There were still grim Victorian-era asylums dotted around Britain when Penelope Campling started out as a young psychiatrist almost 40 years ago. She began her career in The Towers, one of two such places in Leicester. It was bleak: filled with people admitted decades earlier, often on barbaric grounds such as having an illegitimate baby, who were then forced into effective imprisonment and forgotten. They were rigidly controlled, chemically coshed and often subjected to cruelty. Many staff seemed as robotically institutionalised as their patients; one consultant would prescribe electric shocks as punishment for crying.
Campling moved six months later to a new mental health unit tied to a general hospital. This building seemed to embody a brave new chapter in the history of psychiatry as the huge old institutions began being emptied in Britain. The drive to shift their 100,000 patients into community settings had started in the Sixties as the counter culture confronted traditional institutions across society. Radical psychiatrists such as RD Laing — who described insanity as “a perfectly rational response to an insane world” — challenged the core concepts of control, while a series of scandals exposed the brutal realities lurking behind the locked doors of some state “care”.
Significant strides have been made since in unravelling the mysteries of the human mind. We have greater clarity on the corrosive impact of abusive or chaotic childhoods, along with deeper understanding why some people struggle to cope with life, spiralling into self-destructive behaviour and even suicide. Advances have been made in medical treatment, evidential insights gained into effective therapies. There is more openness on mental health and fewer taboos talking about such issues with celebrities, sports stars and even members of the royal family opening up about their trauma.
On the surface, it seems as if we have made great progress away from those dark days when we hid away disturbed people to suffer in hulking asylums on the edge of towns. But have we really? Campling is unconvinced. “Perhaps the truth is that severe mental illness is just as frightening, just as stigmatising, just as much a taboo as it has always been,” she writes in Don’t Turn Away, a superb account of her life on the psychiatric frontline. “We do not seem to want to face the reality of the suffering of those with more serious mental health problems, nor to fund their care properly. It is easier to tranquillise, restrain, separate, lock them up or ignore them than it is to engage properly with their needs and their pain.”
She is right. I stumbled onto these issues while investigating the dehumanising detention of autistic people and citizens with learning difficulties, discovering they were being stuffed into secure psychiatric units due to the dearth of often-cheaper community services. Almost everyone accepts this is wrong — a shocking denial of human rights that tends to greatly intensify problems — yet still thousands continue to be forcibly sedated, physically abused and locked in solitary cells in NHS-funded hellholes. Then the more I looked into our secretive psychiatric system, the more I saw similar issues of a struggling sector that is buckling under abuse, avoidable deaths and inadequate community provision while being milked by profiteering private firms.
Campling writes sympathetically on cases seen over her career, skilfully describing the complexities of dealing with damaged patients, the dilemmas of assessing risk and determining why some people enduring mental pain end up harming or killing themselves. Some stories are bizarre, some depressing, but all are fascinating.
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