by A. N. Wilson
7
Mental Health and Suicides
When Naomi Campbell was asked by a journalist what she liked reading, the cultivated scribbler came away with the impression that the super-model had said ‘Foucault’: it subsequently appeared more likely that she had in fact uttered two words, the second of which was ‘all’. Michel Foucault (1926–84) was undoubtedly one of the emblematic prophets of our times, and his History of Madness, first published in 1961, one of the most influential texts. Though Naomi Campbell might not have read, or heard of, Foucault, being too busy throwing scenes in restaurants and yelling at journalists, many of her more intellectually pretentious contemporaries at polytechnics and colleges throughout Britain would have absorbed the ideas of the Poitiers-born anarchist thinker: namely, that the very concept of reason was no more than an instrument of political control. For every conscientious student who had actually read Foucault, there would be ten thousand nerds who believed that the French savant has somehow or another rumbled a confidence trick being played upon the multitude. Foucault’s ‘philosophy’ was a confirmation of the chippy paranoia which exists in the minds of many ‘little people’, namely that the policeman pacing reassuringly up and down at the end of the pavement, the nurse bustling unselfishly about the hospital ward, the doctor working long hours in the surgery, the prison warder keeping dangerous knifers, rapists and muggers from our doors at night are all engaged in a mysterious conspiracy to curtail our liberty. Refusing to recognise the obvious–that in a society without any restraints the weak would inevitably be exposed to attack, mockery, neglect–Foucault saw all restraint, and all convention, as essentially sinister. Foucault taught a whole generation to distrust authority, even when it appeared to be attempting to protect the weak from attack, or protecting the vulnerable from themselves.
The humorist Tony Hendra recollected: ‘When I went up to Cambridge University in the early 1960s it was to complete my studies as a Benedictine monk… But then I bought a ticket for Beyond the Fringe. I went into the show a monk, and I emerged having completely lost my vocation. I didn’t know things could be so funny. I didn’t realise that authority was so absurd.’1 The stage show, of comic sketches which had begun at the Edinburgh Fringe, and was repeated to outstanding acclaim on the stage at Cambridge and Brighton, as well as in London and New York, launched the careers of Jonathan Miller, Alan Bennett, Dudley Moore and Peter Cook. It first appeared at the Fortune Theatre in London on 10 May 1961, from which Michael Frayn dated the arrival in the capital of ‘satire’. But by the standards of Pope and Swift, for example, or of the magazine Private Eye, Beyond the Fringe was hardly violent in its satirical abuse. What its first audiences found so liberating was that it refused to take anything seriously. As an early enthusiast, Bernard Levin, wrote: ‘These four immortals take on such targets as the Prime Minister, Dr Verwoerd, Mr Mboya [the Kenyan African nationalist leader], the H-bomb, Mr Cousins’ opposition to the H-bomb, capital punishment, patriotism, Shakespeare, the clergy, the linguistic philosophers, the Sunday-night religious television programmes, history, lunacy, and anti-semitism…’ When it first happened, Beyond the Fringe caught its audiences by surprise. The young monk who was so bowled over by the show in Cambridge might have been unusual in wanting to be a monk; he was not unusual in finding Beyond the Fringe a revelation. Larkin, in his cycle clips in the 1950s, had presupposed that ‘someone will forever be surprising/A hunger in himself to be more serious’.2 Beyond the Fringe reminded the British of their equally strong need, felt at the beginning of the 1960s, to be more facetious. This ushered in much good comedy in the theatre, and some more alarming theatre in the supposedly serious worlds of academic medicine and psychiatric care. Even in the opening decade of the twenty-first century, a hostile review of a retranslation of Foucault’s History of Madness could provoke extreme reactions.
