Dr Warwick Brunton presents an article of interest to those involved in mental health and to others involved in long-term residential care.
Student post-mortems on their exams are inevitable with the findings shared and occasionally aired if the content has strayed too far from examinees’ expectations and hunches. That goes for last year’s NCEA Level 2 question in history paper 91231.
Students were asked to examine perspectives on ‘the way patients were treated and/or responded to treatment at Seacliff Asylum’. That’s an unusual and relevant topic, so congratulations to the NZQA for including it.
Mental health allows each of us to realise our abilities, deal with life’s challenges and stresses, enjoy life, work productively and contribute to our communities. Mental health is a positive sense of emotional and spiritual wellbeing that respects the importance of culture, equity, social justice, personal dignity and diversity.
‘Mental health services’ are a euphemism for professional ways or specialised facilities for dealing with mental health problems, illnesses or disorders. Nearly half of us are likely to experience a form of mental illness some time in our lives. Public disquiet about these services prompted a public inquiry about once a generation since 1858.
The latest, in 2018, attracted a huge and unprecedented degree of public interest. Now a royal commission is learning about the ugly side of residential programmes, including the facilities that evolved from 8 provincial lunatic asylums into 13 psychiatric hospitals and four psychopaedic (intellectual disability) hospitals.
Otago readers need no introduction to Seacliff, that small coastal settlement north of Dunedin whose name is synonymous with the major mental hospital there from 1879-1974. Seacliff will always be associated with the origin of the Plunket Society (1907) by then medical superintendent Frederic Truby King, and for a ghastly fire (1942). Seacliff invariably evokes images of R.A. Lawson’s grand Scottish baronial architecture and size, 182 metres long and 69 metres yards wide with a tower 49 metres high. The foundations are still visible.
There was pride in such colonial achievement, but prejudice too. Planning for Seacliff began the trend for second and third generation asylums to be built miles from any large settlement. The Dunedin Lunatic Asylum (1863) had outgrown its site, which was taken over for the Otago Boys’ High School (1885). Administrators wanted a rustic site for therapeutic reasons and for a degree of agricultural self-sufficiency.
Public prejudice was also setting in. Public sympathy for mentally ill people had prompted provincial governments to build the first generation of asylums in or near their capitals. That accomplished, sympathy was largely overtaken by indifference, suspicion and fear, thanks to sensational gothic novels and prejudicial stereotypes derived from exaggerated differences between “them” and “us” conveyed by penny daily newspapers from the 1870s.
Lionel Terry and Janet Frame were among a handful of Seacliff patients given the opportunity to cultivate their literary or artistic abilities. Excerpts from their writings were among four patient perspectives chosen as resources to help NCEA students answer their exam question.
Like Avis Hunter, they were patients at Seacliff and other mental hospitals, whereas Johanna Beckett was admitted to Seacliff only. Each was Pakeha, an implicit acknowledgement of the monocultural character of the mental hospital system before the 1980s.
Giving voice to their perceptions and experience before the Code of Health and Disability Services Consumers’ Rights (1996) presents themes of unwarranted imprisonment, stereotypes of mental disorder, and conformity or non-compliance with institutional routines and rules.
Terry’s poem ‘Emotional Insanity’, without the racist middle stanza, was one of the exam resources. Edward Lionel Terry (1873-1952) was a good choice though some students and members of the Chinese New Zealand community have taken exception because Terry was a white supremacist who murdered Chinese immigrant Joe Kum Yung in 1905 to publicise his extreme views.
Such sensitivity is entirely understandable given New Zealand’s shameful record of racial prejudice but what about the strong historic public prejudice against people with a mental illness and mental health services? The 1945 census recorded 3,150 people born in China. That year, three of the chosen writers were among the 8,431 patients in one of our mental hospitals. Sixty percent of those patients were officially deemed incurable.
Focus on Terry’s crime risks underplaying his mental state and ignores the complex and controversial factors involved in his safe-keeping and care. The jury found Terry guilty but strongly recommended mercy on account of his ‘craze’.
Sympathetic petitioners made the same point. The government then commuted the death sentence to life imprisonment. In 1906, Terry was certified and spent the rest of his life as what is nowadays legally called a ‘special patient’. Describing his charge as ‘one of the most typical text-book cases of paranoia one could see’, Truby King bluntly said that Terry was neither hero nor criminal, but unquestionably insane and irresponsible.
The NZQA has reportedly said that Terry is ‘little known’ yet his life is included in the Dictionary of New Zealand Biography. Lionel Terry is named 3,948 times in Paperspast. He is known through local histories and academic research.
Terry’s colourful personality, florid psychosis, personas as Prophet, Superman, Lawgiver or Prisoned Patriot, his crime and striking physique (194 cm. tall and very fit) gave him a mythical status because of the popular stereotype that mistakenly associates insanity with dangerousness.
Terry had a genteel English background, some education and means, but was a single man with a restless nature. He found mateship in British army barracks before emigrating in 1895, then spent a decade travelling and working in the anonymity of frontier development settlements in the British West Indies, Cape Colony, Canada, Australia and New Zealand, where he arrived in 1901.
