Editorial Note: The last three posts give examples of medical kidnapping happening now. The Doctor Munchausen series of posts on David Healy in July and August 2014 give some more examples. This post and two to follow outline how we ended up in a position where people can be kidnapped.
Medical Kidnapping goes back a bit. In 1706, Daniel Defoe, perhaps the first journalist and, with Robinson Crusoe, one of the very first novelists, reported on the case of a woman wrongfully locked up as mad by a husband in an effort to dispose of her. This was, it seems, close to the start of a new trade in kidnapping.
Before 1700 for the most part the mentally ill, the elderly infirm and mentally handicapped were looked after by their families and communities. If they were poor and annoying or antisocial, they might land in prison along with beggars, vagrants and criminals. If they broke the law they were tried and punished.
A 1714 British Act distinguished for the first time between impoverished ‘lunatics’ and ‘rogues, vagabonds, sturdy beggars and vagrants’. Under this Act two Justices of the Peace could authorize those who were ‘furiously mad and dangerous’, who were probably almost always delirious, to be apprehended and locked up in a secure place where, if necessary, they could be restrained but only during the period of madness (delirium).
This Act appeared in parallel with the emergence in Britain of a market in mental health care. It didn’t address the linked abuses that might happen.
Eliza Haywood, perhaps the first female novelist and journalist, in a 1726 play ‘Love in a Mad-house’ shows there was no legislation to prevent anyone, sane or insane, being taken off to a private madhouse by force where the proprietor made a living out of detaining residents for unspecified periods of time.
Eliza Haywood
In an effort to curb the growing abuses, in 1774 a Madhouse Act required anyone who was housing more than one lunatic to have a licence for the purpose.
In 1828, there was another effort to curb abuse in an Insane Person’s Act. This required that a person had to be certified as mad. People could not be carted off to a madhouse willy-nilly. The order for detention had to be signed by a Justice of the Peace and it had to have a medical certificate signed by two doctors who had seen the person.
1845
In 1845, two Acts were passed in Britain – The County Asylums Act and The Lunacy Act. The Asylums Act mandated the building of asylums. These were based on a new idea that good food, clean air, temperance, personal cleanliness and work could bring about recovery in many people who had gone insane.
Under the Lunacy Act if it was decided that someone, by virtue of the specific alienation of reason that a mental illness can produce, was incapable of exercising the correct judgement in terms of their own safety, or health or the safety of others, with the agreement of their family, that person could be detained.
At the time, there was a presumption that asylum care would produce a benefit so that in the foreseeable future the person would be able to take their affairs back into their own hands.
The previous Acts had aimed at curbing a variety of abuses. The 1848 Act was permissive – it was about getting treatment to people who might need it. It was recognized that in some instances in the domain of lunacy, families could do unfortunate things, especially when money was involved, but it was also recognized that the bulk of caring of people with mental disorders was being undertaken by families and communities. The asylum was a new therapeutic instrument, which it was hoped might support families and community efforts.
The Lunacy Act was not about disposing of problems. It was about treatment. A mental health patient was someone whom their families thought had a problem even though they might not be obviously delirious or a clear public threat. Where doctors’ were involved, their judgement had to dovetail with the assessment of a family who described to a magistrate the behaviors they felt incapable of managing at home.
This was the era in which the notion of a medical patient was properly born. These Acts created a new framework based on therapeutic optimism. Specialist treatment would enable patients to recover. In this – as in so much else – psychiatry blazed a path for the rest of medicine.
Treatment in the asylum depended on the consent of the family. The decision to detain was theirs. The family could discharge the patient ‘against advice’ if they believed the proposed benefits were not being realized, or the patient might remain in hospital when families felt unable to cope with them after discharge. Some patients were discreetly given shelter if there was a concern that the patient might be vulnerable.
In 1845, the new asylums came with a hope that moral treatment was highly likely to produce a good outcome. The data supported that presumption. For the first forty years of the asylum era, schizophrenia was rare and the psychoses and melancholias that came into hospital were turned around within a 3 to 6 month period. Detention was an evidence based treatment.
It was fifty years later, heading towards 1900, as admissions for chronic psychoses became more common that the specter of commitment to a hospital without the prospects of a benefit began to raise concerns. The notion of a warehouse for the insane began to take shape. In addition, the asylum filled with the elderly infirm and mentally handicapped. New stories of sane people being incarcerated emerged to parallel the accounts by Daniel Defoe and Eliza Haywood – but these were rare. In fifty years worth of records in North West Wales between 1875 and 1924, the number of cases that might fall under this heading can be counted on the fingers of one hand.
There are two points to make.
