Impressions of Bethlem

The Bethlem Royal Hospital is not the same as the old asylums that were closed during the care in the community initiative in the 1990’s. Those hospitals were populated by patients roamed the corridors and grounds wearing shabby hospital issue clothes that were handed out every year to long stay patients. In comparison Whereas patients in the old asylums had a limited access to therapy, seldom seeing a psychologist or  attending group therapy, patients at Bethlem benefit from a more progressive approach. In the old hospitals art therapy was either a stepping stone to rehabilitation, or for chronic patients who could not do anything else. Once you were referred to the long stay wards from the admission wards it was usually safe to say that you would not be leaving the hospital.
When I visited the Bethlem Royal Museum, I met Patricia Alleridge who was then curator. Later I met J. Michael Phillips and it was his assistant Colin Gale who suggested I visited the art therapy department where I met Beth Elliott who took an interest in my work after I had shown her some postcard prints of my work. Beth was working with Karen Risby at the Bethlem Gallery, and I would visit the gallery sometimes watching the gallery when there were no staff available. Karen and Beth arranged for me to to show my work in my own exhibitions first at the Bethlem Gallery then at the Institute of Psychiatry.

Bethlem is known for its Museum and art collection. Louis Wain and Richard Dadd are the artists associated with the museum. Louis Wain, well known for his pictures of cats was an inmate at Bethlem from 1924 to 1930, but the museum also home to the work of Cynthia Pell and many lesser known artists who despite their illness have produced visual art. But there are also other cultural connections with the outside world. Samuel Beckett, the writer, used to visit Dr Geoffrey Thompson                       who allowed him to look at the patients on the ward. Samuel Beckett’s first book ‘Murphy’ tells the story of a psychiatric nurse, but the characters in his later books seem to be influenced by the bizarre conversation of schizophrenics that would have been more common on the wards in pre phenothiazine days. Surely his work owes much to the patients he witnessed on his visits to Bethlem in the 1940’s.

                 The 19th century, the forerunners of expressionism, Vincent Van Gogh and Edvard Munch experienced mental trouble. Van Gogh's illness has been well documented with varying degrees of accuracy. Self-harm, self neglect, alcohol abuse, hospitalisation and eventually suicide accompanied his gift for painting. Munch's psychological problems were a result of his reaction to the appalling suffering and fatal illness his family was subjected to. Munch would become hysterical but learned to channel his hysteria into his painting scratching and scribbling at his canvases to record his frustration and grief. At the time he was thought insane to do this but besides introducing the basic expressionist style, he was using his art as therapy, to confront and deal with the grim world he saw around him.                      Though it is possible that Egon Schiele's work was informed by that of Jean-Martin Charcot, who illustrated medical journals of the day with pictures of female patients suffering with various mental illnesses, we do know that Schiele gained access to a hospital to draw the women there. Expressionist painter Ernst Kirchner achieved popularity and success in the early 1900's. When the First World War broke out Kirchner joined the army but became too mentally unfit to serve because of his alcohol and barbiturate abuse. He found a sympathetic doctor who referred him to a sanatorium for the duration of the war. Erich Heckel, also an Expressionist, took madness as a major theme.   

Since the beginning of the twentieth century artists have been inspired by artwork of the mentally ill. Bethlem Royal was the first hospital to show the art of the mentally ill in 1901 and again in 1913 and soon after similar exhibitions took place in France at Germany. Artists understandably did not wish to suffer the torment of psychiatric illness but recognised that the vivid dreams and hallucinations that many psychiatric patients experience could provide a direct insight into the subconscious. In 1909 Max Ernst visited asylums and was fascinated by the art of the mentally ill. It was the year he started painting. He joined the DaDa artists in Zurich who were inspired by so-called primitive art; Oceanic and African art, the art of the mentally ill and the art of children.