Years after Foucault’s death, psychiatrist and scholar Andrew Scull had the temerity to expose Foucault’s many errors of historical fact. Foucault had claimed, for example, that ‘it was in the buildings that had previously been both convents and monasteries that the majority of the great asylums of England…were set up’. Only one–the Bedlam, or Bethlehem Hospital, had such an origin and the great majority of English asylums were the products of the Enlightenmen.3
Scull’s book Decarceration is a devastating indictment of the care of mental patients ‘in the community’. He claimed that the therapeutic effectiveness of much so-called anti-psychotic medicine–mainly the phenothiazines–had been greatly exaggerated. He was a Marxist who wrote from his own belief that the state had a duty to nurse and protect its vulnerable citizens. Studying the plight of mental patients in America and Britain who had been turned loose into the community, he noted that they were often living as down-and-outs, or being cared for by the Salvation Army. ‘Yet more exist by preying on the less agile and wary, whether these be “ordinary” people trapped by poverty and circumstance in the inner city, or their fellow decarcerated deviants.’4 Scull’s review of the reissued Foucault excited some passionate defences of Foucault in the following issues of the Times Literary Supplement. Perhaps the fairest came from Bill Luckin of the Centre for the History of Science, Technology and Medicine, at the University of Manchester–‘Had it not been for Foucault, British and American social history undergraduates would still be plodding their way through stodgily Whiggish accounts of the history of penology, education and madness and much else. Better that these parts of the academic universe should have been theorized, under the pre-eminent influence of Foucault, than that students should have continued to be subjected to blandly non-problematic versions of the past…’5
Foucault’s errors of fact did not trouble his many admirers, since they found in his pages one of the central doctrines of our times, namely that all authority is dangerous. For Foucault, one of the most expressive emblems of an Enlightenment society was Jeremy Bentham’s Panopticon, the architectural control tower, designed by the Utilitarian philosopher for use in British prisons, and which would allow the authority to keep an eye on every aspect of the inmates’ lives. For Foucault, the Panopticon was not merely a device for spying on criminals. It was an architectural parable of the way that the closed societies of the recent European past imposed discipline on the populace, in schools, in factories and in hospitals.6
Foucault did not create the modern open society, in which sexual mores changed, in which punishment was no longer deemed appropriate for ‘deviant’ behaviour, but he was one of the most persistent and beguiling of arguers against restraint. The 1960s were rightly seen as times in which all manner of restraints were questioned. Foucault was the prophet of this questioning.
The manner in which societies care for the mentally ill reveals much. In primitive societies, mental illness could be seen as a form of diabolic possession. In post-Enlightenment times, the most disturbing feature of madness was its assault upon order. The phrase was that a man or woman had ‘lost their reason’–a terrible thing by any standard, but if your entire social and metaphysical system was, as you supposed, based on reason, madness was especially to be feared. Hence the post-Enlightenment view that those who had ‘lost their reason’ should be incarcerated. Violent crimes, and murders, and even thefts, tended not to be punished by imprisonment until the close of the nineteenth century. Floggings, hangings or transportation, or (same thing) pressing the criminals into military service were thought better ways of dealing with both crime and its causes. For the Victorians, who cared so deeply about financial probity and about the exercise of reason, incarceration was the appropriate treatment of the indigent and the insane. The workhouse was the place where they locked up the poor who had fallen upon hard times, whereas the debtors’ gaol was for the more genteel Mr Dorrits and their families. The mad were housed in mental hospitals which dotted Great Britain until the mid to late twentieth century, great buildings, very often on the edge of towns, often referred to with a jokey mixture of dread and pity, by all the local in
habitants. The idea behind such institutions was a fundamentally kind one, namely that lunatics were not equipped to look after themselves, that they might do themselves and other people damage, and they were better off institutionalised. The actual treatment, however, could be harsh, since almost the only form of treatment allowed to the patients until the mid-twentieth century was restraint. Indeed, in publicly owned mental institutions very little was spent upon palliative medicine for the insane.
