The Last Asylum: A Memoir of Madness in Our Times 
by Barbara Taylor.
Hamish Hamilton, 296 pp., £18.99, February 2014, 978 0 241 14509 8
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‘Madness is a childish thing,’ Barbara Taylor writes in The Last Asylum, a memoir of her two decades as a mental patient. The book records her breakdown, her 21-year-long analysis, her periods as an inmate at Friern Mental Hospital in North London, and in addition provides a condensed history of the treatment of mental illness and the institutions associated with it. Taylor was in the bin during the final days of the old Victorian asylums, before they were shut down in the 1990s, and their patients scattered to the cold liberty of the underfunded, overlooked region of rented accommodation or life on the street known as ‘community care’. Loony-bins. ‘Bins’, we called them for short, as Taylor does, just as we called mental illness ‘madness’ and ‘being crazy’. We recall our secret stashes of meds we’d only pretended to swallow and were keeping in bulk for a rainier day, and reminisce together about the time we tipped too far into our roles and were held down by half a dozen nurses while another injected us with a major tranquilliser. (‘Haloperidol?’ ‘No, chlorpromazine. The first time, anyway.’ Comparative demerits then explored.) In public the conversation has the same steely glint of challenge in one direction and moue of camaraderie in the other that you sometimes see when Jews tell stomach-curdling Jewish jokes, while the uncircumcised grope in their bag of possible socialised reactions for a way to respond.

I say ‘we’, because reading The Last Asylum was an uncanny experience for me. I spent inmate time in several asylums, mostly in the late 1960s, long before Barbara Taylor’s breakdown (although we are of a similar age), later in Friern itself, only a few years before her various stays there, and also in the controversial ‘patient-run’ Paddington Day Hospital, mentioned by Taylor as the model for the Pine Street Day Centre that she attended, both of which were closed down as a result of the fear they aroused in the authorities. (I decided, after several conversations with professionals about those times, that when talking about institutions you can distinguish between inmates and staff because the former were ‘in’ them while the latter worked ‘at’ them.) As I read, I saw myself flitting through the pages of Taylor’s account like a precursor-ghost, or perhaps more a tetchy sprite, engaged in a debate with her text, ticking off the similarities between her experience and mine and weighing up the differences. Once I bumped into my own name and a description from my first novel of a ward round I suffered during my own very brief stay at Friern, which I fled to evade the threatened sectioning that would have allowed them to put me under lock and key and submit me to the treatment of their choice. (‘Mm, lobotomy or ECT, it’s a toss-up … ’) I thought it a mistake to miss out the most objectionable thing about that experience of twenty or so suited doctors and social workers sitting in a circle interrogating me: on the coffee table in the centre of the circle, the open gold cake box with a half-finished cream gâteau inside that no one thought to offer me.

This, then, is not even a pretence at a neutral, objective review. On the contrary, I was struck by the thought that rather than a professional, or even adult reading, I was grabbing a miniature shadow-analysis for myself. I observed my responses to Taylor’s suffering (competitive), her experiences (comparative) and her analyst’s heroically determined interaction with her (part impatience, part envy), and found them looking more and more like the transference and counter-transference that analysts and analysands speak of with such awe. At any rate, the Poet said he’d never seen me so exercised about a book I was reviewing when he got back from work to find me spluttering, ‘I should have been MUCH madder than I was. I haven’t been NEARLY mad enough.’ (‘Probably not. A bit late now, eh?’ he said, hopefully.) ‘She describes what the worst of her anguish feels like, but it’s what I feel like every hour of every day. I need an analysis, five days a week for 21 years or the rest of my life, AT LEAST, whichever is longer.’ (‘You can’t afford it, and I’m about to retire,’ he said.) ‘And I want to be LOOKED AFTER by a coterie of close, concerned friends.’ (‘What friends? You haven’t got any.’) ‘And phone my shrink in the middle of the night and when he’s on holiday demanding that he help me.’ (‘You don’t much like being dependent.’) ‘But I SHOULD have been! I’ve been cheated out of a proper madness.’ Then, as if my fifty minutes were up, I heard myself, the supposedly detached reviewer, me-me-me-ing, furious and wounded, deprived, jealous and greedy. It was quite startling. When I came across that sentence, ‘Madness is a childish thing,’ I thought of H, from my nine months in the Maudsley at the end of the 1960s, with whom I still argue about which of us was really mad or maddest when we were best friends in the bin. ‘You were really mad, I was just, you know, angry.’ ‘No, you were much madder than I was. I just couldn’t express myself. Actually, you still are madder.’ It’s never quite clear whether my claim (or hers) to be the saner is a statement of superiority or a confession of failure. It comes back to me vividly that part of being mad, as I understood it, was that you never felt mad enough or properly mad, compared to others who were genuinely suffering. Or you suspected that you were probably only acting mad, while the others were actually mad, and felt extreme guilt as a result; an impostor, and a loser in the anguish stakes. Others have told me it was the same for them.

