The Last Asylum: A Memoir of Madness in our Times

Author Barbara Taylor is in a unique position to write about mental health services: as a historian, mental illness sufferer, and one of the last residents of a Victorian-era asylum in London, she not only had an inside view of “the old way” of dealing with mental illness, but she also has had twenty years to digest her own experience and bear witness to what came next; what came after institutionalised care was abolished.

                              

In The Last Asylum, Taylor shares her Canadian childhood (as the daughter of an activist father who had fought Franco's forces in the Spanish Civil War and a mother who, while a sitting judge, suffered her husband's abuse and philandering), her adult life in England (as an academic, sexual adventurer, drug and alcohol abuser), her twenty-one years of psychoanalysis (five days a week!), her three admissions to Friern (lasting from two weeks to six months), and her years of after-care in Day Centres and other supportive services that no longer exist. Along the way, Taylor shares many anecdotes (from many sources) and sketches the historical backdrop of evolving attitudes towards those with mental illness and the type of care that those in power believed should be available to them.

Taylor's story is agonising and beautifully told, but despite sharing so much personal information, I'm left with no real picture of what her mental illness actually looked and felt like (besides wanting to stay in bed, get drunk, and yell at her therapist) and neither do I have any clue as to how her decades of psychoanalysis ended up curing her. There are many transcribed sessions like this one, which I found to be painfully circular:

I'm in the bin, you bastard! So what are we going to do now?
Psychoanalysis? That's what you come here for, isn't it? Or maybe it isn't?      Maybe you just come here to punish me?
Punish you? For what??
You just said. You're in a mental hospital. And this is somehow my fault.
Yes!
Yes what?
Oh...oh...I don't know...! Fault, whose fault?...I don't know?...[Angry  silence]What if I can't come here any more? What if they lock the door and  won't let me out?
Has anyone tried to do that?
Well, no...But they could! And then what? Would you come to me?
No.
Never??
No, never.
So! You bastard! You drive me crazy, I end up in hospital, maybe locked up in  there, and you won't come and see me?!
I haven't 'driven you crazy'. And I'm not going to come to Friern to see you, not  ever. I'm not going to give you more reasons for staying in hospital.
Huh! You don't care what happens to me!

As for her time in the asylum, Taylor doesn't get as detailed as, say, Girl, Interrupted, but despite some elements of danger and poor resources, she demonstrates that Friern (her “stone mother”) was a vital port in her storm – and Taylor in particular makes the case for the importance of asylum for the low income patients on her ward; those who are today cheerily sent off with a list of community services that they are self-empowered to access at their own discretion. While she mentions briefly the connection between the closing of asylums and the rise in homelessness, she provides these stats on the prison system; the new asylum:

In Britain it is estimated that over 70 per cent of the prison population have two or more mental disorders; similar estimates are made for the Canadian prison system. In the United States right now, the three biggest mental health providers are prisons.

No real surprise there. As for the miracle drugs that are supposed to allow the mentally ill to lead independent lives in the community?

Decades of intensive research, much of it funded by drug companies, have thus far produced no persuasive evidence for the neurobiological origin for any mental illness.

So what does Taylor conclude, based on her experience and observations?

The mental health system I entered in the 1980s was deeply flawed, but at least it recognized needs – for ongoing care, for asylum, for someone to rely upon when self-reliance is no option – that the present system pretends do not exist, offering in their stead individualistic pieties and self-help prescriptions that are a mockery of people's sufferings. The story of the Asylum Age is not a happy one. But if the death of the asylum means the demise of effective and humane mental health care, then this will be more than a bad ending to the story: it will be a tragedy.

When I've thought of a mental hospital like Friern, I've always imagined straight-jackets and electric shock therapy and evil Nurse Ratcheds. Their closure – which have not really been replaced by on-site hospital wards – always seemed like a progressive move to me, but perhaps that policy change was a mistake after all. Taylor has packed so much information into this book – not least of which was her own crazy childhood, while avoiding making this a “misery memoir” – and it will continue to give me much to ponder. Solidly 3 and a half stars and I'm rounding up for the excellent writing.