They had no other cures and few other diagnoses.
Under Scots law from the fourteenth century onwards, ‘fatuous’ people were the responsibility of the nearest male relative on their father’s side, and ‘furious’ people were fettered by the Crown. Scots law might not always have reached into the distant islands and glens, but it touched such mainland Highland burghs as Inverness, where as late as the eighteenth century ‘violent maniacs’ were imprisoned beneath a grill on the pillar of the town’s old stone bridge.
In 1843 a coalition of the great and the good in the Highlands established a committee with the aim of ‘promoting the erection of a lunatic asylum at Inverness for the Northern Counties’. While Lord Lovat, the MacLeod of MacLeod, the MacKintosh of MacKintosh and their friends were busily raising money, in 1855 a Royal Commission was appointed ‘to inquire into the condition of lunatic asylums in Scotland, and the existing state of the law of the country in reference to lunatics and lunatic asylums’.
The commission reported the story of a 68-year-old ‘male pauper lunatic’ in the Wester Ross village of Achintee, who had been failed by Gaelic charms and incantations.
He had been insane for forty years. He lived in a turf house, the roof was leaking and the door, about four feet high, opened directly into the place where the patient was confined, and there was no window or any opening for one.
The turf walls were damp and the floor was of earth. There was no furniture of any description except the bed to which the patient was chained. No bedding except a quantity of loose straw was provided. The patient was wrapped in a piece of blanket, old and dirty, and two pieces of old bed-covering. Except for these bits of rags he was naked. He had been chained for thirty years. The chain was two-and-a-half feet in length, and its end was fastened round the patient’s ankle. He never left his bed. His knees were now contracted and drawn up on his chest and completely rigid. He was stated to be occasionally ‘furious and excited’. He never washed, except twice in the course of the year.
The publicity given by the Royal Commission to such wretched cases caused outrage. Something clearly had to be done. The Inverness Asylum Committee redoubled its efforts. It acquired an exposed and stony plot of land on the upper south side of Dunain Hill, two miles west of Inverness town centre. (Creag Dùn Eun, its Gaelic original, means rocky hill of the bird.) It was both a remote and, in the nineteenth century, tremendously scenic spot. It looked east over the River Ness flowing towards the Caledonian Canal, the silver Moray Firth and the North Sea. Beyond those waterways the high round hills of the central Highlands rolled into the distant south. Below the hills Inverness itself crouched like a toy town beneath a pall of smoke.
On that hilltop the committee built of red whinstone a grand Victorian sprawl of an institution, two to three storeys high, with decorative high turrets and two water towers. Inverness District Lunatic Asylum would contain more than 350 patients before it was considered, in 1879, to be overcrowded. In May 1864 Donald D., the mariner, was admitted. He was followed over a further 136 years by many, many thousands of others.
The word lunacy, with its origin in the phases of the moon, itself suggests that the Victorians were no nearer than their predecessors or their successors to reaching a reliable definition of insanity, let alone a cure. Inverness District Asylum slowly filled up with an assortment of drunks and depressives, unmarried teenage mothers and middle-aged indigents, sociopaths and socially innocuous individuals who considered themselves to be Mary Queen of Scots or a bumblebee. Their commonality was that they could not be reconciled to their homes and societies because they were a danger to themselves, because they were a danger to others, because they were a financial burden, because they were an embarrassment, or, most usually, for some synthesis of those four reasons.
Although there was a reasonable turnover of patients admitted to the asylum, there was also a good number of lifers. Over a third of those admitted were released within two years. But many of them were subsequently re-admitted; as the decades passed admissions continued to outstrip discharges by almost two to one and the number of patients who died on the premises – frequently from old age – steadily increased.
In 1931 it was noted with bafflement that there were twice as many registered ‘pauper lunatics’ in the Highland counties as in the rest of Scotland. A pauper lunatic being by definition somebody who was both unbalanced and unable to subsidise himself (few wealthy lunatics were referred to Inverness District Asylum), Highland poverty was clearly part of the problem. The subsistence lifestyle common in much of the rural Highlands at that time did not drive an unusually large percentage of the population mad. But it did mean that families often could not afford to support their chronically sick; they could not without great difficulty carry for a lifetime the burden of an unproductive member. In the late nineteenth and early twentieth centuries in some remote islands and parishes in the north-west of Scotland the system of local poor relief occasionally collapsed because there were too many paupers and too few ratepayers.
Doctors, officials and other experts scrabbled around for the rest of the equation. It was suggested that certain wily but sane Hebrideans had themselves certified as pauper lunatics to win a small allowance from the state. It was stated that emigration ‘has drained the Highlands and Islands of much good stock, leaving behind weaker and older people who are unable to stand up to the strain of daily life on the sea coast or among the hills’.
Part of the reason for the boom in Highland lunacy lay in the all-embracing, ambiguous definitions of the term. One in every five admissions to Inverness District Asylum would be for intemperance. Those patients were most frequently discharged after a few weeks, once they had sobered up and dried out – and just as frequently re-admitted. Some men and women were registered as pauper lunatics because they had venereal diseases.