- All interventions, both medical and legal can have unintended consequences. Drugs with a short term benefit can produce long term harms. In a similar manner the asylum system was not intended for long stay patients. With longer stays the problems of institutionalization emerged.
- Once a medical system and a legal process is put in place, some component of what happens next will, on a simply bureaucratic basis, involve actions by the system to perpetuate itself. This will give rise in some instances to perceptions of a conspiracy. This is an almost inevitable consequence of any intervention in human affairs.
To be continued.
annie says
I suppose I was unlucky to have one of these ugly, grey, depressing, buildings not too far from home..
I suppose I was unlucky in that the Indian Doctor, who didn’t speak English, thought it was an hysterically good idea to write a referral to this Granite Gringe ..
I suppose I was unlucky that the man I saw was a very boring bachelor, given to talking so much about anxiety and depression that I hardly spoke…
I suppose I was unlucky that he was an institutionalised being through and through his thin suit to his thin blood..
I suppose I was unlucky that he wrote about Paroxetine Abrupt Discontinuation Symptoms, never bothering to tell me..
I suppose I was unlucky that the she-devil did not even pay attention to the GSK leaflet, 10 mg. less and then 10 mg. less..
I suppose off, on, off, on, off, on 20 mg.for 14 days seemed a good idea to her..
I suppose the 7 weeks leading to hysterical madness and told to drive myself to the mental hospital seemed a good idea..
I suppose the Paroxetine liquid was a good idea imposed by a Pharmacist..
I suppose the constant nitpicking, talon scratching, pecking was what I deserved..
A week is a long time in P….a Mental Hospital for the Mentally ILL..
The impetus to get out came from my airline pilot, our daughter has ‘nits’, country life, I don’t know what to do..
A little letter from a little girl….mummy, please come home..
It is strangely comforting to read this history of Kidnapping and I cannot wait for Part Two to make sense of why I/We have been treated like complete imbeciles and why it is still going on today…
mary says
I, obviously, don’t know how the following two posts are going to read nor whether they will concentrate, in any way, on our North Wales asylum before its closure. This week’s start to the story is very interesting but I fear that what follows will not be a comforting read!
I can only say that, as far as I can see, the saddest day here in North Wales, as far as mental health care is concerned, was the day of the asylum’s closure.
Johanna says
This is some fascinating history – and I know there’s a lot of evidence that early asylums had a better record of helping patients than later ones (or our modern chemical-custody plan). Still, I’m always cautious about wishing for the “good old days” …
The 1840’s in England were a time when the Industrial Revolution was tearing through the society like a tornado. Millions of people’s lives became far more miserable than ever before, at least for a time. So if the asylums were offering good food, physical safety and a clean wholesome environment, how did the authorities keep thousands of people from trying to fake their way in, just to access those basic blessings they lacked?
I pulled out my beat-up copy of The Condition of the Working Class in England (1845), and searched for the word “asylum.” I found it – but in reference to workhouses (poorhouses), not hospitals. Those were designed on purpose to be so dreadful that no one who could possibly work for a living would want to crash the party. Googling around, I found that a fairly large portion of “lunatics” were actually stuck in the workhouses, some of which had “insane wards.”
Not clear exactly what the numbers were, or the divisions. Some accounts said “pauper lunatics” went to the workhouses, or to separate “pauper asylums.” Others said the authorities tried to reserve the asylums for those who were either clearly curable, or clearly dangerous, while the harmless-but-hopeless were often sent to the workhouse. Any idea what the real story was?
mary says
I have no real information about exactly who was/ wasn’t taken into the asylum but do know that conditions were not described as ‘ideal’ to put it mildly. The Most Haunted team used our North Wales asylum for one of their DVDs – their tales, obviously, were of some morbid accounts but, there again, they wouldn’t have a tale to tell if all was favourable would they!
I can only tell you why I say that the asylum’s closure was a very sad day for us here in North Wales. As well as the ‘main part’, it also had a separate house which catered for short-term ‘cases’. My maternal family lived in the vicinity of the asylum and two of my mother’s siblings, two of my first cousins and the son of another first cousin spent time there, on different occasions, between roughly 1940 and 1960. Their ‘problems’ were mainly anxiety or mild depression. Each praised the care and support given to them and none came away on medications or suffered a relapse following their treatment.
Can we, in this area (or any other in GB), say the same today? Certainly not as far as I can see!
Maybe my family’s (and many others’) experiences were not general for the whole of North Wales, maybe we were just lucky that the asylum was close by and that the local GPs were listened to immediately if they suspected that one of their patients could benefit from a short stay at the asylum.