Colonial experiences shaped Terry’s racist views on capitalism and immigration restriction. Such views tapped into a strand of contemporary thinking. In 1904, Prime Minister Seddon sought to boost population by establishing state maternity hospitals and registering midwives.
If increased from ‘British stock’ rather than the ‘inferior surplus of people of older and alien countries’ self-governing colonies would further strengthen and buttress ‘our great Empire’. Increasingly fashionable eugenics ideas had racist undercurrents.
The Plunket Society served imperial purposes. ‘If we lack noble mothers,’ Truby King wrote in 1909, ‘we lack the first element of racial success and national greatness.’
Far from expunging Terry from the exam question, we should note his significant personal influence on service development and public and professional attitudes about mental health. Terry personified the social responsibilities of mental hospitals: care, cure and social control.
Getting the right balance with such a well-known figure was difficult amid fickle social attitudes and therapeutic limitations of the day. He was clearly a ‘tremendous responsibility’ whose real danger (menace) and perceived threat (myth) fused during a rebellious decade against incarceration at Sunnyside, an asylum-annexe at Lyttelton Gaol and Seacliff that was marked by attempted arson, nocturnal shrieking, clever escapes, and force-feeding during hunger strikes.
Secure single rooms in the Victorian main building at Sunnyside Hospital, Christchurch, typical of that occupied by Terry.
Terry’s perceived threat to society and to ministerial and departmental reputations contributed directly to the plan in 1906 to convert Larnach Castle into a national criminal asylum. Official reassurances about prison-style security behind a 5 metre fence could not allay howls about Terry’s supposed risk by all manner of local communities and organisations on the Otago Peninsula. The government capitulated to nimbyism. The place became a white elephant and closed (1918}.
Next, a national maximum-security facility planned between the adjoining Tokanui Mental Hospital and Waikeria Borstal failed to materialise. So did the idea of sending Terry to Broadmoor, a forensic facility in England. Terry’s name was always prominent on lists of prospective inmates for a New Zealand equivalent, but the National Security Unit at Lake Alice Hospital (1966) only materialised after structural deterioration hastened the evacuation of patients and the demolition of the Seacliff main building in 1957.
Lionel Terry skewed the understanding of mental disorders by generations of medical students at Otago University. Six lectures and a 2.5 day block course at Seacliff were the cornerstone of undergraduate teaching in psychiatry. Former students remembered Terry paraded and quizzed like a prize exhibit.
Clinicians who chose to display Terry like this subtly conveyed their own power, preferential status, paternalism and privileges within the national network of mental hospitals that was run like one huge hospital by a central government department from 1876-1972. Progression through the national career service involved acculturation into the institutional ethos.
The annual fuss undoubtedly flattered Terry and reinforced his special status in the institutional hierarchy. His white suit, beard and flowing hair gave him a messianic appearance. The method of teaching psychiatry reinforced the separation and isolation of mental disorders and mental health services from physical diseases and mainstream health services. It underlined the monopoly and centrality of specialised institutional care in a low-status medical specialty.
Institutional interests fought to retain their dominance through ‘practical psychiatry’ at Seacliff. Academic psychiatry with its ‘high falutin’ [psychoanalytic] theories threatened them. The objections of two prescient students who challenged the course in 1930 for its lack of depth and breadth, relevance to general practice and other fields of medicine were dismissed. The existing course was deemed demanding enough for students who were too immature to handle the topic.
No other patient matched Terry’s lifestyle between the wars. True to his word to Truby King not to escape, Terry was given ‘the greatest possible consideration’ compatible with secure management. He was held in the most secure MB ward, continually “specialled” by two or more attendants, and had his own specially caged exercise yard. Nevertheless, he occupied not one but two locked single rooms, one as a sitting room-library-writing room-art studio, and the other his bedroom where he prepared his vegetarian meals.
Escorted by his “specials”, Terry kept a smart pace on 8-10 km walks around the hilly countryside and the village where he distributed distinctive gilt-edged cards with one of his poems or drawings. Terry had his own flower and berry garden. He built an elaborate pergola in his rose garden. He kept a pet goat and a sheep or two. Terry made his own carrot, parsnip and elderberry wine.
This extraordinary lifestyle would probably have continued after 1940 had a less confrontational approach been adopted over a typhoid inoculation. After refusing, he was forcibly restrained by several attendants while the injection was administered. The doctor then ordered the withdrawal of Terry’s privileges. The incident probably broke Terry’s spirit. He seldom left his room during his remaining years.
PATIENT PERSPECTIVES ON TREATMENT
Terry’s poem ‘Emotional Insanity’ offers a lofty disdain and wry cynicism for the medico-legal process of committal. Being “put away” only began the treatment which Terry mentioned in several poems, but not this one. ‘Sanctuary’ may have been a better choice:
The honest man is the happy man,
Tho’ Mammon’s hirelings reign,
On trade, finance and politics
He looks with cold disdain,
Tho’ prisoned in a Madhouse
And branded as insane,
He dwells serenely in a realm
No rogue or fool can gain.