In 1902, exactly one-third of the 157 new admissions that year were ‘considered hereditary’. Four years later the strange case of two young sisters was thought to illustrate that hereditary principle. In 1906 a girl from the island of Skye was referred to the asylum with ‘acute mania’. Her sister went to visit and found the occasion so distressing that before she could return home, she also ‘developed an attack of acute mania and had to be admitted’.
There were orphans in there, and old people who could no longer fend for themselves, and young women who had been willed out of their ‘hugger-mugger’ communities for the shame of having an illegitimate child, who for the rest of their lives had nowhere else to go.
In 1927 the asylum physician decided that of his 99 patients previously diagnosed as suffering from melancholia or mania, 22 were actually afflicted by dementia praecox. Dementia praecox, premature dementia, or precocious madness, was a disorder characterised by rapid cognitive disintegration, which was usually first observed in the patient’s early adulthood. Dementia praecox would itself within a few years be absorbed in the medical lexicography by another delusionary, dysfunction al condition widely popularised as schizophrenia. But when dementia praecox were the words in use, Dr J.C. MacKenzie of the Inverness District Asylum noted that, by early-twentieth-century Highland standards, its sufferers ‘tend to lead protected lives, and live long’.
Despite and possibly because of all that, a sense of shame attached itself to the big house on Dunain Hill. ‘The dread of the Asylum and the feeling of prejudice against it,’ wrote medical superintendent Dr John Keay in 1897, ‘once so strong, is happily dying out.’ Dr Keay was too optimistic. Sixty-seven years later, in 1964, one of his successors reported that ‘a letter arrived from a doctor seeking admission for a patient, saying that she was now willing to come into [the asylum]. Her previous reluctance to do so was because of the stigma attached to such a move.’
That mark of disgrace was not unique to Inverness among British asylums. But it was stronger in self-consciously moral societies, and more pervasive in tightly knit, interconnected communities such as those scattered across the Highlands and Isla
nds. It sprang from pride and dread of public failure. It was of course self-defeating, in that if residency in Inverness District Asylum was considered to bestow the mark of Cain, there was little point in a patient bothering to recover. He or she would only carry the mark back home with them, and once there be somehow tainted for life. For many, their only course after entering the asylum lay either in leaving the Highlands and Islands altogether (which was even in the twentieth century too big a step for a lot of Scottish Gaels to contemplate), or spending the rest of their lives being fed and protected in the increasingly familiar surroundings on Dunain Hill.
In that sense of humiliation may lie another part of the reason why the Highlands had so high a proportion of registered pauper lunatics, and why Inverness District Asylum had so many lifelong patients and so many deaths in residence. Once inside, fragile Highlanders could barely imagine leaving again. They had no other future. They became, in a twentieth-century word, institutionalised.
Angus MacPhee entered Inverness District Asylum on 31 December 1946. He was one of 137 new admissions to the asylum of 842 patients that year. It was recorded that among the admissions in the previous year, ‘44 were cases of melancholia, 17 of Mania, 13 of Schizophrenia, 25 of senile states, 12 of mental deficiency, 7 of acute confusion, 2 of epilepsy and 1 of delirium tremens’.
Angus MacPhee was among the schizophrenics. His ‘simple schizophrenia’ diagnosed in Stirling may have been one of the less aggressive mental and behavioural disorders. But as his family had discovered, it was serious enough.
‘Schizophrenia’ would be popularly misinterpreted. It did not suggest an unusual level of dual or multiple personalities. It merely implied the same apparent loss of comprehension, expression and capability that could earlier have been called mania, or dementia praecox, or mental deficiency, or acute confusion, or nervous collapse, or even melancholia.
As the twentieth century progressed, the catch-all term of schizophrenia would encompass a number of varying conditions, such as paranoid schizophrenia, hebephrenic schizophrenia and catatonic schizophrenia. Angus MacPhee’s variety of simple schizophrenia was often used, as the World Health Organisation pointed out, as a convenient label for a relatively mild form of the disease. It was a schizophrenic disorder nonetheless, and
schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and by inappropriate or blunted affect.
Clear consciousness and intellectual capacity are usually maintained, although certain cognitive deficits may evolve in the course of time. The disturbance involves the most basic functions that give the normal person a feeling of individuality, uniqueness, and self-direction.
The most intimate thoughts, feelings, and acts are often felt to be known to or shared by others, and explanatory delusions may develop, to the effect that natural or supernatural forces are at work to influence the afflicted individual’s thoughts and actions in ways that are often bizarre.
The individual may see himself or herself as the pivot of all that happens. Hallucinations, especially auditory, are common and may comment on the individual’s behaviour or thoughts. Perception is frequently disturbed in other ways: colours or sounds may seem unduly vivid or altered in quality, and irrelevant features of ordinary things may appear more important than the whole object or situation.
Perplexity is also common early on and frequently leads to a belief that everyday situations possess a special, usually sinister, meaning intended uniquely for the individual. In the characteristic schizophrenic disturbance of thinking, peripheral and irrelevant features of a total concept, which are inhibited in normal directed mental activity, are brought to the fore and utilized in place of those that are relevant and appropriate to the situation.
