Reviews

Rethinking the Closure of the Asylums in the Age of Community Care

Barbara Taylor's "bin memoir", as she terms it, tells a story of neglect, dysfunction, and failed expectations. She recovered; the mental health care system didn't.


The Last Asylum: A Memoir of Madness In Our Times

Publisher: The University of Chicago Press
Length: 320 pages
Author: Barbara Taylor
Price: $20.00
Format: Paperback
Publication date: 2015-04
Amazon

Barbara Taylor never specifies the diagnosis that lands her in London’s now defunct Friern Mental Hospital (formerly called Colney Hatch) in the late '80s. Instead, she offers us an ominous description of her afflictions: ''A lightless misery engulfed me. The world drained of warmth and colour; a cold blankness was everywhere.''

She then launches into a riveting account of life as a mental patient in the years when Friern and other asylums were closing down. Her electrifying prose melds humor with jolting realism, historical research with personal anecdote, social activism with the detached perspective of the academic. Without promising easy answers, the resulting memoir illuminates the eternal question of how to care for the mentally ill.

True to her nature as a historian, Taylor lucidly narrates the process of change that affected her mental health as well as the larger mental health care system in the UK. Both are characterized by deterioration. Colney Hatch's initial status as a progressive Victorian psychiatric facility, for example, took a turn for the worst when ward populations began to swell and the optimism sparked by moral treatment soured into cynicism. ''Care collapsed into custodialism,'' Taylor writes, "as the mad were pronounced 'tainted persons,' and the asylums became their prisons."

The asylum's transformation into Friern Hospital in the mid-20th century was not enough to save it (or any other asylum, for that matter) from the blows dealt by proponents of deinstitutionalization, angry patients, and reform-minded government. After finally closing down in 1993, Friern reincarnated as a luxury apartment complex, the garishly named Princess Park Manor. Friern's former patients, such as Taylor herself, were left to fend for themselves in a system that promised community and support but provided neither.

Taylor's personal story traces a similar trajectory, although by the time she recovers, she has seen enough to know that very rarely is detainment in a mental hospital worse than homelessness and isolation. One of the questions Taylor attempts to answer throughout her memoir is what would have happened to her if she had suffered her breakdown today. The answer to that question proves disheartening. Taylor emphasizes the ways in which she was fortunate: she had a willing network of friends who offered her shelter and support; she benefitted from an attentive psychoanalyst and psychiatrist; she had the means to finance her treatment; and she is not a racial minority.

In short, had she more closely resembled the average consumer of public mental health care in the UK today -- who lack such privileges -- her rehabilitation would have depended on luck, location, and sundry other factors outside of her control. Her recognition of this fact spurs the memoir's most important message: the end of the Asylum Age did not usher in an era of effective and humane mental health care. On the contrary: what remains is a shaky, meagerly funded infrastructure that equates providing ongoing, supportive treatment with fostering dependence, and the remission and medicalization of symptoms with recovery.

Taylor knows, despite everything, that misrepresentations of hospitals, patients, and doctors litter the landscapes of popular culture. The humor in her writing speaks to her awareness that portrayals of ''loony bins", as she flippantly calls them, merit a more original approach. She describes, for example, her relationship with her psychoanalyst (whom she calls V) with comical aplomb: ''My twice-weekly sessions excited me profoundly ... Sitting across from V, I posed and preened and baited him. I felt like Kate Hepburn teasing Spencer Tracey.'' These flashes of irreverence accompany discussions of distressing topics -- the abuses suffered by patients, the inefficiency of the mental health care system -- and counterbalance their gravity. By doing this, Taylor injects a dose of levity into a conversation frequently distorted by medical hubris, layperson ignorance, and strident consumer criticism.

As far as mental illness memoirs go, The Last Asylum is a shining specimen of the genre. Never sentimental or crudely dramatic, Taylor strikes anger into readers' hearts when describing the state of the mental health care system, using a perfect balance of reason and passion. In addition, she satisfies that voyeuristic desire to witness life in a mental hospital, providing glimpses of her experience without ever turning her fellow patients or staff members into caricatures.

Taylor’s acumen as a historian combined with her storytelling talents also lend her credibility. She disarms readers expecting a harrowing exposé of asylum life (à la The Bell Jar or The Snake Pit) by acknowledging its frightening aspects while also emphasizing the shelter and support that patients lose when hospitals close. She gathers evidence of her own madness in typical psychoanalytic fashion -- scrutinizing her parents’ failures, remembering terrifying dreams -- and blends these with comprehensive histories of psychoanalysis, mental institutions, and psychiatric treatments. In this way, part of her strength resides in her ability to accentuate the social, political, and cultural milieu using vivid autobiographical details.

While Taylor writes with the decorum of an academic, the final chapters and the epilogue of The Last Asylum reveal her allegiances. Her primary loyalties lie with the patients; she strongly endorses the psychiatric service-user movement (also more pointedly called the survivor movement) created to empower them. She defends psychoanalysis and laments the decline of psychodynamic therapies, highlighting their importance in a system that doles out pills without ever making space or time to listen to patients. She criticizes the disingenuous language used by proponents of community care models today, claiming that ''independence',' ''recovery',' and ''choice'' have become nothing more than buzzwords for brochures.

Most importantly, she dismantles the notion that the closing of the hospitals signifies an advancement in the treatment of the mentally ill. A supremely important book, The Last Asylum alerts us to a much bleaker reality, and challenges us to act.

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