As ever, living, reading and thinking around the subject, I return to the complete mystery of why some people are knocked flat and incapable by what seem like only the mildest of dysfunctional backgrounds, compared to others whose childhoods were devastated by cruelty and deprivation, let alone those who grow up with famine and war, yet seem to find a way to live their lives as if they were their own. And all that space in between the extremes of near harmlessness and full-blown misery: the whole regular family muddle and mess that everyone has to survive, or not. Like physical pain, which each individual is asked to assess on their own scale of one to ten, how much hurt you have received and how devastating it has been for you is too subjective to bear much comparison. I try not even to imagine the possibility of spending a crazed lifetime not just debating the one and ten of both kinds of pain against others’ assessments, but forever redefining the four, five and six. Whatever hurts you hurts, and however damaged you’ve been is how damaged you are. Yet despite my intermittent insight into my crooked reading of her book, it was impossible to get through Taylor’s singular and carefully structured account of her personal anguish and where it took her, without my childish, intrusive self chattering a comparative commentary. As with my own experience of psychotherapy, and life in general, self-knowledge on its own doesn’t seem to change anything very much.

Taylor describes herself when she was at her most ill as totally panic-stricken, unable to tolerate being herself. Being intolerable to oneself is a feeling I know, one that seems almost impossible to convey effectively. You try this way and that to write it, or describe it, but always fail to do more than point at the name of the experience. Perhaps in an attempt to get closer to the physical and emotional reality of it, Taylor intersperses her chronological narrative with notes or recollections of sessions with her analyst, V, whom she saw at his consulting room five days a week, before, throughout and after her periods in hospital. On one of these worst of times, she lies on the couch, with V sitting behind her in the prescribed way, desperate to convey her feelings and to get V to do something to help her:

What am I going to do? I can’t live like this; I can’t be me any more; I can’t be like this, I can’t survive outside hospital! … Where are you? Where are you? Oh, what am I going to do? I can’t live like this … I CANNOT FEEL LIKE THIS! It is impossible to feel these things and live! Who will help me? I want to die! Where are you? Do something for me!

The condition Taylor speaks from is familiar, and is the most terrible condition on earth, for all one’s awareness, even at the time, of what in all conscience appears to be the much greater real-world sufferings of the poor and oppressed. Her analyst lets Taylor know that he recognises the degree of her desperation: ‘“The worst feeling in the world” was how V described this naked defencelessness to me. “People will do almost anything to avoid feeling it.”’ She speaks of her ‘stranded, homeless’ feelings: ‘Homeless feelings are boundless; they sweep all before them.’

