ladies knickers on their heads, whatever, you know, it was bound to upset people in the cities. They can do all these things out here, in these nice, fresh fields. Even farm work is therapeutic, working with animals. Hard work never did anybody any harm. They were Victorians! Good honest hard work! It was therapeutic, working with animals to the point now where they take petting dogs and cats into hospitals for the elderly patients – it was actually therapeutic if they were stroking something.

Doctors and medicine

So for all these good intentions, sadly architecturally we were in the middle of the gothic era, thinking big, and then the biggest problem came about when they thought, “hmm, who runs these? With these ministers in, how do we run things on a day to day basis?” And they made this total cock up, you know, thought, “doctors know how to run hospitals, lets have doctors!” and the whole process because medicalised. From then on in, dealing with people, living in a free asylum, a place of refuge, you’ve got people now who’ve got to be controlled, as we’ve got the very chemicals to do it with! If the chains won’t work! So the poor little sod was still bored from that moment on, any of the ideals of the asylum movement dissipated as soon as you’ve got the doctors and nurses running the show, they wanted control, to make beds, cure! That’s far more important. And if you’re not cured, you’ve failed! I’m sorry, but you’re a failure, you’ll stay here and live in abject bloody fear!

Alternative models

How different it might have been, if they’d turned to, I don’t know which other group of people? I guess the earliest work of the asylums was done by Quakers, up north, especially, and you know, I’m not religious, I don’t believe anything, but I wish to hell the Quakers had got in instead of the doctors! There would have been a more gentle approach, apart from the puritans dress sense, the Quakers weren’t into straight lines, the doctors and nurses liked to have equally spaced beds, where they’d pause, stand, which made little difference! And they’d force that model onto people who weren’t sick or ill, who didn’t necessarily need all the lotions and potions that were being force-fed on them! And also bearing in mind that the medications that were available were bloody crude! I can remember one old charge nurse saying, that when he started, presumably back in the twenties or thirties, that there were only two medications back then! Laxatives and sedatives! We cleared them out and knocked them out! That was the thinking behind the approach – it was about containment – an attitude had to be broken down and got rid of. I’ll never say Cane Hill was a good place, in that sense. In 67, I couldn’t wait to get out of there. But now, having seen it come full circle to where there aren’t any hospitals like that left, there are slightly sterile psychiatric wards tucked at the back of general hospitals.  So for some of the people I’ve worked with in the community they’d be much happier, living a freer life.  Its ironic because they weren’t free, living in the society they were living in, because their behaviour is such that society wouldn’t tolerate it.

Socialising

Before, they’d have what we perceive as an oppressive and regimed life, but they’d have a good social life with a dance once a week. They were fed and clothed, and they had friends by the score. Sometimes they had affairs and their love life was quite active! You had to watch where you trod in the bushes sometimes! But for people who’d had nothing, and had come from an upbringing in the society they’d been in 50 or 60 years ago, it was actually a step up with a lot of freedom with it!

Containment

You had three levels of environment for containment. People were either strictly confined to a ward, or they had a corridor pass or ticket it was called, a grounds ticket, or a town ticket where they could go into Coulsdon.  If they hadn’t passed that by behaving well in the corridors over some nebulous length of time, or the charge nurse finally thought they were improving, they could now wander around the grounds. For those who wanted to or were deemed capable of doing so, there was the right to go to Coulsdon. I think you could also get a bus into Croydon.

Hierarchies/discipline

It was more harrowing in the 60s. It was an interesting time to be involved, there were so many things that were changing. I wasn’t your usual ‘get demobbed at Caterham barracks’, walk across the valley and sign on at Cane Hill sort of recruit. This was also another major change – they were starting to run out of ex-servicemen. National Service had stopped a couple of years earlier, the older staff who joined after fighting in the war were now out of their forties, so there was a great slump in the number of ex-military that wanted to carry on living an institutionalised life. Out of the 4 deputy chief male nurses, there was a chief male nurse with 4 assistants, one of those was almost permanently on tour with one of the assistant matrons, going round in Ireland, Jamaica and Spain, recruiting.

There were 20 of us starting in the school the year I joined. There were just two of us who’d been born in the UK, and the other guy was from Liverpool. He was a fanatical Liverpool supporter who’d actually risk getting into trouble for wearing red socks if Liverpool were playing an important game! Wearing anything other than uniform was deeply punishable, by extra overtime. It would certainly count against you in terms of any progress you were going to make, and a bollocking off the charge nurse, in any case, which wouldn’t have been welcome! He ended up kipping on my floor – I think he got sacked and we were living in the male student nurses hostel which was the small, odd building to the side of the virgin’s retreat –  the big red one! I think it was John who was trying to climb up the down pipe on the virgin’s retreat, and it started coming away from the building! It was like something out of a carry on film! Luckily he managed to jump back down.

Sports Day

There was an inter-hospital sports day. The only year I took part in anything, I was on the tug of war team. There was this guy who must have been about 7 foot tall – a Basque, assistant male nurse, and he was massive! We wrapped the rope around him and put him on anchor, and we still got pulled by a team of all places; not that you’re going to argue with them, Broadmoor! Yeah, ok, we’ll go quietly….

There were no strong relationships with the other local hospitals; it made it all the more bizarre that everyone was put into teams, and you’d have this inter-hospital sports day. I suppose if you were into sports, and regularly played Football or cricket, then there would be strong relationships. The only time I ever did anything like that was I was part of the Dart’s, Dominos and Pool team. We used to go around in an old ambulance that had been shot at by some locals and had these pellet holes in the side of it!

