Before I Forget

by Fahey, Jacqueline

  Fraser, rightly and properly, went to Maori themselves and gave them the authority to transform a beautiful, large building in the grounds into the Whare Paia, a unit versed in Maori customs and staffed mostly by Maori. Titewhai Harawira was selected to be in charge. The arrival of Titewhai at the hospital was for Fraser a personal achievement. At her welcome into the hospital she appeared convincing; she was certainly imposing and very intelligent.

  Titewhai Harawira didn’t actually cause a collapse of my regime, she just posed a threat. Fraser’s lunch hour was an hour and a half, and I embedded it in my new household organisation. At noon, he was to eat a good-for-him sandwich and drink a glass of milk, then to bed. But he would come home at lunchtime all hyped up, carrying on about hospital politics. I didn’t think this was good for him. After some persuasion, he eventually got with my programme and in no time at all it became an essential part of his survival. I had arranged with the exchange at the hospital that no calls were to be put through to our house between 12.30 and 2 p.m. Only one person continually got through and that of course was Titewhai. How did she do it? A cohort on the exchange? Urgent situations that required the superintendent’s immediate intervention? I don’t know, but get through to the house she did. I would answer the phone immediately so that Fraser would not be disturbed.

  Titewhai was persistent, determined to track Fraser down; and I was equally determined he must have his sleep. It was during these exchanges on the telephone that I had my first insight into her powerful nature. She claimed a feminist stance but although I had invited her to call me Jacqueline she persisted in calling me Mrs Fraser McDonald. This title was pronounced with a special emphasis; my own identity as a painter and writer deliberately bypassed.

  For many conflicting reasons the Whare Paia experiment all went to shit.

  Fraser had underestimated the resentment towards Maori among the staff. There were also complicated tribal customs that led some Maori staff to ignore the authority of a woman like Titewhai. I can see now that for her the whole thing must have been a nightmare.

  However I don’t believe that Titewhai’s Whare Paia could ever have prospered for the very good reason that Titewhai didn’t want it to. Her aim appeared to be to create chaos in a Pakeha institution. Fraser’s aim was to make the Whare Paia work. Some Maori mates of mine in the painting world attended a meeting Titewhai held at the hospital. They were appalled by what they saw as her attack on Fraser as a lily-livered, liberal lackey of the establishment. I knew where this attitude was coming from: out of South Africa. Consider this: a brutal Boer boss man flourishing a whip and yelling profanities was preferable to the hypocritical, mealy-mouthed white South African liberal. With the Boer you knew what you were dealing with, but with that other jerk? He just confused the issue. He couldn’t help, because he couldn’t possibly know. He couldn’t follow through because he had no personal rage to sustain him in the continuing struggle. It was the bum’s rush for the white liberals; they simply got in the way.

  But something else got in the way, something I believe Titewhai discovered in herself. Working in the hospital possibly made her more conscious of where exactly her own personal rage came from. Having control over deeply disturbed Maori men, sometimes rapists, seemed to unleash in Titewhai a powerful wish to see them punished. Titewhai had the wit to blame empire and cultural oppression for the damage done to herself; nevertheless, she found it very difficult to extend that understanding to patients under her control. In other words, she considered hitting the Maori way.

  My friends Eric McCormick and Roy Cowan did not consider this to be the Maori way. There was, according to them, no historical justification for such an assumption. Eric believed it was learnt behaviour, adopted under economic stress – modelled by drunken whalers staggering ashore from leaking whale boats. Those Pakeha guys had been brutalised and Maori had to endure the same process.

  Certainly, sticking to her own therapeutic methods was one way to make sure the Whare Paia failed. Fraser had always made it clear that anyone on the staff who thought hitting patients was a good idea was down the road. And so it painfully developed. Titewhai went down the road and that road ultimately led her into prison.

  I did empathise with Titewhai, for her rage and pain were impressive. However, my empathy was not something that Titewhai had any time for. I was just another lily-livered liberal, superfluous to her grief. But for Fraser it was a proverbial stab in the back, coming as it did when there were so many other challenges in play. Changing Carrington and incorporating Oakley into Carrington had been quite difficult enough for Fraser. Staff naturally had developed their own culture, their own ways to survive these institutions, but Fraser saw some sort of transformation as a possibility. Not with all nurses or paramedicals but enough to turn things around.