This hopeless, helpless narrative is one I recognise very well. It runs on and on in me, like a mantra, unvoiced much of the time, in dreams and anxieties or simple visceral feeling, and has done for as long as I can remember. Sometimes, in my madder (saner?) moments, I’ve spoken it out loud, as Taylor does, demanding help, unreasonably because I know all the while that the help I want isn’t available for the asking, or even there to be given, since I don’t know what it is that could help, and I’m pretty sure that no one, psychoanalyst or psychiatrist, GP, lover or best friend, knows either, beyond their professional or humane conviction that talk and interpretation, medication or a cuddle will allow you to get an insight or a rest. It’s the knowing you won’t get help however urgently you want it that ratchets the feeling up into madness, a spiral that runs out of control. It is not that ghastly notion of the ‘inner child’ we hear so much of, but Taylor’s ‘madness-is-childish’ that speaks, howls this stuff, while the despair, non-mad-non-child, knows no one can possibly ever care enough or do enough, however much they want to, even though it’s their job and you pay them, or they love you for some reason, or simply would do anything to get some respite from your demands. The despair comes from knowing that no one is going to help, that only finding some way of getting on with it is going to help, and getting on with it is the very last thing you are capable of. Except that you have to. But you can’t. (See Beckett, if you will.) There’s nothing moral about it, it’s just the adamantine way of the world. In such a state, and I would say, such a near truthful state, the reason anyone gets to this ten of interior suffering isn’t really the thing that needs most urgently to be dealt with, yet it is precisely the job of psychoanalysis to investigate just that.

Taylor was brought up in Canada in the 1950s by self-involved, actively socialist parents. She was and still is a respected academic historian of radical movements and feminism from the 18th to the 21st century. How she got any work done or proceeded in her career is baffling. For two decades she battled intolerable feelings of rage and deprivation, as well as punishing nightmares, and used drink, drugs and sex copiously in her attempts to escape it all. She acknowledges that she was surrounded by devoted friends and feminist comrades who looked after her, helped her, kept her alive. In addition, all through her hospitalisation and her worst moments of self-loathing, she managed to visit V five days a week. Which is to say that she had some fundamental optimism that she could be helped by psychoanalysis. It isn’t clear whether the pain from her childhood that she investigates in her analysis is the result of thoughtlessness or actual cruelty on the part of her parents. She was looked after by nannies from the local unmarried mothers’ home, all of whom had just given up their babies for adoption. Their silent grief, which must have suffused the house, was never acknowledged or discussed by her mother: ‘And why not give a girl, who has just lost her child, responsibility for your own little ones?’ The young women came and went, giving Taylor much to grieve about too, their losses and hers. It emerges through the book, and the analysis, that her parents were intellectuals and writers manqué. Taylor felt the pressure on her to win prizes, to be a writer – which is apparently what all thinking and politically active people aspire to and require from their children. She recalls moments of aggression from her father and too much intimacy in the way his hand touched or brushed against her as an adolescent; he was openly a philanderer, which caused third parties to appear in the house, father’s and mother’s lovers, their role also not spoken about. Her mother, she recognises, was self-centred and disappointed, and disappointed too in her daughter who wasn’t the genius her parents required, and wasn’t wanted in their dramatic romance and political activism. She comes to realise that she was imperfectly loved and cared for. She developed tics and compulsions. She tried to fill up the void with eating, drinking, sex and drugs. ‘I am starving. Nothing I put into me satisfies me. I could devour the world, but I chew myself (my nails, my hair) instead. When I eat, I keep on eating. There is no repletion, no stopping point.’

V does what analysts do and offers his patient interpretations that relate to their immediate situation in the consulting room and repeat the past the analysand is stuck in:

I think you want to feel fed. But you are afraid.


Yes, fed. Full, satisfied.

(Long silence) Why afraid?

Because if I ever find out that you feel fed by me, I will make you suffer for it … You believe that I would stop doing whatever I had done that satisfied you. That’s what you think would happen … Stop analysing you, stop feeding you, stop seeing you … That would be your punishment for feeling well fed by me.