The Surrealists took inspiration from the mentally ill. Andre Breton and Max Ernst (now a Surrealist), encouraged other Surrealists to study the work of mentally ill artists. Andre Breton, the leader of the Surrealists worked in the psychiatric wards during World War 1. Breton and other surrealists were impressed by Dr Hans Prinzhorns book ‘The Artistry of the Mentally Ill', which was brought to their attention by Max Ernst, in 1922. Prinzhorn’s book is illustrated, with pictures by patients from the collection at Heidleberg psychiatric hospital, now renamed the Prinzhorn Collection. Breton acknowledged the imagination of the mentally ill as an inspiration to surrealism. In his ‘First Manifesto of Surrealism’, Breton said he could spend a lifetime ’prying loose the secrets of the insane’. He goes on to describe the insane,’ These people are honest to a fault and their naiveté has no peer but my own‘.
             In October 1926  Andre Breton befriended a female psychiatric patient. In the short time that he spent with Leona D, (her full name is not known), Breton gathered enough information to write a book. He called this book Nadja at Leona's suggestion. Despite his sympathy with the mentally ill, the reality became too demanding, Breton could not cope with Leona and work, and after a few months, Andre Breton stopped seeing Leona D. Her pleading letters failed to change his mind and Leona D broke down. Hysterical, hallucinating and unable to look after herself, on 21st Mach 1927 Leona was dragged screaming to the Perray-Vaucluse Hospital in Paris. By the time Breton's book was published in 1928 Leona D had been transferred to a hospital near Lille probably unaware of the book that was written about her. Much later Andre Breton would express remorse for his actions.
              In 1929 Andre Breton and Max Ernst attended an exhibition of work by mentally ill artists in Paris and bought work. In 1930 art from Prinzhorn’s collection was shown in an exhibition that toured that toured nine German cities until 1933. But in that year, in Dresden, an exhibition called Degenerate Art was organised by Nazi propagandists. Though the exhibition only contained work by modern artists the exhibition was repeated in 1937, this time expanded to contain works from the Prinzhorn collection, which were ridiculed alongside the art of the expressionists. The exhibition included work by Nolde, Heckel, and Kirchner. This exhibition also toured German cities until 1941. It is common knowledge that the Nazis murdered Jews and Gypsies in the holocaust. It is a lesser known fact that the Nazis started their programme of genocide by killing psychiatric patients. Artists labelled degenerate by the Nazis were forced into exile, those who stayed were sent to concentration camps or at best, forbidden to paint. Kirchner took his own life in 1938. Emil Nolde another Expressionist, stayed in Germany, and though he suffered hallucinations and was persecuted by the Nazis, he painted watercolours in secret while caring for his mentally ill wife. After the war Jean Debuffet and Andre Breton decided to reinstate the art of the mentally ill as part of the Art Brut movement though this was accepted in France where the art of the mentally ill was sold at auction, it was the Abstract Expressionists and Pop Artists that captured the imagination of the art world.    
Psychiatric patients often produce art in austere conditions, in hostels, supported housing, in a community that is often abusive and prejudiced against the mentally ill. With the closure of the old hospitals they are often left isolated in the community under the influence of medication that they neither require nor want, yet they usually endure the distressing side effects without complaint. Some are left to sleep on the streets. When hospitalised they are either separated from their work, have to keep it in the art room or guard it on the ward. Sometimes patients lose their work while they are caught in the mental health system. The mentally ill have seldom been given the credit they deserve, their influence on contemporary art is rarely acknowledged, their work is still undervalued. The work of mentally ill artists seldom follows trends but to this day contemporary artists are inspired by the art movements of the 20th century, not least the Surrealists the DaDa artists and the Expressionists, who in turn were inspired by the art of the mentally ill. It could be argued that the art of the mentally ill helped free the canvas for the contemporary artist. Sadly the mentally ill remain stigmatised by a society that conveniently prefers to believe the myths of mental illness rather than the reality. If the public were aware of the contribution that the mentally ill have made to the art world they might start to overcome their prejudices.
The tradition continues not only with the Bethlem Gallery and Museum, soon to be reopened as the Museum of the Mind, but with the occupational therapy department run by Michaela Ross and the Saturday Studio that meets every month in the art therapy room. Sadly I have had to contend with people who do not care for or understand art as well as they should and the staff at the Bethlem Royal hospital have been supportive during these problems.
I decided to write a memoir, ‘The Road to the Asylum’ first for my estranged son and then when family relationships became further strained, and the book started to take on board wider issues I started to see it as a way of raising awareness of the plight of the psychiatric patient with particular regard to the dual diagnoses patient. The book also examines the relationship between the creative world and the patient as I got to know Terry Burns, David Bowie’s stepbrother, who had a great formative influence over David Bowie. Parallels between David Bowie and Terry Burns with Andre Breton and Leona D and Samuel Beckett and Dr Thompson appeared reinforcing the theory that the mentally ill have played a greater part in the history of contemporary art than is generally acknowledged.

