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Restraint to Recovery: Asylum to Acceptance


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A "work in progress" presentation relating to the Baillie Henderson Hospital from 1890 to the present day in the context of understanding of mental illness, its historical origins and social factors surrounding it.

Published in: Health & Medicine, Spiritual
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Restraint to Recovery: Asylum to Acceptance

  2. 2. First records of the notion of ‘lunacy’. The notion of lunacy (mental disease or illness) seems to have first surfaced in about the 12th Century The Catholic Encyclopaedia gives a date of around 1100 for “an asylum exclusively for sufferers from mental diseases at Mets” (Metz, Northern France) King Henry II established Newgate Prison in 1188 into which both criminals and ‘lunatics’ were incarcerated
  3. 3. Notions of lunacy - continued 1284 – Al-Mansuri Hospital opened in Cairo and had music therapy for its mental patients. 1292 – “A lunatic who had burned a man’s house down was convicted by the justice but released on their authority.” 1295 – A legal case linked “the instigation of the devil” and being “frantic” and “mad”.
  4. 4. 14th Century – Establishment of asylums 1310 – A German ‘madhouse’ is mentioned at Elbing, near Danzig. 1377 – St Mary of Bethlehem priory was confiscated by King Edward III and used for lunatics from 1377. 1405 – A Royal Commission investigates the state of lunatics confined at Bethlem Hospital, London.
  5. 5. Spain – ‘the cradle of humane psychiatry’ 1409 – Spain – Asylums at Valencia, Sargossa, Seville, Valladolid, Palma Mallorca, Toledo and Granada. These institutions removed chains and used games, occupation, entertainment, diet and hygiene to treat inmates – As a result, Spain has been described as the cradle of humane psychiatry.
  6. 6. 16th Century – ‘psychiatric revolution’ Several writers refer to the Sixteenth Century as a time of “the first psychiatric revolution” - The reasoning behind this seems to be based on the work of several 16th Century writers who offered a natural alternative to ideas of demonic possession. 1567 – Paracelsus published a small book whose title in English translation is “Diseases which lead to a loss of reason”. The introduction makes it clear that these are not caused by spirits but are natural diseases.
  7. 7. Bedlam 1559 – Bedlam is shown on the earliest surviving map of London – a copper plate engraving of Moorfields, discovered in 1962 and now in the London Museum.- The map was probably drawn in 1558 by the Dutch artist Anthonis van den Wyngaerrde and engraved by Franciscus Hogenberg in 1559- 1592 – An account of a trial for conspiracy to kill the King contains discussion and definitions of terms applying to the various ‘degrees’ of insanity, such as ‘furor’, ‘delirium’ and ‘dementia’.
  8. 8. 17th Century - Incarceration Michael Foucault suggests that the ‘magnificent developments of psychiatry’ made in the 16th Century were largely replaced in the 17th Century by absolutist governments that resolved social crisis by incarcerating the poor. 1598 & 1601 – The Elizabethan ‘Poor Law’ Act required every parish to appoint overseers of the poor and set up work-houses for those who could not support themselves
  9. 9. Life in the 17th Century Asylum 1628 - Robert Burton’s: The Anatomy of melancholy. What is its,, with all the kinds, causes, symptoms and prognostics and several cures of it .. Philosophically, Medicinally, Historically opened and cut up. was published. The book contained a ten picture engraving which was explained in a verse in the 1632 edition. The verse for the engraving of the maniac is:
  10. 10. Robert Burton’s “The maniac”But see the Madman range downright With furious looks, a ghastly sightNaked In chains bound doth he lie, And roars amain, he knows not why.Observe him; for as in a glass, Thine angry portraiture it was.His picture keep still in thy presence; ‘Twixt him and thee, there’s no difference.
  11. 11. Religion and lunacy 1611 – The Authorised (King James) Version of the Bible had been published. The Bible was a major source and influence on ideas of just about everything in the 17th Century. On the basis of the Bible it was possible to calculate that something spectacular was likely to happen in the 1650’s, eg. It was could be calculated that the great flood took place 1656 years after creation – so 1656 years after the birth of Christ might be equally significant. Creation was then put at 4004 and the flood in 2349. 4004-2349 =1656
  12. 12. Religion and lunacy - continued The execution of the English king in 1649 was therefore woven into speculation that Christ was due to return and establish his kingdom. This sort of thinking was behind the rapture of the Quakers and the armed uprising (to bring about his kingdom) of the 5th Monarchy Men in 1661 In October 1656, James Nayler (a Quaker) entered Bristol on a donkey claiming to be Jesus Christ. He was imprisoned until 1659. Such conflict as this was to continue for around a century.
