I trained as a Learning Disability Nurse in the mid-seventies at a place called Calderstones, in Lancashire. It was one of the largest institutions of its type and at one time over two thousand people with severe learning and physical disabilies, many of whom had mental illnesses, lived there in wards of up to 70.
It was a dreadful place. I can say that now and I shudder because I know it to be true. Human beings segregated from society and congregated together miles from anywhere – treated as less than human. Even the original title of our nursing course – Registered Nurse for the Mentally Subnormal – spoke of how our society thought of the people who were unfortunate enough to be sent there. I remember walking up the leafy drive – it was beautiful, lined with rhodedendrum shrobs, horse chestnut trees, elms and oaks. It seemed to go on for ever. Then it opened out to green manicured lawns, framed and centred with brightly coloured flower beds. Beautifully splendid redbrick buildings with a magnificent clock tower taking pride of place above the largest of them, faced these gardens on three sides. A few wooden seats were neatly placed around the lawns; but no one was sitting on them. I found out later that they were only used by staff occasionally and were largely for visitors who came rarely.
It looked grand and austere. Certainly it was like nothing I had ever come across before as an 18 year-old from Bredbury in Stockport. I was here for an interview to be a Nurse. It was a course I had chosen because I wanted a career, but was too lazy (and hadn’t got the grades anyway) to go to University and I wanted to earn some money while I trained. Nursing seemed a good option, but I didn’t much like blood and hated it when people were ill! I’d tried doing Business Studies at College, but was bored to death, then a bloke at the “Mentally Handicapped Youth Club” (awful name!) where I volunteered, told me about this kind of nursing. So here I was. Not only could I get qualified but I could also leave home and be free from the constraints of parental interference!
My parents were delighted that I was finally getting myself on a career path. The only warning note was sounded from my grandfather, who had visited St Thomas’ Mental Institution in Stockport one time, and urged me to think again – “You’ve no idea what lies behind those walls. Folk don’t get put away without good reason”. He was right – nothing could have prepared me for what I saw behind those walls indeed – some of it was terrifying; most of it was just incredibly sad. He was very wrong about one thing though – folk were “put away” for the flimsiest of reasons. I do believe that no one should ever have been “put away” in those places. It is a terrible indictment on our society that we ever thought it was a good idea to build a place to house the defenceless and the helpless and leave them to the mercy of the unscupulous and merciless.
Do I sound harsh? Yes, I know I do and you’re probably wondering why on earth I stayed if it was so awful. Well, if I am honest, I needed a career – and there seemed to be something of a drive to improve things and find a better way of caring. I saw that on my visit and I heard it at my interview with a fabulous man – Tom McLean – who was then Divisional Nursing Officer. Basically, he was saying that such places needed to be emptied and the people residing there should be living in the community. Well, I didn’t know what to make of that. I had walked round and seen people in the most awful of conditions. They seemed far more disabled than anyone I had met in my brief experience. What I also saw though, which really made me take note, were people there who really did seem to care. I saw nurses who looked like they enjoyed being there, looking after very disabled people and were showing enourmous compassion for them. It hit me that I was incredibly lucky and I felt a strange desire to be in that place doing something that was worthy. I knew I couldn’t simply walk away; I wanted to work there and do some good. I’d never before felt anything like it. I got through the interview and started training 3 months later.
I did see things in that place over the years, however, that horrified me, made me cry, confused me and enraged me – at different times. I saw kindness and I saw cruelty. I saw individualised care and I saw inhumane, institutionalised treatment. Thankfully, the place is closed now (some of it repurposed) and the former residents have largely been resettled to community group homes. I met some incredible people there, made great friends and there were more good nurses than bad. Though I do have to say that a bad nurse could make a horrible difference. I had a good career there and beyond, rising through the ranks to become a Senior Nursing Manager and going on to work in Teaching and then Service Development later.
Why I’m remembering this now is all to do with a book I read recently – “The Vanishing Act of Esme Lennox” by Maggie O’Farrell. It’s the story of Iris Lockhart, a young woman who finds out she has a great-aunt who has been in a psychiatric unit for over 60 years and is about to be released. It’s also the story of the great-aunt, Esme – who was outspoken and unconventional and a source of great embarassment to her well-to-do family, who lived in Edinburgh in the 1930s. Something had to be done. It’s a great read and I highly recommend it. Iris has a wonderful story of her own, making sense of her relationships with her step-brother and mother. Coming to know Esme is both beautiful and perplexing. Do look it up.
Esme was hidden away. Could that happen really? Oh, yes, believe me it did! I could tell you of Beattie – locked away for “wandering abroad with no visible means of support” (found on the streets begging!). Or Mary – who was incarcerated for “low morals” – working as a prostitute on Liverpool Docks. Or Sally who was raped as a young girl when she was in service and had a baby by the house owner and was sent away, never to set eyes on the child. Or Marion – “a gregarious, low-grade imbecilic Cretin” whose parents couldn’t cope when they needed to work. When I met Marion, she was in her 80s, had ginger whispy hair and was usually cheerful and loved the nursing staff. “What do you want for Christmas?” I asked her once. “My liberty!”, she answered and then she was crying. A woman the same age as my gran, who was back home right then baking Christmas cakes and ruling the family, sat crying for her freedom. Heartbreaking.