I was never a patient in Bethlem but I was referred to the drug clinic as an out patient, from the Maudsley twenty four hour emergency unit at Denmark Hill. I spent time in Stone House hospital and include some memories of this hospital for two reasons. Firstly there has been some accusations of ill treatment at the Little Brook psychiatric ward which has replaced Stone House, and secondly I thought it might be interesting to compare the hospital with Bethlem. I have not written about staff ill treatment at Stone House, I wrote this to remember the patients.
 Stone House was not originally a psychiatric hospital it was a converted school.  Patients were expected to attend the industrial therapy unit or the occupational therapy department. Wages were very low; the most you could earn in the industrial therapy was £14 a week, £5 a week in the occupational therapy. Most of the patients were good company, one cannot help that the mean spirited attitude in the community is a result of being spoilt. In fact for a while just before the hospital was closed patients were asked to work for nothing as there was no money for wages. The patients continued to work for nothing, can you imagine that happening in the outside world. With the closure of the hospital both the industrial and occupational therapy services have closed down. Patients enjoyed socialising whist doing therapeutic work. Now they exist in isolation in the community, often abused and exploited.
In Stone House hospital patients were usually given psychiatric medication which had unpleasant side effects and often led to illness in later life. But patients endured their illness usually without complaint. It is a shame when patients are expected to take medication unnecessarily. The asylums that were run by the Tukes, Quaker reformers in the 19th century, who with their ‘moral treatment’ model adopted a more compassionate approach to mental illness, had no need for enforced or coerced sedation. I believe it is a myth that patients become violent when not on medication, in fact it is possible that medication and its side effects causes not only resentment but makes patients more vulnerable to the street drinkers and drug users in the community as it affects their judgement. 
Some patients are aggressive but most are not. Despite the grim circumstances, the medication, the overcrowding and the poverty most patients were good natured.    Andre Breton, the founder of Surrealism described the mentally ill as naive and honest.                                                                          Enduring prejudice against the mentally ill will continue to buy misery all round. I can recall a few of the patients, though all deserve to be more remembered that they are, and I hope this will give the reader a more informed view than the usual media stereotype.  
When I arrived on Vintry, the admission ward, I was given  a bed in a small side ward. All sorts of patients passed through Vintry ward, alcoholics the suicidal depressed, those experiencing manic and psychotic episodes were all monitored by nursing staff their reports read by the psychiatrist who would decide which course of treatment was appropriate. I was very distressed, and was prescribed anti psychotic drugs, which I spat, learning to hide them in my mouth until I left the ward. But I got caught, I was challenged, and put on injections. I was transferred to the main dormitory. Three of the twenty beds were taken by patients who had jumped off the Brent bridge, which spanned a motorway a few hundred yards from the hospital, and survived. There was a gypsy fellow on the ward who was quite friendly unless you happened to leave the dormitory door open whereupon he would punch you. There was a one eyed fellow called Bill. he sat on his bed most of the time and often bought half a bottle of whiskey. Ihad borroed a couple of pounds off him and offered to pay him back when we met in the corridor. 'You don‘t owe me anything‘ he said. Shortly after I passed his bed and heard him say’ When you come to the end of a lollipop’. to no-one in particular . That was the last thing I heard him say the next thing I heard was that he had taken an overdose and died. 