  13. 13. Pay to view insanity 1665 – The Great Plague caused more than 1000 Londoners a week to die and it also reached many provincial towns. 1666 – The Great Fire of London raged for 5 days. 1676 – After the Great Fire, a new Bethlem Hospital was built and opened in Moorfields. In 1705 it held 130 patients. – The new Bethlem was built as a place of display and tourists could pay to see the humans who were incarcerated in the place, often naked and in distress.
  14. 14. Late 17th Century The earliest records of private madhouses in England stem from 1670. 1679 – Habeas Corpus Act was passed 1696 – Bristol Poor Act established a workhouse for 100 boys. The addition of “infants, the aged, infirm, and lunatics” around 1700, changed its character and it became St Peter’s Hospital. In the 18th Century ir had lunatic wards, in the 19th it became an asylum
  15. 15. 18th Century – Psychiatry as Science It is argued that psychiatry became an independent science in the 18th Century – not because of developments in medicine but rather due to the philosophy of enlightenment which existed at the time. Reason was seen as the highest good for philosophers and so “possession of evil spirits” was regarded as superstition and it and the connection with religion was replaced by the argument that the mentally ill had “lost their reason”.
  16. 16. 18th Century - Asylums The first asylums were small and run privately. The best known and largest was Bedlam (Bethlem) in London. It had 130 patients in 1704 1714 – Vagrancy Act is thought to hae been the first English statute to specifically provide for the detention of lunatics 1723 – Guys Hospital opened lunatic wards Charitable asylums were opened in the 18th Century in 8 English towns.
  17. 17. Regulation 1744 – Vagrancy Act – Several naval hospitals were built, including those at Gosport (Haslar), Plymouth and Chatham. Haslar became the main lunatic asylum for the navy. 1774 Madhouse Act – based on a recommendation that, “the present state of private madhouses in this kingdom requires the interposition of the legislature. After 1774, private madhouses had to have a licence and inspection was introduced
  18. 18. 18th to 19th Century Influences 1777 – York Asylum opened 1789 – The French Revolution – Resulted in inmates of madhouses being examined and either set at liberty or “cared for in hospitals indicated for that purpose”. By 1800 there were around 40 private madhouses in England.
  19. 19. 19th Century 1800 – Criminal Lunatics Act – aimed at the safe custody of criminal lunatics, especially any that had threatened the king 1808 – County Asylums Act – this was triggered by fear generated by the long term detention of lunatics after the 1800 Act following John Hadfield’s attempt to shoot George III 1847 - John Connolly published: The Construction and Government of Lunatic Asylums which was to become a standard for asylum building in the 19th Century
  20. 20. The British Colonial Influence In Britain in 1888 asylums became the responsibility of County and County Borough Councils and many improvements resulted The British 1890 Lunacy Act was a major consolidating Act that remained the core of English and Welsh Lunacy Legislation until it was repealed by the 1959 Mental Health Act With emigration of doctors and humanitarians from Britain, new ideas, attitudes and manner of treatment were brought to Australia
  21. 21. 1890 Social Climate – At the end of the 19th Century the failure of asylum therapy had convinced people that insanity was largely (though not entirely) incurable. In the 19th Century nearly 10% of patients died within 3 months of admission from advanced symptoms of cerebral disease causing mental symptoms initially. By the end of the 19th Century there were 74000 people in public asylums in England
  22. 22. Baillie Henderson Highlight Events 1887 - James Renwick began construction of the ‘Lunatic Asylum’. The contract price was £28,775. 1890 - First patients arrived from Woogaroo to what was then the Willowburn Lunatic Asylum – 10 women on 17 May 1890 1902 - 4 Wards in operation 1909 - Golf course built after Home Secretary gives permission