The early 1960s witnessed a peculiar combination of developments–firstly a vast growth in the pharmaceutical industry, leading many psychiatrists to believe that some forms of mental illness could be treated with drugs, and without recourse to incarceration; secondly, governments, pressed to expand other branches of public health care, saw an opportunity here to reduce expenditure; thirdly, there was a revolution in the way that mental health itself was regarded, and in writings of some psychiatrists, philosophers, or ‘thinkers’, the very concept of madness itself was questioned.
The development of pharmaceutical treatment of mental illness was an extraordinary breakthrough. Psychotic illness, especially schizophrenia, was considered by those orthodox medics who continued to believe in the existence of mental illness to be caused by an overactivity of dopamine in the brain. Dopamine is a natural transmitter, known as a neurotransmitter; it transmits messages between brain cells. A new drug, chlorpromazine, developed in Paris in 1953 (marketed as Largactil) blocked receptors in the brain, particularly dopamine. Aggression, delusions, hallucinations could all be held at bay or eliminated from a patient by merely swallowing a small pill. Psychosis, if not cured, could be contained.
This seemed like very good news for mental patients who had hitherto been compelled to face a lifetime of restraint, imprisoned in a Victorian lunatic asylum, sometimes wearing a straitjacket, or in later times simply zonked on heavy sedatives, usually paraldehyde. With judicious pill-swallowing, the nightmare could be over. It was good news, too, for the politicians who wished both to spend more money on the National Health Service and to save money where possible. Macmillan’s Minister, subsequently Secretary of State for Health, J. Enoch Powell, had a grandiose spending plan. No wonder the Secretary of State for Health looked with joy at the prospect of closing the old lunatic asylums.
He overlooked, of course, some disturbing facts. Schizophrenics and others who might benefit from taking Largactil could not always be persuaded to take the pills, and if left to their own devices might well forget to do so. Largactil had side effects, making some patients sleepy or jaundiced. These problems could be worked out if the patients continued to have medical supervision and to have back-up care if they were ‘released into the community’–i.e., let out of the lunatic asylums and expected to live like non-delusional, non-psychotic individuals. Almost no one existed who had been trained in the work of caring for such patients. There existed no halfway houses to assist psychotic patients to make a new life for themselves outside hospital. The state, in opting for pharmaceutical treatment of such patients, followed the trend of medicine throughout Western Europe and America, but they did nothing to help the vulnerable patients. Similar problems would be faced with the benzodiazepine Librium, which was first pioneered in 1960, and lithium, which was used in the treatment of manic depression.
This was to be a very good era for investment in the pharmaceuticals industry. The National Health Service provided a huge customer for the pills and potions manufacturers. Glaxo, the largest UK supplier of penicillin, had a ready-made market when the Health Service began in 1948 and made the shrewd decision to obtain licences from the USA (at great expense in the 1950s) to manufacture the new products which had been developed in America. It also pursued a policy of takeover of smaller UK companies–Allen and Hanbury’s, Evans Medical Company, Edinburgh Pharmaceuticals (in 1962), the British Drug Houses Group in 1967, Farley’s Infant Food in 1968. By the 1970s it was able to cancel its long-term agreements with Schering-Plough (to acquire US products) and acquire an American research laboratory of its own–Meyer Laboratories Inc of Florida.7
In the story of pharmaceuticals versus hospital care for mental health we see the beginnings of a phenomenon which would come out further in the open in Thatcher’s Britain. That is, the alliance between market capitalism and what would once have been thought anarchism. In the place where money counts supremely, there ceases to be such a thing as society. The boom in the pharmaceutical industry preceded, and could be said to have created, the anarchist ideas of Foucault, who, while being the creature of this boom, probably thought of himself as deeply anti-capitalist. We see here the germs of why the old left–right divisions over social and political issues gradually ceased to make sense in our times.