Patients too ill to attend or not yet referred to occupational therapy sat in the day room watching television. In the evening some patients and visitors would socialize in a gloomy smoky foyer by the north entrance to the hospital next to the ward. I remember one of the patients who suffered from 

Gay Watts sat in the day room most of the time, by a shapeless patchwork blanket that she had been knitting. But she didn’t knit anymore because she suffered from Huntingdon’s Chorea which is a physical illness with psychiatric problems. Gay, not yet thirty was so ill that she could not talk, and was not going to get better. In the community she would have been ridiculed and bullied but in the days of the old asylums she could at least be spared that distress. The staff thought the world of her but did not spoil her, and some of patients looked after her during the day as the nurses were always overworked. Everyone looked out for her and no-one complained when she repeated the same phrase over and over again in a heart rending  plaintive voice. ‘My mum’s coming to visit me’ ‘tea with sugar’ and ‘I told you'. Sadly she could only repeat a few phrases as her mind was going along with her health. The other patients would fetch her knitting , or her bean bag, in the hope of quietening her. Once she was walking, with difficulty, holding her skirt which was slipping, to the foyer where patients socialised in the evening with visitors, often ex patients who wanted company. Colin Sams was a visitor in those days. Gay stopped and announced, ’I’ve got Huntingdons. Maureen Rose, a spirited patient who would answer anyone back, said’ Yes Gay you’ve got Huntingdon's. One of the Brent bridge survivors, Arthur Watkins, used to run errand for patients who wanted food from the local Chinese takeaway, situated just the other side of the Brent bridge. He was paid a pound for every order. Such was the camaraderie on the ward that anyone who tried to poach his customers was discouraged.  
For a while I was given the job of feeding Gay at dinner time, until a nurse would take over distract Gay and mix her tablets in with her food, which they are allowed to do when patients are non compos mentis. I would wait around and clear the table for Gay, the she would would calmly up turn a few tables and chairs. I turned them the right way round, worried that the staff would give her more sedatives if they found out. 
Phyllis Rose usually sat around a corner in the foyer. Phyllis was in her late fifties and smoked heavily. She was prescribed valium. She had studied comparative religion at university and worked as a secretary at one of the famous film studios, and had met the stars of the screen but did not go on about irt. She had fallen on hard times and ill health and was a respectable woman who was humiliated by her destitution. I once asked her what she thought of Satanists and out of nowhere and out of character replied that she did not know of a Satanist who wasn't a heroin addict. She liked Arthur and called him her Parisien friend. Arthur was almost mute, offering the odd oh and alright when taking orders from the take away as a reply. Phyllis was concerned that they sent him to the shop because he walked with a limp after jumping off the bridge, but another patient reassured her saying that he was paid well and was the richest patient on Dowgate ward. ‘As long as he gets paid I suppose it’s alright’ said Phyllis. Though life for her was a source of regret I never heard her complain. I asked Arthur  about art therapy in the hospital and he said he had attended in the sixties to get out of going to industrial therapy but could not draw. 

I was referred to a long stay ward, Dowgate. Unlike the admission ward, Dowgate was an all-male ward, mainly middle aged and elderly patients. Some of the patients were committed years ago for petty crimes and indiscretions that would mean little today but at the time were seen to be indicative of mental illness. One fellow. Victor, had been a Desert Rat during the war fighting Rommel in North Africa. When he arrived back in Britain he got into a fight with a policeman and was duly summoned to court. He was found not guilty but the police had him committed under the lunacy act, and he had remained at Stone House for nearly fifty years. There were similar cases  over the years these patients became used to life in the hospital and could not survive with out  it.  But there were also patients that needed care from the start. Many of these were patients on Charterhouse ward. In other purpose built psychiatric hospitals these patients would have been kept on back wards behind locked doors mainly to stop them wandering off but also to stop morbid sightseers. But Charterhouse was walk through and any visitor could witness the appalling physical and mental state of some of these patients. Some were in a semi vegetative state, moved from their beds in the morning to the day room then back to the dormitory at night.
Chelsea ward was locked to stop it’s geriatric patients wandering but there were no locked wards for aggressive patients, these were transferred to Bexley hospital where they did have locked wards. But mainly it is a myth that psychiatric patients are violent. By and large it was safer on the long stay wards than in the community.

