English Psychiatry and the War

 

Dear D.R. 

Like a ghost, you materialised at my side in the heat of the party at the NLS Congress, June 2026. The air conditioning unit above the door was adding to the decibels of the DJ without subtracting any heat from the dancefloor. I could hardly hear you, and it was horribly hot. Where had you come from? What did you want? You bent forward to put your mouth close to my ear and asked me what I was working on these days. Without a second thought I started to say something about my project to take horses to the Bethlem Royal Hospital. Your English barely better than my French was not the most auspicious beginning. The delicate threads of the story were defeated by the heat and the noise. And then you dematerialised as mysteriously as you had appeared, leaving me with the feeling that I had failed to transmit the essence, and the story fell flat on the floor. 

 So let me try again… 

Once upon a time, in a land not too far away, when I began my first analysis and joined CFAR to begin my training, I gave up my job as a research sociologist and went to work on an adult acute psychiatric ward as an assistant nurse at Warlingham Park Hospital, on the southern edge of London. 

Warlingham Park had been created a century earlier as one of the Victorian asylums built on the principles of “moral treatment,” which emphasised healing the mind through a harmonious, structured, and peaceful environment. It was beautifully planned, surrounded by woodland, and had its own farm and workshops. 

When I joined, in 1997, there were only two wards still operating because the hospital was being closed to make way for the new policy of “care in the community.” The beautiful grounds were sold, and a lovely housing estate replaced the hospital buildings, keeping only the central landmark “water tower” or “clock tower” around which all those old asylums had been built. The tower is still a local landmark glimpsed between trees from the surrounding villages, which are now sprawling suburbs of London. In 1999 we moved our patients to newly furbished wards five miles up the road at the Bethlem Royal Hospital. 

The signifier “Bethlem” can be traced all the way back to the thirteenth century when the first institution for “caring” for lunatics was established in London with the longer name of Bethlehem. Bedlam is another version of the same name, more commonly and widely associated with madness. 

The Bethlem Royal Hospital still exists as a state-run institution offering asylum and care for people with mental suffering. Adult acute psychiatry is still supported, along with national specialist centres and forensic units. It is a bunch of ill-assorted buildings on 100 acres of meadowland on the edge of London owned by the City of London Corporation, an institution that can claim an even older pedigree. The Corporation refuses to allow the NHS to build any new structures on the site, a policy which has resulted in the hospital buildings being surrounded by five ten-acre meadows on three sides. 

I worked at the Bethlem for about a year in 1999 before moving to the Royal Free Hospital in Hampstead, but that’s another story. As soon as we arrived on our new wards, I noticed the click of the lock in the door behind me and a subtle change in the way things worked. There had been no locks at Warlingham. I learnt about Warlingham’s “open door policy” on a recent visit to the archives at the Bethlem at the start of my project with the horses. It was due to the actions of T.P. Rees, who was appointed medical superintendent in 1935. His policy had survived even if his name had long been forgotten. The ideas and ideals of the moral psychiatrists, whose Quaker pioneers (led by William Tuke) opened the famous York Retreat in 1796, became ghosts in the corridors of the buildings that were sold. Maybe they continue to rattle the locks in the newly refurbished “gated community.” 

Rees was born in 1899 and served in the Machine Gun Corps during the First World War. At the age of twenty-eight he was appointed deputy medical superintendent at Croydon Mental Hospital where he became chief superintendent in 1935. As soon as he stepped into his new post, Rees “ordered the gates of the Hospital to be left unlocked” and thus embarked on a twenty-year course of reform. He also changed the name of the hospital to Warlingham Park to more directly reflect the philosophy of moral treatment. By the end of his tenure, all the wards in his hospital had been unlocked. 

[to be continued…]