At this point in the therapy I’ve had I’ve always muttered something like ‘You, you, you. This isn’t about you … Yes, I know my hunger is about more than being hungry! And?’ and refused to get aboard the interpretation train to a place where I might perhaps fully grasp my situation and … feel better. (The gap between understanding my situation and feeling better is precisely what has always fed my distrust of the analytical situation.) Taylor is more compliant, more able to take or get what is offered and use it. Is it that essential optimism which helped to keep her on the couch? And what is that optimism: just what you’ve got or haven’t got? She does get angry and argues at first and then takes time to see the truth of the interpretation. To me those 21 years, five days a week seem such a very long time to take to get the point where you see that imperfect love in childhood makes you forever dissatisfied and distrustful, or that eating too much is about being emotionally unfulfilled, but then I am a thoroughly failed analysand, and she is quite clear that she wouldn’t have survived without V’s commitment to taking her through her compulsions and terrors in the way he does.

Much of her madness is expressed through self-hating, vicious and violent nightmares. She brings her dreams to the consulting room and V urges her towards interpretation. A washing compulsion that goes back to childhood and returns in her dreams, contains, he suggests and she concurs, a knowledge of her father’s open philanderings, his chasing away of a nanny, a knowledge ‘so deeply hidden that it took almost a decade of psychoanalysis to disinter it, its presence marked only by its filthy seepage into my dreams and on to my disgustingly filthy face’. Her obsession with dirt is the subject of a later conversation with V. Perhaps she has filthy thoughts, he suggests. ‘The sort that you feel on your face. On your dirty face.’ ‘My dirty face … why my face?’ ‘I don’t know. Dirty looks?’ Taylor queries this. V replies: ‘Your mother’s looks? The way your mother looked at you when you were a baby?’ What are you asking me? Taylor demands. ‘I’m not asking you, I’m making a suggestion. I’m suggesting that your mother might have given you dirty looks; looks that made you feel dirty … When you were tiny, when she was feeding you. She found it difficult feeding you … it upset her. She gave you dirty looks.’How do you know such things??’ Taylor replies. ‘You don’t know such things!’ ‘Of course I don’t know such things! (Deep sigh) I’m suggesting this as a possibility; that she was disturbed and distressed, and that you felt this, and it disturbed you very much.’

Again, madness-is-childish me stamps her foot and starts to look sullen. So here we all are, none of us able to have the faintest idea what her mother’s face looked like when she was breastfeeding, so there’s no right or wrong, only an interpretation of a dream, which, apparently, will do. It’s just a story (one among several, dozens possibly) that neatly accounts for the dream image and which is acceptable to Taylor. This is, I suppose, how analysis works, not so much by digging into and revealing the truth about the past, but finding good enough interpretations of the past in the present to provide a satisfying explanation. We all, in analysis, writing or simply chatting to each other, tell our stories according to, or so that they add up to, our neuroses or psychoses. It isn’t lying. It’s teleology. But I never get past the ‘How the hell do you know?’ stage. Meaning, what if it’s wrong? Or perhaps worse, what if it’s right? So what? And? So I’m suffering from my mother’s lack of love for me. I know! What shall I do about it? What is there to do about it? I’ve never read an account of an analysis that really describes in any detail where or how the analysand goes from there, whether it’s strictly speaking true or a good enough analogy for what the patient is experiencing. I still don’t see how a satisfying explanation alters the fact of the felt lack or deprivation and the subsequent depleted behaviour in the world. You are still and always will be deprived of that notional love and safety you were supposed to have in order to be a balanced person. Anyway, don’t we all know by now that we’re none of us sufficiently or properly loved, one way or another? So why am I or is she or he in such a state about it? And what exactly is to be done? It isn’t clear in Taylor’s account either how exactly the analysis worked, although she uses the word ‘cure’, indeed it’s a chapter heading. It worked for her; there’s nothing more Taylor’s book is claiming for analysis. There aren’t three of us in this telling of an analysis. My perplexity is my own.

