Things I Learned in the Asylum

by Tim Lees

What’s your image of a psychiatric ward? Something from the movies, probably – the sterile cruelty of Cuckoo’s Nest, or the gothic nightmare of a thousand horror films. Or maybe you’ve read Szasz and RD Laing, or other critics of the mental health system. One thing they all agree on: a psychiatric ward is nowhere you would ever want to be, in any circumstances.

But I had no real choice. I wasn’t a patient, but I was out of work, and desperately needed a new set of references.

So I went into health care.

Or, to be honest, I was dragged into it. After a year of futile interviews, suddenly, here were people begging me to take the job. I put up every objection I could – I’d seen Cuckoo’s Nest, too – but it was no use. They wanted me. And a few months later, after the standard police check, I found myself on the secure ward of a psychiatric hospital, very nervous, and not at all sure what I was meant to be doing there.

It was nothing like the films. If anything, it looked like a slightly run-down social club, with patients playing cards in the dining room, or dozing in the TV lounge. In other aspects, though, it would prove profoundly alien.

Almost every door was locked. The gym, the clinic, the office, the kitchen – all locked. The cupboards – locked. Perspex had been fitted to the inside of the windows, and we existed, for the most part, in fluorescent light and recycled air. More surreal was this: the window ledges tilted at 45 degrees, like a set from Caligari. You couldn’t climb on them. Or, for that matter, stand your cup of tea on them.

Most of us, I think, are frightened by the prospect of insanity – either of losing our own grip, or dealing with someone else whose toe-hold on the world is coming loose. I was no exception. Yet from here on, I’d spend a large part of my life with such people. Many, at first glance, seemed surprisingly “normal”. But the regular staff told frightening stories. I was warned about a tall, gangling young man who looked constantly anxious; he’d been known to pick up one of the dining room tables and hurl it across the room like a discus. “That hits you, you’ll know about it,” said my informant. “Or, more like, you won’t.” I spent time with another patient, an obsessive pool-player. He was quiet, subservient in manner, and seemed a safe person to be around – until I read his file. According to his notes, he’d had a dispute with a female patient at a previous hospital, knocked her down and stamped on her until she died. (This was the official version. Years later, we discovered he’d almost certainly been scapegoated for some bad management decisions, and the woman’s death had likely been an accident. No stamping, no intent to kill. Nonetheless, our patient suffered eight years in Rampton High Secure as a result.)

Needless to say, I did not intend to stay in this job. I’d stick it long enough to collect new references, then move on. Or that was the plan. So why was I still there, nearly ten years later?

I had good reasons.

First of these, and something I had not found elsewhere, was the teamwork. It’s a buzzword in a lot of organisations, but in my experience, “teamwork” was a concept largely honoured in the breach. Here, on the other hand, it was essential. On my first day, a patient threatened one of the nurses, and she set off her alarm. I was impressed by the speed with which everyone ran to help, and their obvious concern for her safety. On that occasion, the incident blew over; but it wouldn’t always go like that, and when the bad times came – which they did – you needed to know that help was just a few seconds away. (Those seconds, however, could feel like an eternity…)

I liked the humour, and that, too, stemmed from the dangers that we lived with daily. “The tougher the ward, the darker the jokes.” And they were dark – obscene, brutal and hilarious, and no-one was exempt, from the ward manager on down. Later, I worked on easier wards – safer wards – where the mood among staff was relentlessly, pointlessly grim. I missed the laughs we’d had on the locked ward, where the dangers were real, but so was the trust, and the comradeship.

Mostly, though, I stayed because of the patients. They quickly resolved from the bunch of unkempt weirdos I’d encountered on my first day to familiar and varied individuals, many of whom I grew to like. Getting to know them, I realised they weren’t much different from the rest of us; they had the same feelings, the same wants and needs, though they’d often express them in unusual ways. I’d known people with mental health problems before, but the bizarre, complex delusions I encountered now were entirely new to me. One woman, a probable incest survivor – and gifted painter – would narrate wild tales of her adventures with old lovers, half soap opera, half Mafia thriller; she was also inclined to call the police and complain that Margaret Thatcher had stolen her poems. Another believed himself the King of Scotland, or (more modestly) the CEO of Sainsbury’s. At various times, we had Jesus, the Buddha and James Dean in our midst. Florid as these symptoms were, the one that really shocked me, early on, was comparatively mild. A patient had complained to me about a particular staff member picking on him. I knew the ward ethos by then, and I was sceptical. He grew agitated, then cried out, “Look! He’s doing it now!” So I looked. The man in question was fifty yards off, walking away from us down the corridor to fetch the dinner trolley. But what was the patient seeing? I was too taken aback to ask.

