Even though I have read the admittance notes below many times, it still feels surreal to know they are about my grandfather. His file was released around five years ago, after my brother was diagnosed with cancer and his partner commissioned research to know more about our medical history. Prior to this, other than knowing he died in a psychiatric hospital, I knew little else about his life.
Henry had just turned 32 when remanded to Sunnyside and remained in various institutions until his death at Cherry Farm in 1964, aged 65. His crime, according to his notes, attacking his fellow workers with a shovel. His diagnosis; dementia praecox (now called schizophrenia).
Admittance notes: Sunnyside Lunatic Asylum 24 July 1931
This remand patient instantly creates a disquieting unfavourable impression. Cooperation is poor and he obviously controls himself with difficulty owing to a scarcely concealed hostility. Questions receive sullen evasive answers and if the answer is considered distasteful he side steps into a thinly veiled criticism of the examiner.
His memory and orientation seem very fair. His ideations are obviously of a limited disordered nature. The presence of hallucinations is debatable. But it is in the volitional sphere that we meet with grave disorderment.
There is one dog reiteration that fills up any hiatus in conversation “I have been knocked about”. He explains that he attacked his fellow workers with a shovel because “They were singing off at me“. He does not express contrition as one would expect a normal man to do but grumbles about injuries he received while being restrained at Hagley Park.
Three hours after admission under the pretense of requiring a drink he savagely assaulted two attendants. He smashed the door of the room with his bedstead receiving numerous abrasions to himself in the process. One attendant received minor injuries necessitating him going off duty but it is fortunate the assault was not attended by more serious results considering the murderous weapon he employed.
Ones general impression is unfavourable. Satisfactory bodily health.
Conclusion
Appears to be a Dementia Praecox with unsatisfactory paranoidal and dementing features.
These notes leave me with such a strong impression. Not just about how agitated and unwell my grandfather was, but also of the examiner. Rather than seeing Henry as someone needing help, his language exudes a position of moral high-ground.
The remainder of Henry’s file continues in this vein. Filled with entries using derogatory language to describe him, it gives little away in terms of any treatment he may have received. Therefore, the only way to get a sense of what his life was like during his 33 years in hospital, is to place his notes within the context of psychiatric care during that time.
My grandfather was hospitalised during the period when psychiatry began to embrace the biomedical model. A model that believes mental illness has a physical cause, such as brain disease, which is best treated with medical intervention. It was when psychiatry became zealot-like in its pursuit of cures and experimented with new treatments, such as ECT, lobotomy and Insulin Coma therapy.
When Sunnyside first opened in 1863, the philosophy for patient care was known as ‘moral management’. The Superintendents (now called psychiatrists) believed mental illness was caused by life’s pressures and could afflict anyone under sufficient duress. To create an environment conducive to healing, asylums were often grand buildings with attractive outlooks that provided opportunities for rest, activities and engaging with others. The Superintendents endeavoured to treat their patients with kindness and compassion.
By the time my grandfather was admitted in 1931, things had changed a lot. Casualties from World War I had contributed to a growing problem of overcrowding. Earlier idealism began to dampen as psychiatrists failed to make clear inroads in curing the afflicted. Asylums became places to keep people out of mind and sight.
Consequently, psychiatry began to frame mental illness and patients in a different light. There was a shift away from believing madness could afflict anybody to it being rooted in a person’s biology, e.g. their brain or genetics. Psychiatrists concluded that the soldier’s traumatised by war, must have had some form of weakness before conscription. They believed such biological weaknesses were hereditable and largely passed down amongst an inferior class of people.
In fact, stigma and discrimination towards people with mental illness experienced a peak in the mid-1900s. The language used to describe Henry is harsh and they never call him by name. This is obviously how notes were written at the time. Excerpts from his notes follow.
Degenerate, a very demented man, self-absorbed, mentally enfeebled, irresponsible, suspicious, unfit to be in the outside world, very faulty and has a greedy appetite, solitary and unreliable, continues to be unsatisfactory, persecutory and grandiose ideas, childish and cunning, a highly dangerous type, faulty and untidy, poor cooperative powers, recently refused food for a week and seemed vague as to the reasons.
Such views only added to the shame often felt by those affected by mental illness. My father, who was born about a year before Henry was admitted, grew up believing his father was dead. In a letter sent to my grandmother Leila in 1933, Henry makes repeated requests for her not to visit and to take Robert (my father) somewhere far away. He obviously didn’t think the asylum was a place for visitors.
Dear Leila
I think of you. You are a dear and deserve happiness. Isolation all day. For Gods sake don’t come here. (Don’t come up here). Don’t take any notice of mother. She is a demon. You are not to come here. Robert can stay with you if you go east. Take a train to Lyttleton and go on board a shaw Saville boat. You know an English boat when you see one. Robert is to be taken on a white star or shaw savill boat. When you get to England arrange for a boat to go to Japan. He is to be educated up to Form Two. You are to quickly study the maps and mileage from here to England. Etc.
Love from Henry
In keeping with the biomedical model, my grandfather’s notes focus on how he presents, both physically and mentally, and do not delve into his past or any circumstances that may have led to him becoming unwell. One exception is the mention of a head injury, that could have contributed to his poor mental health yet is seemingly glanced over.
statement from relatives reveal he suffered severe concussion eight years ago
scar left side of head about 2 inches above ear
Apart from a note that he was “tethered” and one mention of medication, there are no notes about any procedures or treatment that Henry may have undergone. However, it is no more a leap in logic to assume he would have undergone procedures fashionable at the time to assume someone admitted to a psychiatric hospital today would be medicated.