  23. 23. 1910 – 1940 Major Expansion 1910 - Compulsory nurse training introduced 1910 – 1920 - Expansion with building of Ray House Ward 1; Jofre House Ward A; Rush House Ward B; New pump house; Tredgold; James House; Hill House; and various residences 1930 - Nurses quarters built 1932 – 1944 - Various residences and boiler house built
  24. 24. 1948 - 1968 1948 - Sewing room (Bootmaker’s workshop) built 1949 - 8 hour working day introduced 1950 - Patient numbers reach 1400 1953 – Name changed to Toowoomba Mental Hospital 1961 - Gowrie Hall complex built 1966 -1968 - Laundry built
  25. 25. Name change – Baillie Henderson Hospital 1968 (August 27th) - Hospital renamed as Baillie Henderson Hospital 1968 – 1970 - Canteen built 1970 - Rockville Training Centre transferred to Baillie Henderson 1972 - Nursing administration cafeteria built 1973 - Outpatient clinic established at Toowoomba Base Hospital
  26. 26. De-institutionalisation Beginnings 1974 - Digby, Connolly & Tuke built 1976 - Rockville Training Centre closed 1980 - Outreach community psychiatric services began 1982 - Whishaw Day Centre commenced 1984 - Recreation complex built
  27. 27. From Institution to Community 1986 - Medical orientated outpatients clinic for dischargees opened at Gowrie Hall 1992 - Ridley opened and patients transferred there from Gowrie 1993 - Final intake into 3 year psychiatric nursing course 1996 - 38 hour week introduced
  28. 28. Integration Beginnings 1999 - Browne House closed 2000 - Baillie Henderson Hospital & Toowoomba Base Hospital become part of Toowoomba Health Service District Laundry refurbished to cater for district District achieves Accreditation Cafeteria closed 2001 - AMHU opens at Toowoomba Base – Hill house residents moved there
  29. 29. Decade of Restructuring 2007 - Mental Health Review by Gerry Fitzgerald 2008 - Toowoomba and Ipswich Health Service Districts amalgamated to become Darling Downs – West Moreton Health Service District 2010 - De-amalgamation – Darling Downs Health Service District formed including Toowoomba & Baillie Henderson Hospitals 2011 - Government announces demise of Queensland Health & establishment of Local Health Networks from July 2012
  30. 30. The Superintendents1888 – 1898 : DR JAMES BALLANTYNE HOGG1898 – 1928 : DR JAMES NICHOLL1928 – 1945 : DR JAMES MCDONALD1946 – 1949 : DR CLIVE BOYCE1950 – 1968 : DR JOHN BAILLIE HENDERSON1969 – 1976 : DR MICHAEL DE GROOT1977 – 1984 : DR JOAN RIDLEY1986 – 2006: DR JEFFERY THOMPSON
  31. 31. DR James Ballantyne Hogg 1888 - 1898 (Recalled to Goodna) First Medical Superintendent of what was then Willowburn Lunatic Asylum. Dr Hogg emigrated from Edinburgh. He was well educated and a sympathetic custodial carer. He was one of the earliest doctors in Australia to insist on disinfectant for treating wounds during operations.
  32. 32. Dr James Nicholl 1898 - 1928 Dr Nicholl’s focus was on discipline, safety & cleanliness, and the provision of available treatments. He introduced recreation activities including football, cricket, tennis, dances & visits by musicians. He also purchased more land around the hospital and lowered some of the high fences
  33. 33. Dr James McDonald 1928 - 1945 Dr McDonald took over in a time of increasing knowledge about schizophrenia and research into medication for mental conditions. During his term of office, new terms were introduced, such as “mentally sick” rather than “lunatic” and “mental hospital” rather than “lunatic asylum”. At this time the hospital was a working farm.
  34. 34. Dr Clive Boyce 1946 - 1950 Dr Boyce had an enlightened attitude to treatment – referred to as his ‘open-house’ concept. He insisted that patients be treated humanely, even during episodes of violence. The model of care at this time was still based on activity and custodial care.
  35. 35. Dr John Baillie Henderson 1950 - 1968 When Dr Henderson took over there were 1400 patients, both adults and children. Dr Henderson aimed to make life easier for patients and introduced new treatments, increased the numbers of staff and improved working conditions. He also appointed the first psychologist, in 1951 an Occupational Therapist in 1957 and a social worker in 1966.