Pool tables

In my day, I don’t think pool had really come in. It was just an American game we saw in films. We had full sized snooker tables in the sixties. And some there were some amazing players! It was all they’d ever done. They were locked in a ward with a large snooker table. The old snooker tables were probably on their way out, to be replaced by pool. Every one of the major wards had one, for the patients. You usually found that the charge nurse happened to be a very good player, as well as some of his cronies! And some of the patients were absolutely shit-hot! If they could have had a chance to get into the playoffs, the primaries for the world snooker championship, they would probably have been going all the way though. It was just sheer repetitive routine, to the point where you can almost picture some of them playing without any passion: It was all routine, automatic.

Routine

Everything was routine, starting off with dress: The haircut for the staff was a short haircut, so I was always getting asked,  “are you wearing a collar, boy? Yes! Well I can’t see it, get your hair cut!” It was typical military.

Then you’ve got your suits, which you got every year. It was a jacket, a waistcoat and two pairs of trousers, because the trousers wear out quicker. They were made and measured by the hospital tailor, and they were made in the hospital tailoring department. They’d measure everything, right down to your toenails, or whatever, and then they’d produce a suit that had no relationship to you whatsoever! Bearing in mind at the time that for suits, there were plenty of people into mod fashion. I thought that if anybody sees me wearing that, I’ll be never be able to show my face again!

So the staff would actually take their suits off and get them tailored. One guy even went as far to say, “Take a little bit off that sleeve and add a little onto that one”, so they were balanced! Everybody wore the same charcoal grey suits. The female staff wore what was more or less a general nursing uniform, but men still had to wear the grey suit. You could take the jacket off when you were on the ward and wear a white coat. If you were a junior student, you’d get a coat covered in blood and faeces! You’d desperately try to keep it relatively clean for visiting days on a Sunday. If you had any conscience at all, you wouldn’t want to appear in front of the families and relatives looking like an abattoir worker!

Visiting day/Unwin

Bearing in mind we’re talking about institutions, on visiting day everybody had to look good. so somebody that hadn’t had a shave all week would be shaved on Sunday, you would change their clothes, make sure they’ve got buttons on everything, try and pick the dirt out from under their nails. I remember doing this on Zachary ward, which was a medical geriatric ward. The ward down from it was Unwin. It was a tiny little ward which had 26 beds, and we’d refer to it as the last post.

Night duty

One of the night duties was to cover Wren and Wesley, and Unwin, and Zachary and York, so it was 5 wards. Zachary had a night nurse, because it was a medical ward for the old chaps that were hopefully going to survive with treatment. If they got moved down to Unwin, it was the last post!

The night duty had to ‘peg on’ every two hours at different points around the wards and dormitories. There were metal boxes, and you had a key that you inserted and turned, and that made contact with the night Superintendent’s office. The Night Super would cover an indicator board in the office, so he could see that you were progressing round the different peg points, to show you were still conscious and still awake. They were mainly concerned about whether you were still awake! It did mean that if anything happened, if you did get attacked, that it would be two hours before anybody noticed! You’d have to look in on Unwin, and make sure nobody had actually died while you were doing your rounds. You’d check each bed and have a little touch. If they’d started to feel chilly, you knew you had some extra work on! You would usually call somebody else, and you’d have to lay the other person out. I’m not saying it was done, but rumour had it that it wasn’t unknown for people to die at 5 or 6 O’clock in the morning, prior to the shift changing at 7. They’d plonk them in a nice warm bath to get the body temperature up, then put back into bed ready for 7 O’clock, so the day staff would have to deal with it! I never remember actually seeing it, but rumours existed back then.

Wren

Wren wasn’t a popular duty. The students used to do 3 months on each different type of ward, including admission, bedding hall, and refractory ward. Wren was where they had a double locked security ward. There was a padded cell in there, and one in the admission ward, which was Nightingale. In 1964 there were only two on the male side, and probably two on the female side. The single rooms were there as well. The perception was that they were punishment rooms, but they were highly sought after!

The ward hierarchy probably wasn’t as most people imagine. There was the Charge nurse, on each shift, then probably next to the charge nurse in terms of influence, there was some old assistant nurse, who had worked with the charge nurse since they were spawned, and then would probably come the Staff nurse, the tea boy, the Kitchen boy, who was actually referred to as the kitchen boy. That was the technical term.

Every long term patient aimed for a side room because they got their own room, with lots of perks and privacy, and control over the kitchen! I learned a lesson from a charge nurse on Vincent, when it was on the second ward on my rotation. I said hello to the charge nurse, and was told to go and make him a cup of tea – I thought at least I can make a cup of tea, I’m not going to get into trouble yet! I walked in through the door to the kitchen at the end of the walk, and a pan came flying across, “Get out of my facking kitchen!” Now you know exactly where you fit in, don’t you? The senior charge nurse was actually one of the nicer guys. He was also the one who said “You’re going to learn about all these fancy pills and things when you’re in the school, but when you’re on the ward, I shall you teach you how to cut cheese! And you used to come in with a 7lb block, so if there were 72 people on the ward, you’d had to cut 72 lumps of cheese out of a 7lb block, and these amazingly wonderful skills you would pick up. I can cut cheese with the best of them nowadays.

Retirement

I think they could retire at 55, and a lot of them would be made charge nurse for the last year or so, so they got a better pension, so as soon as they retired, they’d come back as a temporary staff nurse, so the family would keep it going, train up the next brood. It was very regimented. I can remember I was up on Wren and usually they would be rooting at 7 o’clock at the morning, waking people up and supervising them getting dressed, if they need any support as you’d call it now.