During the time he was hospitalised, treatments used in New Zealand include insulin coma (ICT), deep sleep and electroconvulsive (ECT) therapies, leucotomy (a type of lobotomy), and from the mid-1950s, psychotropic drugs.
Dr Robert M. Kaplan portrays these treatments as trial and discoveries in his lecture series to the Royal Australia New Zealand College of Psychiatrists (RANZCP). Rather than given an honest account of the harm caused during this period Kaplan, who is the RANZCP Chair of the Binational Section Philosophy and the Humanities in Psychiatry, engages in an upbeat white washing of psychiatric history.
More has come to light about these therapies through independent research and accounts from former patients and hospital workers. The Abuse in Care – Royal Commission of Inquiry1 gathered testimonies from patients admitted to psychiatric institutions around the country. It includes stories from Sunnyside, Ngawhatu and Cherry Farm, the hospitals my grandfather stayed in.
Insulin coma therapy (ICT) put patients in a semi-comatosed state that led to convulsions, which were deemed beneficial by Superintendents. This was despite leaving them with nausea, confusion and irritability, and some with permanent brain damage. And occasionally a patient died. Its popularity waned in the 1950s due to concerns about its effectiveness and safety. Research published in 1957 revealed ICT was based on false science and claims about recovery rates were inflated.2
Electroconvulsive therapy was used regardless of diagnoses, even though it is now deemed effective only for depression. It was also sometimes used as a form of punishment or to subdue. A nurse who trained at Ngawhatu in the 1950s when my grandfather was there, tells of how “she held down patients while they were shocked, 12 or more times each day. Afterwards, the patients, some of them with burns on their temples, were like cabbages.”.3
Though the inventor of the lobotomy (Egas Moniz) won the 1949 Nobel prize for medicine, it’s a procedure that psychiatry might rather forget. An investigative journalist uncovered that 65 of these procedures were carried out in New Zealand between 1944 and 1950. “Patients were prepared using electroconvulsive therapy, or ECT – electric shocks rendering the patients unconscious. But behind all this “success” were complications, suggesting the study was downplaying the damage caused. On average, patients spent more than six months in hospital after leucotomies.” 4
The majority of patients selected for this treatment were inpatients from publicly run psychiatric institutions with chronic and severe conditions, such as schizophrenia. My grandfather met both those criteria.
The one mention of medication, “continues to take his Stelatine”, is in a letter addressed to the Superintendent from a medical doctor who examined Henry shortly before his death. The letter also includes reference to a “significant abnormality ….a right sided Horner’s syndrome”. This condition affects the face and eye on one side. It can be caused by the disruption of a nerve pathway from the brain to the head and neck. I can only speculate about what caused this condition as it was never mentioned earlier in his notes. The doctor also states he was unable to get information from the patient due to his reduction in mental capacity.
My grandfather died on the 5th of October 1964. The last entry about him reads like a summary of his time in institutions (even a eulogy). Yet is dated before his death.
A demented schizophrenic. Used to be aggressive but now well controlled. Can respond to instructions but does not converse.
***
The final part of my grandfather’s file contains his Death Certificate, followed by a note stating they were unable to contact any relatives as no-one had visited him in years. They must have tracked my grandmother down though, as there is a letter dated two months after his death notifying her. Around this time my father received a phone call from a distant relative who told him his father had just died. This would have been a huge shock for him as he grew up believing he was dead.
Some two months later my grandmother received a second letter.
Dear Madam
The following effects belonging to your late husband are enclosed:
Safety razor
Blade
Strop
Blade razor
Pocket Diary
Kindly acknowledge receipt of these articles on the duplicate copy of this letter and return same to this office as soon as possible.
Yours faithfully
P. Elliot
For Medical Superintendent (Cherry Farm)
***
Things are way better now. I mean, if I ask myself would I rather be hospitalized today or back then, my answer would be a resounding now! But history leaves a legacy and my grandfather’s story helps illustrate how the biomedical model, that now sees psychiatry use medication as its treatment of choice, can dampen hope and cause harm.
My grandfather needed to be hospitalised as he was very unwell and also violent. And while he may have fared better today with the advances in drugs in terms of being able to help stabilize and manage his symptoms, the biological approach remains ignorant to the complex causes of mental illness. It largely ignores stresses from the likes of intergenerational trauma and other forms of social disadvantage. It dehumanizes those who need help and invalidates their suffering. If psychiatry had viewed those people hospitalised in the 1900s as fully human, then I doubt they would have been able to carry out such callous treatments.
The biomedical model that treats mental illness as a disease, also tends to overlook the possibility of recovery. I often read statements such as, there is no cure but you can go on to lead a meaningful life, or there is no cure but you can go on to become symptom free. Surely both those statements equate to recovery. Research shows that many people go on to recover from serious mental illness and those who do tend to have good support systems and address all aspects of their wellbeing.5
In terms of my grandfather, all my family is left with is knowledge of a very sad life in institutions and hope that we continue to learn from the past. This is so that future generations receive more informed and compassionate mental health care.
[3] https://www.newsroom.co.nz/our-terrifying-treatment-of-mental-illness
[4] https://www.newsroom.co.nz/our-terrifying-treatment-of-mental-illness
[5] https://www.sciencedirect.com/science/article/pii/S0920996422004248