Does that happen today? Certainly not in our area anyway. Getting support is like trying to draw blood from a stone. Therefore, I say bring back the best practice from a bygone era but, I am very willing for any poor practices, that I’m sure existed, to be left in the past!
annie says
David kindly sent me a reference about Elizabeth T. Stone which he thought it might be interesting for me to read, many, many years ago..when the Paroxetine debacle had just reared its ugly head..
After a bit of research, I turned it up at the Boston Public Library and here is the Story.
I think everyone should read this Story:
ELIZABETH T. STONE,
AND OF HER PERSECUTIONS,
WITH AN APPENDIX
OF HER ^f&,.
TREATMENT AND SUFFERINGS
WHILE IN THE
CHARLESTOWN McLEAN ASSYLUM,
where she was confined under the
Pretence of Insanity.
1842:
http://ia600301.us.archive.org/32/items/sketchoflifeofel00ston/sketchoflifeofel00ston_djvu.txt
“May God bring to light this awful crime, for my sufferings do not
end in this world, although the crime was done by others.
In conclusion, before this work is attributed to insanity why will
not the public demand an examination of the affairs and management
of the Mc’Lean Assylum, and see whether my charges be true or
false.
Currently unavailable
https://www.amazon.co.uk/sketch-life-Elizabeth-T-Stone/dp/B0068PP57O?ie=UTF8&*Version*=1&*entries*=0
https://openlibrary.org/books/OL6890783M/Elizabeth_T._Stone_exposing_the_modern_secret_way_of_persecuting_Christians_in_order_to_hush_the_voi
Edition Notes
“All heaven is interested in this crime.”
Found it….ordered it
https://www.bookdepository.com/Sketch-Life-Elizabeth-T-Stone-Her-Persecutions-Elizabeth-T-Stone/9781331846420
This will add to my contemporary collection the evidence, however, is clear and crazy and it was and dear luise
https://www.amazon.co.uk/Dear-Luise-powerlessness-Denmarks-psychiatric/dp/0988412209?ie=UTF8&*Version*=1&*entries*=0
5.0 out of 5 starsOne of the most extraordinary books about healthcare ever written
By David Healy on 18 May 2014
Dear Luise is something close to a masterpiece. Mainstream medicine learnt 50 years ago to listen to the concerns of a mother even when the diagnostic apparatus didn’t support what she was saying. It hadn’t always been like that. But within mental health, the culture not only fails to listen to mothers and family but will often demonize them, call them schizophrenogenic, or over-involved or expressing too much emotion when they question what is happening a family member.
In brief and understated vignettes Dorrit Cato Christensen outlines the sequence of events that killed her daughter. It feels like a Drug Traffic Accident happening in slow motion in front of you leaving the reader paralyzed.
This a book for anyone who is a patient, a relative or friend, an advocate or a mental health professional. Its not about some rare event. There is almost certainly a case like this happening every day of the week in every psychiatric unit in the land. Few books make a difference – this one might.
Johanna says
Thanks for this, Annie! If this woman had any “mental illness” at all, it was probably a brief breakdown related to religious upheaval. That was recognized in 19th-century America as one of the Top Five causes of insanity — and one where the “moral treatment” David describes had a pretty good cure rate.
However, Elizabeth Stone was given pills. Forced to take them, actually. I wonder what they were? (The “McLean Asylum” by the way still exists; it is New England’s most prestigious private psychiatric hospital, closely allied with Harvard U.) Here’s an extract from Ms. Stone’s story:
“But it is not the imprisonment or the cruel treatment that I received there that I speak of, for I would have borne that without a murmur. But it is the medicine they gave me that racked and tortured and killed the spirit of Christ within me. It is that spirit that gives a person a hatred to sin, supports them up under any torture … ”
“Again the medicine was brought to me; I told the attendant it was destroying me, hardening my brain, and taking the spirit of Christ from me; she said I must take it. I did not know what to do, I could not help myself; to resist I knew would not do, and yet having partly the spirit of Christ, which is non-resistant, I took it, which increased my distress … This day passed away; the medicine was brought me to take twice a day, pills and a little mug of mixture; what it was I do not know, but I think I could tell the different kinds that I took if I could see them.”
mary says
Thanks for the suggested read Annie. Have downloaded it and am about to start reading now.-.how Saturday nights have changed!!!