A world of difference lies between the perceptions and descriptions of treatment of Terry and Janet Frame who was a patient in various psychiatric hospitals intermittently between 1945-55. That was the best and the worst of times characterised by terribly over-stretched resources, heightened therapeutic optimism and better living conditions.
The woman’s eye of Mabel Howard, Minister of Health (1947-49), keenly observed conditions and she expedited spectacular and overdue improvements in furnishings, clothing and diet. Unlike Terry, Frame received or was considered for the new treatments of electro-convulsive therapy and pre-frontal leucotomy. She passed through filters from front (acute) to back (chronic and more secure) wards according to prognosis and behaviour. Her writings reflect that wider experience.
Terry wrote self-centredly of his treatment, but Janet Frame saw beyond her plight to treatment-in-the-mass. The extraordinarily perceptive depiction of mental hospital life in Frame’s Faces in the Water (1961) explains why it was used for staff training.
The story of our mental hospital system is threaded with endeavours to prevent or counter the effects of institutionalisation on staff and patients. We should honour the vocation that inspired professionals, administrators and policy-makers to try to improve conditions wherever they worked in that system.
Despite many and sometimes overlooked improvements and some fine nursing traditions, persistent and interlocking problems besieged the national system: overcrowding, outdated asylum-era architecture, staff shortages, power relationships and hierarchies, bureaucracy, a virtual monopoly of specialised care, functional and geographical segregation, an insulated organisation upheld by vested interests, and a siege-like mentality.
This combination subordinated values like dignity, individuality, privacy, variety, fashion or homeliness to the basic attributes needed for institutional functioning under stress: order, neatness, cleanliness and work. You can almost smell that unforgettable institutional aroma, a mix of disinfectant, over-cooked cabbage, floor polish, and tobacco smoke. Frame strikingly conveyed the resulting and all-pervasive “themness” a few sentences down from the excerpt from her autobiography provided for the exam students:
I grew to know and like my fellow patients. I was impressed and saddened by their – our – capacity to learn and adhere and often relish the spoken and unspoken rules of institutional life, by the pride in the daily routine, shown by patients who had been in hospital for many years. There was a personal, geographical, and even linguistic exclusiveness in this community of the insane who yet had no legal or personal external identity – no clothes of their own to wear, no handbags, purses, no possessions but a temporary bed to sleep in with a locker beside it, and a room to sit in and stare, called the dayroom. Many patients confined in other wards in Seacliff had no name, only a nickname, no past, no future, only an imprisoned Now, an eternal Is-Land …
Paper 91231 was intended to examine sources of an historical ‘event’ of significance to New Zealanders, but the dishful of quotes was more about the phenomenon of institutional care that dominated mental health services for so long. The exam was designed for history students, but let’s look beyond mere antiquarianism to applied history. That exam question can provide contextual information for a wider, practical and very current purpose.
The Royal Commission into Abuse in State Care and in the Care of Faith-based Institutions is hearing a litany of brutal and heart-breaking experiences of people once in New Zealand’s catch-all mental hospital system. It is too easy to brush these revelations aside as the product of less enlightened times, unwitting or intentional human failing, blinkered vision, toxic elements of organisational culture, and the flaws and imperfections of total institutions and those who worked in them.
Yet whatever the many internal systemic failings, the mental hospital system should not be scapegoated so flippantly. It was ultimately a product of social attitudes and political priorities. While the Royal Commission’s work may be salutary and salving, the sin of “themness” that begets depersonalisation and differentiation from us is ever present irrespective of care setting.
New Zealand society cannot shun ultimate responsibility for its fickle attitudes that isolated, starved and trapped people within mental hospitals for far too long. Janet Frame’s couplet aptly puts it, ‘Loony, loony down the line / Mind your business and I’ll mind mine.’ Lionel Terry can also be read that way. He should get the last word:
Fools and cowards all remind us
We, of work, may dodge our share;
And, departing, leave behind us,
Loads for other folk to bear.
References: The poems are taken from Frank Tod’s The Making of a Madman: Lionel Terry. Dunedin: Otago Foundation Books Ltd, 1977, pp.132-33 (Emotional Insanity) and 140 (Sanctuary). The final untitled poem has not been published, to the best of the author’s knowledge, who states: “It is one of three quatrains in Terry’s handwriting that I saw among Terry’s memorabilia at Seacliff many years ago. I don’t know where it is now.” The lengthy quote from Janet Frame is in An Angel at My Table: An Autobiography: Volume Two, Auckland: Hutchinson of New Zealand, 1984, pp.72-3. The couplet can be found on Faces in the Water, Christchurch: Pegasus, 1961, p.15.
Dr Warwick Brunton is an historian and Honorary Senior Teaching Fellow at the University of Otago’s Department of Preventive and Social Medicine in Dunedin. His PhD thesis studied the development of national mental health policy in New Zealand, 1840-1947. He was involved in policy review and development in that field at various times between 1972-96 during his earlier career in the Department / Ministry of Health.