  Fraser didn’t believe in a chemically induced turnaround for patients. The new drugs could function as a replacement for a straitjacket or for shock treatment, but were not necessarily any improvement. Drugs have side effects, and the cure could often be worse than the disease. Actually, for the patients just having people being nice to them was beneficial. Granted that wasn’t going to help murderous psychopaths, but treating all patients like murderous psychopaths didn’t help either. (Incidentally, I am calling patients ‘patients’ here as I don’t believe clients is any improvement on the word patients. It was simply moving patients from a medieval reality to a capitalist one. Same difference from where they were looking.)

  Fraser also had the good sense to expand group therapy at Carrington. Of all the treatment units, the neurosis unit became the hospital’s jewel in the crown. It was run by Drs Graham and Eileen Evans. They brought to Kingseat and then to Carrington valuable experiences from a large psychiatric hospital near London, where they had pioneered group therapy treatments. It was in fact Eileen’s father who had come up with the idea of encounter groups in the first place.

  The success of the unit gave Fraser great satisfaction. That patients should get to see themselves as others saw them, in an intelligent protected environment, could have magical results. Participating in psychodramas in a group setting could help reveal the true source of a person’s grief and conflicted emotions. This was often as much a voyage of discovery for the doctors and the nursing staff as it was for the patients, and there was an excitement and energy to the unit. A genuine intellectual curiosity was shared by everybody involved.

  Group therapy became the most intelligent treatment for disturbed, unhappy people available anywhere in the world – and we had it here. It was available for everyone whose problems suited this experience, not just for those who were rich. The fashionable stance at the moment, still prevalent among mental-health commentators, to condemn mental hospitals outright is grossly unfair to those who dedicate their lives to the unwell and dispossessed. Many joined the staff of these hospitals to make the world a better place; and they did that; they did make the world better. We know a lot of bad things happened in mental hospitals but I assure you not as many bad things as happen to vulnerable people sleeping on the street. I would like us to remember some of the good things that happened in those hospitals and we could happily start with Eileen and Graham Evans.

  However, improvements weren’t happening fast enough for the government, who began to cleverly pull the rug out from under Carrington’s and so also from under Fraser’s feet. This all happened while the Labour Party was embracing Rogernomics. First, the unions were eunuched and then the market was presented as the universal solution. Fraser’s idea that institutions were not the best solution for patients with mental problems was used against him. The government closed Carrington on that rationale, citing non-existent community centres as the intelligent panacea to mental problems. Welcome to the new age of doublethink. The unions, if they had been functioning as they should have, would have been a great help. But the unions’ inability to include women and Maori in their power structures led to their downfall. Keeping the unions as the preserve of
the white male worker was their death knell.

  Here’s an example of pulling the rug out. The market rate in Auckland for renting a house was high. Our rate was reasonable but now we were asked to pay market rates. This applied to all the housing in the grounds. Fraser could no longer lure a good staff nurse with a low-rent house. There was of course no compensatory increase in salary.

  Doctors employed at the hospital earned about a third of the money that they could make in the private sector. Suddenly, we heard much talk about having a calling, a special calling to serve the community. When the government starts talking like that you know they are going to cut spending – it’s the sort of crap teachers are always getting. You are told how serving the community takes a special sort of person: well, it certainly does, the sort of special person who gets with the programme designed to serve the interests of the rich. The privileged did not believe that the closing of mental hospitals would impinge on their lives anyway. After all, if the rich person’s child went bananas they would not be treated at Carrington, but at a private clinic in Remuera. In their hearts I do believe that they thought that the enlightenment found in encounter groups and other treatments should be available only to those who could pay for it. Community medicine was, as Fraser complained, used against him.

  Fraser was setting up community centres, outpatient units, outside the hospital. He did not believe institutions were the complete answer, but also did not believe that closing the institutions before proper community centres were established was a bright idea either. That, sadly, is what happened. Arbitrariness prevailed. So the minister of health closed Fraser’s community centres first, before the new ones were in place. Next came the closure of the institutions themselves – because institutions were ‘bad’ and community psychiatry was ‘good’. There was, however, as yet no explanation of what the replacement community psychiatry would be. The shambling halfway houses replacing organised community centres hardly fit that criteria. Failing a shambling halfway house, the other choice was the top of Queen Street. Now when I walk down K Road, I encounter beggars. They are often suffering from schizophrenia or some undiagnosed psychosis; they are cold and hungry – but, come, they are free! We must celebrate, for, as they say in New York, they are now free to starve on a park bench. All of these changes slowly played out during Fraser’s last days at Carrington. The major players in this fiasco were the hospital board and the government, but certainly Titewhai played her part.