These were people whose lives had been derailed by illness, and whom we were trying, as best we could, to return to some sort of functional and, hopefully, satisfying life. For most, it was an uphill climb, exacerbated by the effects of long-term hospitalisation. Patients might hate being locked up, but for some, the outside world had become a daunting place. I coaxed many a nervous young man through bus journeys and other everyday activities most of us would take for granted. Even a trip to McDonald’s could begin to look like an Arctic expedition, planned for days and undertaken with the utmost care and gravity.

I recently published a novel, The Other Country: Adventures in an English Asylum (IncunabulaMedia), based loosely on my experiences, and it made me wonder what I’d learned from this unlikely detour in my life.

Firstly – and forgive the philosophical pretensions – I think it changed my sense of what it means to be human. I saw people stripped of everything we might consider baseline humanity – perception, reason, language itself – yet they remained, not just human beings, but complex, recognisable individuals, with their own tastes, moods, habits and mannerisms. I sat with people talking what, in any other circumstances, would be dismissed as nonsense; yet they were clearly trying to tell me something they thought important, and sometimes, I could tease out the deeper meaning – even if it was just, “Please listen to me.”

The idea that the mentally ill “can’t communicate” is a fallacy. But sometimes, you need to know them very, very well to work out what they’re trying to say.

We are social animals, and like all social animals, status is important to us. This went double on the wards. Delusions of grandeur were common, and no doubt served as compensation for people who in all other respects had hit bottom. So we had our share of messiahs. On a more mundane level, there was dominance behaviour and bullying, which as staff we were always trying to stamp out. Yet, as I suggested above, what people wanted most was simply to be listened to, and taken seriously – to be treated, in short, like human beings. Rejected by society, caught up in the vast, impersonal machine of the mental health system, they needed to know that somebody, at least, was hearing them, and taking their views into account.

What else did I learn? I learned that acts of kindness, no matter how small, are remembered.

I learned that a diagnosis is not a person. Even if you accept the medical model, which not everybody does, treating mental illness can be as much an art as a science. Everyone responds differently to their condition, and to their treatment. I knew people who were floridly psychotic, yet likeable and good-hearted; several who had committed horrific crimes while ill, but, once recovered, were sociable, trustworthy – and deeply regretted what they’d done; a majority, who could be difficult in certain circumstances; and a few, a very few, who would have been nasty pieces of work, no matter what their mental state.

Caring for the vulnerable is one of the most important functions of a civilised society. Yet it’s a sad fact: for most of us, care work is what we do when all else fails. It’s low-paid, low status, sometimes dangerous, and, to do it well, it requires a range of skills that can’t (officially) be learned in school. I hold a Master’s degree, but on the wards my most useful talents lay in playing pool and hand-rolling cigarettes.

Over time, I came to see the shortcomings of the system, especially in the lack of rehab places, and – beyond that – the shortage of support for people returning to the outside world. As a result, we had a bottleneck of patients stranded on wards they should have left long ago, still waiting for a suitable place to become available.

Psychiatric wards have a poor reputation, and sometimes, sadly, they deserve it. It’s true that for many people, they are places of imprisonment. But they are also places of healing, providing help, support and safety in the midst of a crisis, and rehabilitation for those likely to return to normal life. For those who don’t, they offer asylum – a word I’d like to see lose some of its negative connotations and return to its first meaning: sanctuary.

Tim Lees is from Manchester, England, but now lives in Chicago. He is the author of the much-praised historical fantasy Frankenstein’s Prescription (Brooligan Press), and the “Field Ops” books for HarperVoyager (The God Hunter, Devil in the Wires, Steal the Lightning). His latest story collection, The Ice Plague and other inconveniences, is available from Incunabula Media https://incunabulamedia.com/, as is The Other Country, his account of working in a psychiatric hospital. When not writing, he has held a wide variety of jobs, including film extra, conference organiser, warehouse worker, teacher, and lizard-bottler in a museum.