What I completely recognise are Taylor’s descriptions of the bin, her stays in Friern and her time at the Pine Street Day Centre and halfway houses. In her potted history of the asylum in general and Friern in particular, she describes the late 18th-century movement to reimagine the mad: places with decent optimistic conditions of airiness and light were built to house them and they were recast from Calibans to patients to be treated with rationality and humanity. Then, with a loss of interest in weakness and need, and the collapse of the idea of progress, the monumental asylums became monstrous institutions, dilapidated, overcrowded, with back wards inhabited for decades by neglected, tormented patients, the broken-down state of the fabric echoing the casual brutality of many of the staff and very little in the way of therapy apart from the chemical cosh. When Taylor got to Friern Hospital, the apotheosis of the Victorian asylum, it was already slated for closure. It knew it was dying and had been the subject of public scandals in the late 1960s and the 1970s when patient coercion and abuse were revealed to have been regular occurrences. Taylor got there three years after I’d been for my overnight trip. I remember the famous corridor she describes, the longest madhouse corridor in the country. (I only got halfway down it before I found a linen cupboard with a window to hide in.) Some of the patients who walked up and down its length, very slowly – there were no collisions – looked as if they had been doing it and getting nowhere without anyone noticing for many years.

The other side of all that is the warmth and camaraderie of the bin, which Taylor describes so well. It was a place, she says, where people looked out for each other, and often knew each other’s needs better than the staff. In the Maudsley, we played a game after lights out in which we held a nightly ‘staff meeting’, voices in the dark as we lay in bed, assessing the progress of our experimental treatment of staff who we pretended were patients pretending to be staff. How well had they done that day, what setbacks had we noticed, should we alter our pretend-patient behaviour to improve their treatment? It was a kind of joking, knowing inmate conversation you only find in 24-hour institutions. Taylor describes nurses coming to patients to ask them to help out with someone in a crisis. I remember that, too. People protected each other, for the most part, and laughed a lot in a spirit of embattled camaraderie. It’s the only time I’ve experienced such a powerful feeling of community, however fraught and fragile our relationships might have been. Taylor confirms this without neglecting the other truth: that being an inmate could also be scary, chaotic and threatening. She describes times when

I was too paralysed by pain to reach out to anyone yet could not stand to be alone. So I would join the smokers in the dayroom, placing myself next to Magda if she were there. Magda would glance over at me and sit on quietly; once she took my hand.

Soppy, maybe, but it really was like that sometimes. But I also remember being told to ‘be quiet. You’re only a patient, keep your place’ when I remonstrated with a nurse who was pushing a dementia patient into a chair though the patient was doing nothing more than wander round the room holding out a rolled newspaper to everyone she passed. Sometimes we were babes in the wood, sometimes vile school-kids plotting mayhem. It was never boring. And if you were having a bad time, you could have it. Everyone knew why you were there.