Sally Macgregor says
For anyone (Johanna!) interested in the history of the asylums (in the UK) Roy Porter’s ‘Madmen’ is good, but focused on the 18th century – before the Victorians got hold of them. He’s (or was, now dead) a social historian. And a more recent book ‘The Last Asylum’ gives the history of one of the biggest 19th century ones, Friern Barnet in London. The writer, Barbara Taylor (also a historian by training) was there as an inpatient before it closed, and gives a load of interesting history although personally I had to skip the bits about her 25 year therapy with a Harley Street psychoanalyst..they got a tad boring. There’s a great book waiting to be written about the old asylums, all now closed – most have become very posh housing complexes.There was a kind of stirring in the 1960s when a generation of young psychiatrists appointed as Superintendents of those vast old 19th century asylums were trying to open up the doors and improve conditions – but that seemed to come to a grinding halt. (Interestingly they faced the fiercest resistance to their new ideas from the existing staff). And now, here in 2016, we have a situation in which Connor died in circumstances which don’t seem all that different to the abuses of the old madhouses. The only significant change is that if you are in a crisis, however desperate you are there, will be no bed for you anyway – so you’ll probably expire at home. I understand that suicide figures have risen by something like 20% for people under the not-so-tender care of an abhorration known as Hospital at Home. It seems to me that treatment of madness has gone seriously backwards – and yes, Mary, my strong feeling is that we threw the baby out with the bathwater. Failed to keep what was good: respite, reasonably good food, something to do other than smoke, peaceful surroundings
I’m looking forward to the next instalment ….
annie says
I just didn’t get the hostility.
It poured out of the gp’s pores…all the stuff she didn’t write in her medical notes like pull yourself together, no more men, don’t come here looking for sympathy, and on it went like a droning train….
After the tortuous 7 weeks off Paroxetine my head was zapping, my emotional lability was off the wall, crying and sobbing, hyperventilating, extreme nightmares, and all the rest….yes, I needed a hospital; I had expected a general hospital to sort out the physical manifestations of drug poisoning.
But, no, off to the mental hospital I was sent.
The state I was in defies belief, by the time I got there in 25 minutes; I was shaking with fear and trepidation.
It was a Friday.
There was an admissions procedure.
The young Chinese man was rude and unapologetic.
He threw questions at me I couldn’t answer very well.
He got very cross.
His form was not filled in very well.
Then two ladies who strip searched me and took away my two packets of Seroxat which was deeply distressing.
My first thought was I had paid hard cash for two packets, which I couldn’t afford, would I get them back
I got in to the little bed in a large room with lots of beds.
There was one other woman, who was crying and screaming.
I had a bit of company when a young girl came in from a heroin overdose
There didn’t seem to be any staff.
There was no one for me to talk to.
The days passed as I was dispensed Seroxat and Diazepam and I kept asking why isn’t there anybody I can talk to.
Six days later was the day of the rounds on the Wednesday from my consultant psychiatrist.
I left the hospital and drove home in a worse state than when I had arrived
I remember being a staring, zombie, looking at my surroundings.
I didn’t know where I was.
I didn’t know how to behave.
When I arrived in the general hospital three days later on a Sunday, there was no one to talk to.
I kept asking for someone to talk to.
I had left my Seroxat at home.
I was completely beside myself.
An md turned up a couple of days later.
He organised a registrar.
I got the Seroxat back.
I told him quite lucidly the story of Seroxat.
He wrote it all down and sent a copy to the medical practice.
And, then events and things happened that you would find totally unbelievable. I hammered back for 8 years taking on every avenue available to me and the curtains came down.
Seriously diss missed.
So, Elizabeth T. Stone and I got a lot in common. And that for me was probably the light bulb moment when I read it and took on board chiefly the paras that Johanna has highlighted
We can say Seroxat is deadly poisonous, but, in my case it was more the deadly poisonous offhand nature of groups of doctors who all in their individual way managed to depart from human kindness with the savage persecution that only persons who are guilty are capable of…and GlaxoSmithKline putting doctors in decidedly tricky situations is really the Crime of the Century…
It is very important to talk on equal terms even when the terms aren’t equal and this I feel is what Elizabeth T. Stone did in her own words and how it is now progressing through today’s writers…
mary says
Have finished reading ‘Dear Luise’ as recommended by Annie (above). Once I started ,I couldn’t put it down. Very many of us have been on the same journey, but thankfully in our case the tragic ending is missing. From what we know so well, it is easy to believe every word of the story – from the insinuations of being an ‘interfering mother’, through instances of ‘not being listened to’, the ‘increase versus decrease’ in medication levels debate to the ‘we are the experts – who do you think you are trying to tell us how to do our work’ tone of voice – it’s all there and more besides.
It is a difficult read which , I found, opened old wounds – but well worth all of that to marvel at the courage of this mother, not only in standing up to those in authority but also in bringing the ‘real Luise’ across to us in such a caring and selfless way.
Thank you Annie for drawing my attention to this book.