Posts Tagged ‘Unlocking the Asylum’

‘Unlocking the Asylum’ Project- A Case of Unrequited Love

April 17, 2019

Whilst looking recently at one of our patient case books, staff working on the Unlocking the Asylum project came across an interesting diagnosis. Often seen with more prominence amongst the female case notes is what is termed as ‘love affairs’ or ‘love disappointment’.

Ann Beatrice Ward, a private patient, was admitted into the asylum on 9th July 1890 aged 25, diagnosed with mania, the supposed cause of this was recorded as love disappointment. Her case notes reveal that before entering the asylum she was delusional and incoherent of speech, she attempted to burn herself with a candle, and once went wandering the streets at 3am in her nightdress. Upon her assessment at the asylum Doctors wrote that she was:

“full of delusions but they have a direct connection with the most important one being that she is engaged to her Music Teacher, and that their marriage has been ordained in Heaven, and that although he has never proposed to her, she knows it through a particular hymn which she hears at Church”.

Ann’s case file, detailing her behaviour leading up to her admission.

Ann’s case file, detailing her behaviour leading up to her admission.

The case notes go one to provide descriptions of her at intervals during her time at the hospital, in Aug 1890 she is described as lazy and indolent, in November 1890 it is noted that she accused the nurses of all sort of fancied slights and insults, and that she is selfish and self-willed. On 16th Apr 1891 on the orders of her Father she was transferred to Portsmouth Asylum, the case notes stating that none at the asylum regretted the steps he was taking.

What makes this case particularly interesting to look at is that included amongst the case notes is a letter written by Ann herself, so it gives us an opportunity to hear from Ann in her own words. What’s quite unique about this particular letter is a little flower which has been pressed between the pages and has remained there all this time. The letter is written to someone called Johnny L. who we can presume is the gentlemen that Ann believed she was engaged to. In the letter she writes

A letter written by Ann to her music teacher in July 1890, including a pressed flower.

A letter written by Ann to her music teacher in July 1890, including a pressed flower.

“My dear Johnny L. I don’t know what you would do if you were here. I see nothing quite right, if only I were home again, it’s rather sad when you come to think of it, being in an asylum without knowing the reason for what I’m here”.

Ann was discharged from the Portsmouth Asylum on 6th July 1891, unfortunately after this date we have no further information of what happened to her.

Lindsey Sutton

Project Archivist (Unlocking the Asylum)

 

‘Unlocking the Asylum’ project- Patient Files

March 18, 2019

As Project Support Officer for the ‘Unlocking the Asylum’ project, a large part of my work involves the listing and repackaging of approximately 23,000 patient files. These files begin in 1948 (when the NHS was formed), up to the closure of the North Wales Hospital in 1995.

Repackaging

Before a patient file is repackaged, all metal fastenings (treasury tags, pins, staples, paper clips, rubber bands etc.) are removed, and replaced with brass paper clips and plastic treasury tags. Metal fastenings can cause irreversible damage to the files, their removal will prevent future damage. Each file is kept in its original order, however depending on the length of stay and treatment a patient received, a file can be as small as one piece of paper, to a file that can fill 2 boxes. Each individual file is repackaged in archival folders, tied and safely stored in archival boxes.

Listing

Information extracted from the files are listed on a database, detailing the patient number, patient name, date of birth, admission and discharge/death date. The diagnosis (if given) is also listed, along with any additional details such as treatment given, outpatient information, psychiatric social work notes, number of admissions, referral information, notes/poetry/sketches made by the patient and psychiatric reports for court proceedings.

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As the development of medicine progresses quickly during the mid-20th century, there is reference to a wide range of treatments within the files; for instance Insulin Coma treatment, Electro Convulsive Therapy, Leucotomy, Malarial treatment, Aversion therapy, Psychotherapy, and the use of early Anti-depressants such as Largactil and Tofranil are all well documented.

The first Annual Reports of the hospital (1850-1860), list only five ‘forms of disease in all cases admitted’- mania, epilepsy, dementia, melancholia and idiot. In comparison, the database (so far) has over 800 different diagnoses, ranging from acute alcoholism to Wernicke’s encephalopathy. Long term patients’ diagnosis’s also evolved, one example is of a patient admitted in 1949 with Manic depressive psychosis, who was discharged from the hospital 45 years later in 1994, with a diagnosis of Bipolar disorder.

Metal Fastenings removed from patient files during February 2019

Metal Fastenings removed from patient files during February 2019

The most common and most frequent treatment used during the 1950s to the 1970s, was ECT (Electroconvulsive therapy), however its reputation made many people consider it more of a punishment than a treatment. Despite this, it is evident from listing the patient files, that ECT was still used at the hospital up until its closure in 1995. ECT is in fact a therapy that is still used today, psychiatrists and patients still consider it to be a safe and effective treatment for severe depression and bipolar disorder. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anaesthesia to avoid pain from the electricity.

As a result of the Abortion Act of 1968, there is a marked increase of patient files containing referral for psychiatric assessment in the late 60’s early 70’s. It was now possible to obtain an abortion under the NHS if a psychiatrist was prepared to sign a recommendation that proceeding with the pregnancy could damage the patient’s mental health.

In addition during this time, Psychiatrists were required to produce reports for the justice system, with needs to respond to probation officers and legal officers in providing evidence for court reports. However psychiatric reports were not only needed for criminal cases, but also for divorce proceedings, Court of Protection applications and claims for industrial injury and road collisions, as the compensation industry was established and was rapidly expanding.

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Of the 22,800 files listed 8,015 were outpatients or referred to outpatients upon their discharge from the hospital. The work of the outpatient clinics expanded rapidly in the immediate post war years, in 1947 the medical superintendent said he regarded the outpatient clinics as the most fundamental service provided by the hospital. By the end of the 1950’s the hospital ran outpatient sessions in Rhyl, Bangor, Wrexham and Dolgellau. Several of the files include notes by the psychiatric social worker, who supported the outpatient clinics by spending time investigating the home environment of patients. The social worker evidently had a valuable role to play in the after care of the patient, ensuring a smooth re-entrance into family, occupational and community life.

Very notably during the late 70’s into the early 80’s that there is a sharp spike in those admitted for drug addiction and alcoholism. The admission of a growing number of patients with drug related problems had implications on hospital management. The needs of these patients were very different, some of them, usually quite young, could be disruptive, particularly to the already established routines on the wards. By the late 80’s so high was the demand for rehabilitation, the hospital had its own drug and alcohol unit for treatment and recovery of patients diagnosed with addiction.

These files clearly contain a wealth of information, and there is so much more to be discovered in relation to medical advances and social trends in the mid to late 20th century. Please note that due to NHS regulations records of patients containing sensitive personal information are closed to the public for 100 years. These records may be available to researchers who belong to an academic institution upon request. If you are interested in using the North Wales Hospital collection for academic research please contact us.

Rhian Evans- Project Support Officer ‘Unlocking the Asylum’