Whether the Secretary of State for Health in 1962 was ever to be prescribed anti-psychotic drugs himself is not vouchsafed by his biographers. He was undoubtedly one of the more interesting figures in British political history. J. Enoch Powell, only a short time later associated with fervently xenophobic views and with the desire to restrict immigration, had, as Health Secretary, been only too happy to fill 34 percent of junior hospital posts with immigrant doctors and nurses.8 The politicians of Powell’s generation, as of almost all generations, were nonentities. With his long, vulpine, lopsided face, his somehow mean moustache, his curious cowlick of Brylcreemed hair swept back from a professorial brow, and his penetrating cold grey eyes, Powell stood out from all his colleagues; not least because of his Brummy accent. He had been a Fellow of Trinity College, Cambridge. Walter Hamilton, his tutor, said that Powell was the finest Greek scholar he had ever taught.9 Powell became a Professor of Greek at Sydney University at the age of twenty-five, and he rose to the rank of brigadier (having enlisted in the Royal Warwickshire Regiment as a private). There was something about him which called out for attention. For whatever reason, however, whether being of a much lower social class than that from which brigadiers and Conservative Cabinet Ministers usually came (his parents were elementary school teachers), or whether because he was a much-indulged only child, the mere possession of remarkable abilities was never quite enough for him. He needed to go out on a limb.
Nobel Laureate, novelist and self-appointed sage, the dwarfish Elias Canetti, who had been compelled to leave Vienna after the rise of the Nazis, and who spent most of his post-war life in Hampstead, came across Powell in the 1950s. ‘What immediately struck me about him was the Continental, one might almost say the Central European way he presented himself. He straightaway broached Nietzsche and Dante with me. Dante he quoted in Italian and at considerable length. The thing that attracted him about Dante was the explicitly partisan nature of it… “In Dante’s time, people were burned at the stake…hatred of the enemy burned.”’10
Once out in the street, having had their first conversation, Canetti asked Powell if he was upset by the British loss of India. ‘He stopped in the middle of the street and beat his breast several times: “It hurts in here!”’ Powell was a notable example of a type more often found among autodidacts than academics, namely a very clever person with no judgement. The desire to cut a dash, to hold improbable or paradoxical opinions always seemed stronger than the desire to submit his proud intellect to the judgement of a sensible majority. Securus judicat orbis terrarum, the tag from Saint Augustine which had eventually converted Newman to Catholicism, would have been a repellent one to Powell, who by the end of his life had accumulated a whole bundle of heterodox beliefs, including the view that the Earl of Oxford, rather than ‘The Man of Stratford’, wrote the plays of Shakespeare, and that the Gospels lied when they stated that Jesus had been crucified. Powell, a regular churchgoer, believed, on no evidence, that Jesus had been stoned to death by the Jews, the customary penalty for blasphemy.
Whether or not Powell was himself deranged has often been discussed. As Health Secretary, he was enjoying his first real taste of administrative power, having resigned on a point of monetarist principle with Thorneycroft and Nigel Birch–and had be
en part of Macmillan’s ‘little local difficulty’. As Health Secretary he was in charge of the most unwieldy and expensive of government departments, and the arrival of pharmaceuticals, which could be prescribed to patients instead of expensive hospitalisation, seemed like an answer to a prayer. Largactil spelled the end of the lunatic asylums. In America, it was the monetarist governor of California, Ronald Reagan, and S. I. Hayakawa, psychologist, academic and US senator, who pioneered the policy of shunting the mentally ill from hospitals into ‘community’ facilities, clutching their packets of pills. In March 1962, at a conference of the National Association of Mental Health, it was pointed out that ‘community care as it then stood was largely a fiction.’11 Nevertheless, Powell believed that by closing 75,000 beds occupied by mental patients, he could launch a programme of improvement in care for the physically sick: ‘£500 million over a decade, building 90 new hospitals, drastically remodel 134 more and provide 356 further improvement schemes, each costing £100,000.’12
Powell’s speech about the lunatic asylums was a sort of poem: ‘There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising, unmistakeable and daunting out of the countryside [sic]–the asylums which our forefathers built with such immense solidity…These…are the defences we have to storm.’13