I am most proud of the fact that I was part of the movement to close down those awful places and resettle residents into their own homes. I am also proud that I spent most of my career working to make services better. Striving for personalised care – when it should always have been a right. So O’Farrell’s book resonated with me considerably. I had known so many women just like Esme – the only difference being that the women I met had been declared “Mentally Defective” (yes, that used to be a legal term!).
What must it be like to find yourself in such a place? When you really just wanted to be heard. You were different to other people – you knew that – considered “odd”. But could that really be a reason to be sent away and locked up for your whole life? We’ve moaned in these Corona-driven-locked-up-days of having our freedoms curtailed, but to be prevented from even leaving the building; having all our rights and liberties taken away; reduced to being a lesser being – could we bear that? And worse…?
” There is a smell of disinfectant and floor polish and the person in the bed in the corner mutters all night long. A light in the ceiling flickers and buzzes. Esme cries. She struggles against the belts, tightly buckled, tries to wriggle her way out, she shouts, please, please help me, until her voice is hoarse. She bites a nurse who tries to give her some water…She finds herself haunted by the life she has left, been pulled out of. As light drains from the room at dusk, she thinks about how her grandmother will be descending the flagged steps into the kitchen to see how the dinner preparations are coming along, how her mother will be taking tea in the front parlour, counting out sugar lumps with clawed tongs, how the girls at school will be catching trams to their homes. It is inconceivable that she is not taking part in these events. How can they happen without her?”page 201 – The Vanishing Acto of Esme Lennox – Maggie O’Farrell (2006) – Headline Publishing
I felt sick reading this bit and actually had to put the book down. I thought of all the Margarets and Sallies and Marions I had known. Had they experienced anything like this? Poor Esme. She’ll be an old lady before she is back in the world. Everything she had taken for granted whipped away from her – by her own family. She was too much for them and so they hid her from their view. Some of the women I knew at Calderstones were visited by family but a great many were not. There was nothing sadder than seeing those women standing at windows waiting for sisters and brothers who never came.
I remember too that small things often mattered very much. Possessions like a bag or a dress took on great value. I think of a lady, Hilda, carefully washing her cup, which she’d bought with her some of her meagre weekly allowance, drying it and putting it away in the bottom of her wardrobe. It was precious to her. An ordinary mug with a picture of a dog on it. “I love dogs. Woof, woof!” she’d chuckle. But it was the day trips that lit up those strange lives the most. An outing to the Lakes to sail on Windermere. A coach trip to Blackpook to walk on the prom. I watched little Marion standing there, staring out at the sea once. What was she thinking?
“Esme turns back to the sea, to the keening of the gulls, to the rearing monster-head of the Bass Rock, which are the only unchanged things. She scuffs her feet in the sand, creating miniature valleys and mountain ranges. She would like, more than anything, to swim. People say you never forget. She would like to test this theory. She would like to immerse herself in the cold, immutable waters of the Firth of Forth. She would like to feel the ceaseless drag of the currents flexing beneath her. But she fears it may frighten the girl. Esme is frightening – this much she has learnt. Maybe she shall have to settle for removing her shoes.”page 135 ibid
There were several women I met during my time nursing who were quite scary – but looking back, I wonder why more of them didn’t put up a fight. When did they settle for ‘this is it’? When did they stop begging to be let out? When I arrived, in 1975, it was a few years after the Mental Health Reform Act which had basically stated that people with learning disabilites (mental handicap, as it was defined then) could no longer be ‘detained’ in hospital and were free to leave if they were able to. They were redefined as ‘Informal’ patients. Of course, most of them couldn’t simply walk out of the place. They had no means for a start and most would have no idea of how to look after themselves. However, it did give an impetus for change; the drive to close down institutions such as Calderstones really gained momentum at that point.
I’ve been thinking though about my own perceptions of the place and the women and men I met there. I had them labelled – they were ‘residents’ (previously, termed patients) – as different to us. My heart told me it was right that they should be treated with dignity of course, but my understanding of them was marred by how they were defined to me. The messages I was given. We had our roles – I was nurse/ sister etc – they were residents. I went home at the end of the shift – they lived there; that was their life. A home in a hospital ward – a bed, a wardrobe and possibly a bedside locker. Our lives were poles apart. How much did I question any of it? I remember getting angry about how things were – how had it happened that places like this had been built and that people had actually been sent there to live out their lives? Did I get angry enough though? Still, they’ve more or less gone now. Although, smaller institutions, often privately run, have sprung up to fill a void left – and there have been scandals about the poor care and neglect discovered in some places – Winterbourne being one such example.
I’m left asking myself about embarassment. Questions about who does, or does not, fit in. Are we any more tolerant or are we just better at hiding it?