This advocacy of asylum is a crucial part of Taylor’s book. Friern was shut down in 1993. The Paddington Day Hospital and the Pine Street Day Centre were closed too. They had been places where people could spend all day; in Paddington they could do intensive day-long group therapy; in all of them they could work together or alone on projects, stare, do nothing, feel they were in a safe space, with the physical warmth of other human beings around, and though the fights and dramas were plentiful, they happened in a peopled world that tolerated you. All those places, all the old institutions disappeared; it was the great triumph of Thatcherite libertarianism. Instead, general hospitals have emergency psychiatric wards, with a limited number of beds and as fast a turnover of patients as anti-psychotic drugs can sustain. Then, you’re on your own with the pills, and the underfunded, understaffed, sometimes mythical care in the community. Taylor makes the case that what we lost was not just the institutions, which had their problems, though with a will (admittedly unlikely) these might have been solved; we lost our asylums, and (not only in the realm of madness) with them the essential idea of asylum: a place society provided where one could go when overwhelmed by the terrible ‘stranded, homeless feelings’ that V described as ‘the worst feelings in the world’. Taylor points out that they were hardly luxurious by the time of her and my visits; grim, stony places, cracked and falling apart. But they contained. They held out the promise of containment, given the goodwill and understanding of those who ran and paid for them – essentially ourselves when we are feeling better. You could get relief from feeling socially obligated and guilty, because you were finally in a place that knew what you were and how you were, even if it couldn’t do much about it. Sometimes you need to bury yourself, to be enabled to sit the worst out without the world pulling at you, asking you what the matter is, or reminding you of the things you should but can’t be doing. It sounds like an almost absurd expectation in the current austerity/hardworking family rhetoric. But providing places of safety to people who are ill might not be economic madness. William Tuke and Philippe Pinel instigated ‘moral treatment’ at the Retreat and the Salpêtrière, believing that once they’d freed the mad from shackles, cruelty and isolation there was a possibility of alleviating suffering, even bringing about an improvement. Their liberalism may well have been theoretically at the service of repressive Foucauldian power, protecting the status quo, but in practice they offered some chance of treating people decently and giving them a space to exist when they feel they can’t. When in the 20th century, the libertarian anti-psychiatrists and the Thatcher/Reaganite libertarians had their strange meeting of minds, and set out to deconstruct mental illness and its institutions, they disregarded, deliberately or ignorantly, the often implacable suffering of individuals, and the need for places of safety. They shouldn’t really be so hard to provide, given the will. Taylor’s bins and day centres and mine were not the Priory, comfortable asylums for the rich or those with medical insurance, but shabby, run-down places providing asylum on a low budget for people who for a while or even permanently, couldn’t get on out in the world. It’s obvious that someone lying on the ground with a broken leg can’t walk, so no one expects them to get up and pop into A&E to get it set, and then get on with their business, but it seems it is much harder for many to believe in the physical anguish, debilitations and incapacitations of mental illness, and see the need to offer relief.

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Vol. 36 No. 5 · 6 March 2014

Jenny Diski speaks of her experience with mental illness, along with the catastrophe that has enveloped mental health patients since the 1980s (LRB, 6 February). It’s her celebration of the subversive camaraderie of fellow sufferers that I most identify with. I well remember sitting beside a new arrival in our day room, a fellow manic depressive who was beginning to slide out of his garrulous state (dressed as Batman, he had jumped through the front window of a bank), when a nurse placed a pint of haloperidol in front of him before offering a sherry glass full to me. We looked at each other and burst out laughing, though, as it turned out, we were both lambs to the slaughter. Six hours later I was being rushed to emergency, all but comatose, head frozen skyward with my tongue lolling out – a savage reaction to the drug.

I never experienced medication as anything other than a chemical version of the physical restraints of previous regimes. Yet the drugs did have the major effect of acting as a spur to fight the affliction through willpower alone. After eight years and four further hospitalisations, I developed an effective management regime. Still, I count myself lucky that my recovery was sandwiched into that brief spring between the late 1960s and the 1980s. The collusion between laissez-faire economics and laissez-faire psychiatry is well eviscerated by Diski. It was a worldwide affliction. One crazed New Zealand psychiatrist announced that he could cure schizophrenia overnight by closing all the asylums. A wacko in normal times, he published in reputable journals and gained the ear of the minister of health. And so she did close them, and overnight too. It made perfect economic sense.

I was working as a patient advocate through these desolate times and was witness to a long string of health establishment obscenities: long-term, seriously disabled patients bused into apartment blocks en masse without preparation or warning; patients systematically defrauded by their new landlords; patients selling their meds, then being punished by having a further week’s meds withheld; 32 patients listed as having died in the first year (but none under suspicious circumstances); patients deliberately committing crimes to get themselves placed in custody so they would no longer be a burden on their families; patients with ungovernable sexual impulses desperately trying to get themselves admitted to hospital and being turned away by doctors who refused to see them, with the inevitable results; patients killing their own families on being released into their care. This is a stench I can’t get rid of.

Derek Schulz
Raumati Beach, New Zealand

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