Open Research Online The Open University’s repository of research publications and other research outputs ’Challenge and Change in a Cinderella Service’: A History of Fulbourn Hospital, Cambridgeshire, 1953 – 1995 Thesis How to cite: Adams, John Stephen (2009). ’Challenge and Change in a Cinderella Service’: A History of Fulbourn Hospital, Cambridgeshire, 1953 – 1995. PhD thesis The Open University. For guidance on citations see FAQs. c 2009 The Author Version: Version of Record Link(s) to article on publisher’s website: http://dx.doi.org/doi:10.21954/ou.ro.00005679 Copyright and Moral Rights for the articles on this site are retained by the individual authors and/or other copyright owners. For more information on Open Research Online’s data policy on reuse of materials please consult the policies page. oro.open.ac.uk John Stephen Adams BSc (Open), MA(Cambridge), MA (Leicester), MPhil (Leicester) ‘Challenge and Change in a Cinderella Service’: A History of Fulbourn Hospital, Cambridgeshire, 1953 – 1995 Thesis submitted for the degree of Doctor of Philosophy of The Open University, in the Faculty of Health & Social Care Date of submission: 2009 Abstract This study of Fulbourn Hospital uses oral history and documentary sources to explore the models of mental illness and the therapeutic practices associated with them in one provincial English psychiatric hospital during the second half of the twentieth century. The appointment in 1953 of a new Medical Superintendent from the Maudsley Hospital, Dr David Clark, set in train a process of change which transformed the hospital through the implementation of a social model of psychiatry. This period was ended by the appointment of the leading biological psychiatrist, Professor Sir Martin Roth, as the University of Cambridge’s first Professor of Psychiatry in 1976. The subsequent years saw the appointment of psychiatrists who shared support for a medical model of psychiatry. Attention then turned to the development of care in the community through the establishment of group homes and community mental health teams. The implementation of sectorisation proved to be controversial, as did the increasing role afforded to general managers. It is concluded that many of the elements of the social model introduced by Dr Clark became absorbed into the working practices of the nursing staff, after they had been abandoned by the psychiatrists working in the hospital. This study therefore illustrates the process through which professional boundaries shifted in response to changing models of practice. 2 Contents Chapter 1: Introduction 8 Chapter 2 : The History of Mental Health Care: A Review of the 15 Literature Chapter 3: Research Methodology 48 Chapter 4: The New Superintendent 86 Chapter 5: Winds of Change 122 Chapter 6: Hereward House and Westerlands: The Creation 157 of a ‘Therapeutic Community Proper’ Chapter 7: ‘Social Therapy’ in Practice 203 Chapter 8: Nursing Reforms at Fulbourn 237 Chapter 9: The Critics of the Fulbourn Regime 265 Chapter 10: Reaching Out from the Institution 303 Chapter 11: Conclusion 346 Appendix 1:[Removed] 361 Appendix 2: Brief biographies of oral history interviewees 365 Bibliography 369 3 Tables Table 1: Chronological list of oral history material (Ch. 3) 75 Table 2: Work groups of patients 1954 and 1961 (Ch. 4) 115 Table 3: Percentage of work groups discharged (Ch. 4) 116 Table 4: Diagnoses of patients (Ch. 6) 161 Table 5: Individual treatments for ‘disturbed ward’ patients (Ch. 6) 161 Table 6: Themes and practices in the therapeutic community wards (Ch. 178 6) Table 7: Occupation of patients in Hereward House on 2 February 1969 187 (Ch. 6) Table 8: Admissions, re-admissions and patient numbers for Street and 211 other acute wards (Ch. 7) Table 9: Mental Health Act 1959 (Ch. 7) 218 Table 10: Diagnoses of patients admitted to ‘Swift ward’ (Ch. 7) 219 Table 11: Ward links, from 1966 (Ch. 8) 239 4 Abbreviations AWA Asylum Workers’ Association CPN Community Psychiatric Nurse DICT Deep Insulin Coma Therapy DPM Diploma in Psychological Medicine DSM Diagnostic & Statistical Manual of Mental Disorders ECT Electro-Convulsive Therapy FRCP Fellow of the Royal College of Physicians GNC General Nursing Council GP General Practitioner GPI General Paralysis of the Insane ICD International Classification of Diseases LREC Local Research Ethics Committee MPA Medico-Psychological Association MRCP Member of the Royal College of Physicians MRCPsych Member of the Royal College of Psychiatrists NAWU National Asylum Workers’ Union NHS National Health Service RMN Registered Mental Nurse SRN State Registered Nurse WHO World Health Organisation 5 Illustrations Illustrations removed for copyright reasons. 