Thus thinking becomes vague, elliptical, and obscure, and its expression in speech sometimes incomprehensible. Breaks and interpolations in the train of thought are frequent, and thoughts may seem to be withdrawn by some outside agency.
Mood is characteristically shallow, capricious, or incongruous. Ambivalence and disturbance of volition may appear as inertia, negativism, or stupor. Catatonia may be present. The onset may be acute, with seriously disturbed behaviour, or insidious, with a gradual development of odd ideas and conduct . . .
[There are] ‘negative’ symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses, usually resulting in social withdrawal and lowering of social performance . . . [and also] a significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.
It was not realised in 1946 that Angus MacPhee’s age and fractured life made him most vulnerable to the latent condition. Schizophrenia, which can lie for a lifetime as dormant as some malevolent frozen seed, usually surfaces in young men in their late teens and early twenties, and in young women a few years later. Almost no 10-year-olds or 70-year-olds suffer acute schizophrenia for the first time.
It is often triggered by insecurity and physical dislocation. Young immigrants are exceptionally prone to schizophrenia. So are people within the vulnerable age range who leave their childhood homes for more ordinary purposes. Students can develop schizophrenia during their early terms on an unfamiliar campus. And by the late twentieth century it would be recognised that an unusually high proportion of young men manifest the illness during their first year of military service.
In the years before diagnosis and treatment, schizophrenics played different but readily identifiable roles in Western society. The ‘oddities of conduct [and] inability to meet the demands of society’, which along with self-absorption, idleness and aimlessness were identified by the World Health Organisation as symptomatic of simple schizophrenia, were displayed by Angus MacPhee.
As the World Health Organisation observed, in the absence of a safety net they are also a formula for vagrancy. The same symptoms are evident in the tramps and down-and-outs of the developed world. At its zenith in the nineteenth and early twentieth centuries, between the decline of rural communities and the introduction of the welfare state, the lifestyle of the British tramp could have been framed for a schizophrenic. Simple schizophrenics certainly helped to define the lifestyle of British tramps. Eccentric, aimless, unwashed, unemployable, simultaneously dependent and ungovernable, and harmless to all but themselves: before the welfare state and the motor car, the life of the gentleman of the road was a natural career choice for a simple schizophrenic.
Many seriously afflicted schizophrenics are and always must have been propelled by metaphysical, religious impulses. The mystics and visionaries common in medieval Europe and in much of the rest of the modern world often were and are schizophrenic. The itinerant, dishevelled, mendicant holy men who cared nothing for their personal appearance or hygiene and who spoke to villagers in voices of unimaginable things, would probably be diagnosed as schizophrenic in the twenty-first century. Modern psychiatrists might look at a latter-day Saint Joan of Arc or Saint Theresa of Avila and observe the symptoms of schizophrenia.
The saints were in good company. Another notable fact about schizophrenia was not properly recognised when Angus MacPhee entered his asylum in the late 1940s. Schizophrenics are unusually creative. ‘Almost all schizophrenics paint,’ said the art therapist Joyce Laing.
Depressives just walk away from therapeutic work, don’t want to know. But schizophrenics all paint, quite strange things some of them.
The subconscious seems to be stronger with them. Medication now means that none of them need to be in hospital, but on the other hand none of them can hold down a job. Jean Dubuffet said that they were unable to do anything but produce their own work, that they were self-taught. My definition now is that they couldn’t hold down a job in Tesco’s for a day. I’m sticking to that. They just couldn’t stack shelves for a day. They’d start stacking and then their imagination would st
art to fly. They’d think, ‘What if you made a tower!’ And they’d be away . . .
Schizophrenics are unusually creative in many meanings of the phrase. They are unusually creative because a higher than average proportion of schizophrenics are gifted, unusually because their work is unusual, and unusually because many of them reach peaks of brilliance that mundane humanity can only describe as genius. Their very condition relieves schizophrenics of many inhibitions and allows them to view and interpret the world from a fresh and startling angle, whatever their inventive field.
In the words of Patrick Cockburn, whose 20-year-old son Henry developed the illness while at art college, ‘the genetic inheritance that produces schizophrenia . . . is related to the genetic combination endowing people with exceptionally original and creative minds’. The painter Vincent Van Gogh was almost certainly schizophrenic. The musician Syd Barrett of Pink Floyd was schizophrenic. The novelist Evelyn Waugh fictionalised his own most vivid episode of schizophrenia in The Ordeal of Gilbert Pinfold. The Nobel Prize-winning mathematician John Nash, who was celebrated in the film A Beautiful Mind, suffered from schizophrenia for most of his adult life.
So have millions of others. Schizophrenia, whether dormant or active, is blind to nationality, class, colour or creed. At any given time roughly 1 per cent of the world’s population either suffers from or is prone to the condition. There are few early warning signs. Henry Cockburn was as a child and a youth consistently ‘able, original, likeable and articulate, but . . . he could be spectacularly ill-organised, was forgetful of all rules and regulations, and did only what he wanted to do himself’. That describes a normal rather than a worryingly abnormal teenager, and the teenage years almost invariably precede male schizophrenia.
The Silent Weaver Page 7