On Dowgate ward patients were at least ambient and though some were almost mute most attended therapy during the day leaving a few who could not work on the ward. One patient Frank, who did not attend therapy, made it his job to keep the kitchen tidy. The kitchen was kept locked during the day except at tea break and coffee break when it was open for half an hour and at lunch break for an hour when patients could make their own tea and coffee. We would have to buy tea from the hospital shop as the ward tea was made with industrial size tea bags. Sugar was put in the tea pot along with milk and poured straight into the cup. There was a rota for the patients to take turns for kitchen duty, making and pouring tea and washing up the cups and dinner crockery and cutlery as dinner was served on the ward. In the evening nurses left the kitchen open for a couple of hours after evening milky drinks. After the kitchen was locked patients had to make tea from the warm water in the washroom. As the water was not boiling to prevent patients scalding themselves this was not a very satisfactory brew. 
Though most of the patients on Dowgate were quiet and friendly, one patient, Ray became agitated at evening meal time, he was a big fellow and the food sent up from the kitchens was never enough for him. He would march down to kitchen and demand another dinner, banging on the kitchen door until one of the kitchen staff presented him with a second meal which he would bring back to the ward. Ray, allegedly on a twenty year section for setting fire to a psychiatrists barn was said to have spent time in Rampton. He told me that he was not even supposed to leave the ward, such were the conditions of his section, but this did not stop him occasionally absconding and signing on homeless at the Elephant and Castle. During the day the nurses would have to inform the police of Ray’s disappearance. The police would then visit the ward. Ray would return of his own accord in the evening making no secret of the money he had obtained from the social security. The staff were always indignant and would demand he give the money back as it was obtained under false pretences but Ray would steadfastly refuse treating himself to tobacco and other luxuries from the hospital shop. On one occasion the nurses conspired to win the money back from Ray in a game of cards. Ray was usually sedated on his return and the staff thought that they had the advantage and could easily win the money back, but like the fellow who can hold a tune however drunk he gets Ray was an exceptional card player, and won money off the nurses.    
Most of the patients on Dowgate were abandoned by their families and to save patients feeling left out the nurses would collect money of the patients and buy them a present with their own money, handing out the presents on Christmas morning. On the patients birthday the nurse would ask the kitchen to send up a cake which would arrive with the evening meal.    
Sometimes a couple female patients from Walbrook ward would visit Dowgate, looking for company. Walbrook was the female long stay ward. Patients on these wards were usually there for life. This changed when it was announced that the hospital was to close. Like Dowgate any patient squabbles were usually about cigarettes. Two of the patients on Walbrook were blind, but quite talkative. Like Dowgate most of the patients attended industrial or occupational therapy and sometimes there was talk of who was working and who wasn’t. The wards were usually fairly quiet patients would watch television when not at therapy. I doubt if the so-called sane members of society would be so well behaved under the same circumstances their behaviour would probably soon degenerate. 
There was a tradition of nurses emigrating from Ireland to work at Stone House. I remember one day a few of the female nurses singing Irish songs in the hall, they had beautiful voices. Not all nurses were from Ireland, some were from India, China, Malaysia and Mauritius. Some of course were English. The staff were multi-racial and none the worse for it. In the hospital there was little of the bigotry and blame culture that exists in the community. Patients and staff were too busy to indulge in petty prejudice; racism and homophobia were almost unheard of.
When the hospital closed wards were merged as patients were found homes in the community. In the old hospitals the days were long, patients were woken at seven in the morning, and though the patients slept in crowded dormitories, had little money, and had to take medication that often did them no good they had a roof over their head and three square meals a day. Patients since the closures are more likely to end up sleeping in a doorway on the street, where they will probably fall in with beer drinkers and drug users and the same is true for those who manage to find a place in a hostel, a bed-sit or accommodation in social housing. In either case they may be obliged to take medication which only undermines their resolve. Without the old hospitals patients can seldom recover from manic or psychotic episodes on the ward and they seriously mentally ill that need long term nursing are more likely to be subject to neglect. It is to society’s shame that better provision has not been made for the mentally ill who later in life will usually  also suffer from physical illness. While society prefers pay football and celebrity culture, financiers and the captains of industry astronomical wages to name but a few of its unnecessary expenses, the mentally ill will suffer causing resentment and distress throughout society .