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Presumed curable
  1. P Tyrer

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    By Colin Gale & Robert Howard. Wrightson Biomedical Publishing Ltd, Petersfield, 2003, £14.50, pp 128. ISBN 1-871816-48-3

    After 38 years as a clinical psychiatrist I still find a good description of a psychiatric patient a revelatory experience because the richness of psychopathology will always exceed the ability of any classification system to condense it into easy categories. What has surprised me is that this fascination does not seem to extend to many of my lay colleagues, even though I have argued with them sometime that the description of mental health problems is much more amusing and interesting than the more popular equivalents such as James Herriot’s account of practising as a vet in the Yorkshire Dales. There are several problems in writing about psychiatric patients, two of which are often insuperable to honest publication; the ethical issue of confidentiality—full disclosure is seldom approved and many accounts are bowdlerised—and ambivalence about the way, in descriptions, that patients are perceived. At its worst this ambivalence can be expressed as schadenfreude, the experience of pleasure at other peoples misfortunes, which clearly belittles the experience of mental illness. This book escapes these problems, firstly by writing about patients who were admitted to the Bethlem Hospital in the late Victorian period (although their descendants may be concerned that rather too much is being disclosed) and, secondly, avoided by a frank and objective commentary to what are, in effect, the patients’ own stories.

    All of them were admitted to Bethlem Hospital between 1880 and 1900 and the title of the book comes from the regulations of the hospital between 1867 and 1906, indicating that “all persons of unsound mind, presumed to be curable” were eligible for admission. What is abundantly clear from this account is that Bethlem was not a Victorian snake pit or workhouse. The high spot of the month was the patient’s ball, which was highly regarded by not only those in Bethlem but outside as well. A cartoon appeared in the Punch magazine in 1882 in which a young man of high social standing is boasting to a young lady that he is going to the patient’s ball at Bedlam next week. When she expresses concern that he might be detained he responds “don’t worry, they only take in the curable cases”. However, the accounts of the 60 patients in this book, each with their own photograph (several taken by that polymath Francis Galton in his eugenics phase), indicate that a large proportion were “discharged uncured” to private or public asylums. Each account included a description of form of admission, often with quotations from relevant doctors’ letters, and a brief summary of the outcome. In between there is a great deal that describes the patients’ own experiences and feelings. All these have been set forth extremely sensitively by the editors and I consider the outcome to be an outstanding piece of mini-biography, which encapsulates the essence of (largely) people with psychosis, with little or no insight, angrily but ineffectually taking on people whom they considered to be their oppressors. Thus, we read of William Chark, attempting to obtain his discharge by refonning the Lunacy Act, of Walter who complained fonnally to the position superintendents that “you have systematically and fraudulently ruined my social and commercial position” but was still able to “forget himself at dances and noticed to be taking ladies round the waist with both hands”, and William who took a particular dislike to Dr Savage, Bethlem’s Physician Superintendent (later be one of Virginia Woolf’s medical attendants, and therefore mercilessly dissected in her writings), by writing a poem to him which remained in his case notes, it illustrates that although our Victorian patients may have been ignored more than their equivalents today they were still just as vocal, and at times it is hard to believe that we are not reading about today’s patients.

    This book is a great read for all involved in mental healthcare. It makes us aware of the enmity we engender whenever we use our powers of detention. Part of William’s ode to Dr Savage is an apt reminder:

    “Dear Doctor,
 When the trumpet sounds,
 And God proclaims the judgement day,
 You’ll try I know to be at least,
 Some 50 miles or more away,
 ‘Twill be of no use no tree no bush,
 Will hide you from God’s searching eye,
 With other savages you’ll have
 To toddle up your luck to try”.

    And Virginia was yet to come.

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