6 Dedication To Gwen Adams and Anna Adams. Acknowledgements A doctoral study employing oral history as one of its main sources necessarily relies upon the active assistance of many people, but responsibility for any errors, and for the interpretations drawn from source material, remains mine alone. The initial debt is owed to my colleague Nick Smithson, who first encouraged me to embark on this journey of discovery, putting his own historical resources at my disposal and introducing me to Dr David Clark. This study could not have been undertaken without the assistance of the twenty-six other individuals who agreed to be interviewed. They were unfailingly helpful and hospitable, despite the demands that I was making upon their personal schedules. Librarians and archivists have provided much valuable help and advice. At the Open University, Professor Pam Shakespeare facilitated the transformation of a personal enthusiasm into a project proposal. Dr Sheena Rolph and Professor Dorothy Atkinson supervised the study in a wholly supportive manner, and I am very grateful to them for their judicious balance of critical appraisal and positive encouragement, sustained over the last six years. Professor Joanna Bornat and Dr Tessa Muncey generously agreed to act as critical readers for final drafts of the study. Finally, this thesis is dedicated to my mother and to my wife, who have lived with my enthusiasm for the history of some of the less fashionable corners of the health and social services for over two decades. 7 Chapter 1: Introduction This thesis reports a research study which examines the development of treatment regimes in one English provincial psychiatric hospital in the second half of the twentieth century. The initial plans for the study envisaged covering the history of the hospital from its opening in 1858, but the wealth of detailed oral and written sources for the post-Second World War era led to a focus on the period after 1953. This was a time of significant change in both psychiatry and mental health policy. Now that the era of the large psychiatric hospitals, with their imposing buildings and their many hundreds of patients, has come to an end after an existence of more than a century, it is an opportune time to study their final years. Such large and complex hospitals present many potential themes for the researcher to explore. Several historians have produced detailed administrative studies of similar provincial hospitals, detailing the processes involved as individuals and committees struggled to meet the manifold demands imposed by legislation, budgetary constraints, and professional agendas. 1 Other studies have focussed on the experiences of patients and service-users. 2 While both these factors are inescapable elements in any account of a psychiatric hospital, they do not form the main focus for this study. Instead, it aims to explore the following questions focusing upon the many developments discernable in the recent past:- 1 For example, R. Hunter & I. Macalpine, Psychiatry for the Poor: 1851 Colney Hatch Asylum-Friern Hospital 1973: A Medical and Social History (London, 1974), J. Crammer, Asylum History: Buckinghamshire County Pauper Lunatic Asylum – St John’s (London, 1990); P. Michael, Care and Treatment of the Mentally Ill in North Wales 1800-2000 (Cardiff, 2003).; S. Cherry, Mental Health Care in Modern England: The Norfolk Lunatic Asylum: St Andrew’s Hospital, 1810-1998 (Woodbridge, 2003). 2 For example, D. Gittins, Madness in its Place: Narratives of Severalls Hospital, 1913-1997 (London, 1998); K. Davies, ‘’Silent and Censured Travellers?’: Patients’ Narratives and Patients’ Voices: Perspectives on the History of Mental Illness since 1948’, Social History of Medicine, 14 (2001), pp. 267- 292. 8 (1) What were the competing discourses in British mental health care in the second half of the twentieth century? (2) What light can the study of one English hospital shed upon the history of institutional mental health care? (3) How did the competing medical discourses impact upon nursing practice? The seeds of my interest in the recent history of Fulbourn Hospital were sown in 1996 by the BBC television documentary, Unlocking the Asylum , which was broadcast in a series about the unsung medical pioneers who had worked in parts of the National Health Service which did not usually attract positive media attention. 3 The theme of the programme was the determination of Dr David Clark, its last Medical Superintendent, to ensure that the ‘social model’ in psychiatry was not forgotten in a heedless scramble to equate mental health problems solely with altered brain physiology, and it created a lasting memory for me. Several articulate psychiatrists and mental health nurses were shown endorsing Clark’s arguments, while the defenders of a ‘biological model’ in psychiatry, led by Professor Sir Martin Roth, appeared rather negative and narrow- minded. This documentary led me to make further explorations in the hospital history, beginning with Clark’s memoir, The Story of a Mental Hospital: Fulbourn 1858-1983 .4 In his foreword to the book, the late Roy Porter rightly describes it as ‘a rare document, fascinating to read and invaluable as historical evidence’. 5 Clark provides an engagingly modest and wryly humorous account of his struggles to reform the hospital during his tenure as its last Medical Superintendent.