  36. 36. Dr Michael de Groot 1969 – 1976 Dr Groot instigated the integration of the male and female sides of the hospital. He placed great emphasis on staff training, appointed 3 nurse educators, broadened the curriculum & upgraded the library. In 1976 there were 770 patients remaining in the hospital
  37. 37. Dr Joan Ridley 1977 - 1984 Dr Ridley brought a new emphasis on deinstitutionalisation and the development of community services. She established the first Community Liaison Nursing Service, the forerunner of today’s Community Mental Health Teams. She was an advocate for staff development and education and had a focus on social skill programs for patients. Dr Ridley saw the hospital as just one component of an integrated mental health service
  38. 38. Dr Jeffery Thompson 1986 - 1996 Dr Thompson had been Dr Ridley’s assistant and continued her work by further developing rehabilitation and community services. Notably, Dr Thompson reorganised the structure of the hospital to focus on 5 extended care patient groups, put simply: •Elderly demented & disturbed •Mentally retarded •Brain damaged •Psychotic & assaultative •Chronically schizophrenic
  39. 39. The Administrative EraThe new millennium brought about an increasing shift fromlocal to centralised control and the era of administration asopposed to clinically orientated decision making.The era has been one of constant changes at executive leveland much instability. An unfortunate consequence of thishas been a lessening of the links between the hospital andthe local community.At the same time, this period has seen a rapid accelerationin the need for mental health services, ever increasingcosts, and some considerable uncertainty about the future.
  40. 40. 2010 and Beyond In 2011 the State Government announced that it would split up Queensland Health and establish local Hospital and Heath Networks. These networks will, once again, put more control in the hands of local communities through the establishment of local Boards to oversee hospital management. There will still be centralised support and supervision but more decision-making will rest at the local level.
  41. 41. The MuseumFor the centenary celebrations of 1990, a museum wasestablished in one of the original buildings of the hospital.Unfortunately, since that time there has been little attentiongiven to either the building (which is now in an extremelypoor state of repair) or to the artefacts held within it.In 2010 attempts were started to revitalise the museum witha hope that much can be preserved and eventually used forpublic display once more. This work is ongoing.
  42. 42. Confinement & Containment In the early days, psychiatry was in its infancy – Freud was postulating about dreams (1900) and psychology didn’t exist. There were no medications as we know them today and little understanding of the range of mental illnesses, their symptoms and manifestations Treatment was about confinement, work, and discipline
  43. 43. Sterility of the pre-medical eraWomen’s admission ward
  44. 44. Window Treatments Windows were generally barred on the outside and provided virtually the only ventilation in the wards. However, the high-ceiling design of the wards was specifically intended to create a minimum area of air space for each patient.
  45. 45. Straitjacket In the early years there were not the medications that we have today. In many cases, physical controls were the only resort of the carers where patients were violent and intent on harming themselves or others.
  46. 46. Hand Muffs
  47. 47. Peaceful sleep?
  48. 48. Dr Whishaw’s demiseFire nozzle On 7th December 1908 Dr. Reginald Robert Whishaw was hit over the head with a fire nozzle wielded by one of the patients. Dr Whishaw died the following day of a fractured skull
  49. 49. Self sufficiency – work as therapy For many years the clothes used in the hospital were made by patients. Shoes and other items were also made within the hospital. As activity was the main therapy, patients were put to work – women mainly in sewing and men in the fields. For two years the sale of produce actually covered the cost of running the hospital!
  50. 50. Commode Room A small room – one on each floor of the building – was the only internal toilet facility available to patients.
  51. 51. The ‘Facilities’
  52. 52. Shower Stalls
  53. 53. Dinner is served!
  54. 54. Recipe Book
  55. 55. Nurse Registration
  56. 56. Nurse in uniform
  57. 57. Nurse’s bedroom
  58. 58. Female ward dining room 1913
  59. 59. Early wheel-chairs
  60. 60. Medicine bottles
  61. 61. General view of hospital - 1915
  62. 62. Steinway Grand Piano
  63. 63. Don Featherstone – Resident Artist
  64. 64. Art as therapy
  65. 65. Communion Table Religion was a significant element for many patients who often saw their conditions as some sort of punishment for wrong doing
  66. 66. Bread slicer and butterer
  67. 67. Dentistry
  68. 68. Ground Floor
  69. 69. First Floor Ward
  70. 70. Gardening par excellence Many trophies were won by the hospital for its gardens. The hospital floats took out several first prizes in the annual Carnival of the Flowers in Toowoomba
  71. 71. The Museum Building Today
  72. 72. THANK YOU!THANK YOU FOR YOUR ATTENDANCE Roger Hawcroft Manager, Clinical Library Services Darling Downs Health Service District