  Last night my youngest daughter Emily rang. Emily is packing up after a year teaching in Otorohanga. In an old filing cabinet that I had given her, she found a statement Fraser had written, defining policy at Carrington. Interrupted now and then with a few sobs, Emily read it to me over the phone. It read as fresh and new as on the day it was written, as heartfelt and as inspiring. Here are parts of it.

  It is headed with a quote from Hamlet, ‘Though this be madness, yet there is method in it’.

  My memories of patients sharpen and clarify themselves, as I look back over the nearly forty years I have spent as a psychiatrist and as superintendent at Carrington and at Kingseat for some twenty years.

  I remember when Carrington held over two thousand patients. Many of the residents were perfectly capable of being placed in the community but because of the prevailing philosophy and because of the staff structures of the hospital, this was extremely difficult. The upstairs eastern wing was a ward which had 130 patients in 1974, with one staff nurse looking after them. You may well wonder how one nurse could look at 130 insane people. The fact of the matter was, the patients ran the ward. There were groups of them doing the cleaning, polishing the floors, making the beds, dishing out the food and supervising the bathing. This meant that there existed hierarchies among the patients. The staff nurse’s favourites, her ‘pets’, to whom she gave treats and privileges. Also what she gave was power and control over the other patients.

  The nursing staff, naturally, were very unwilling to discharge their ‘good patients’ without whom they could not run the ward. There were no domestics, no orderlies, basically no labourers, all of this was done by the ‘good patients’. If they had been discharged the hospital itself would have ceased to function.

  As a result a whole underground hierarchy of power, both economic and social, developed and ran in conjunction with the official, superficial control system. The underground economy was maintained by a system of bartering for all sorts of favours, including sexual. All of the patients knew who were the top dogs in any one ward and where the power structure lay.

  A variety of make-shift huts and trysting places were a part of every psychiatric hospital. Normally including a still for alcoholic drinks and storehouses for goodies for the most powerful of the patients. Very rarely did the nursing or medical staff ever have any sort of access to knowledge about these unless they stumbled on them accidentally.

  This complex hierarchal structure with its hundreds of secrets was maintained by these so-called insane people. In many ways it was a small system in which they all knew what the rules were and they knew that they had some control, position and status within this society. Whereas in the outside world they usually only had areas of confusion, ambivalence or hostility. In this sense one can say that the concept of community psychiatry was in existence even in the old discredited institutions, but in a distorted, abortive, often destructive and limiting way.

  True community could be said to be the natural, fruitful development of the social structures which the patients forged for themselves within the old structures, their pains and sufferings were not in vain, but in fact led to the production of something so much better.

  To try and change the huge expensive institutions like Carrington, with their fixed ideas and fixed philosophies could not be done overnight. To me it seems amazing that over the period of the last 30 years, this has been achieved. A crucial factor was the development of medication which enabled contact with previously unreachable patients thus raising the possibility of their living outside of an institution.

  Nursing staff and doctors prior to this had a completely different attitude from those currently held about psychiatric illness. For instance, there was a tremendous pessimism about whether people could recover from psychiatric illness. In fact it is generally assumed that once you’d had a breakdown, you could really only be looked after like a child or a severely handicapped person in an institution which one hoped would be humane and kindly. The best nurses were in fact like kindly farmers who looked after their flocks of strange animals in the most humane way that they knew how. The possibility of really treating them like other human beings often didn’t cross their minds.

  It has taken a long time to change the attitudes of staff to the patients and to work out techniques of dismantling the old institutions and setting up new institutions in the community. A colossal task which has really only just begun. There was never any money for anything except running the institution because government departments function from year-to-year and all you got was the budget to run the expensive hotel with rather strange inhabitants, and that was that. Unhappily, as seemed to happen always in the old system, it needed scandals to occur before money became available for any sort of change. Again, one had to put up with seeing politicians grabbing the idea of community psychiatry with a view to saving money rather than to delivering better services.

  During all this time there were mistakes, there were tragedies, but 30 years is not a very long time in the history of psychiatry and the changes that have occurred are the most momentous that have ever occurred in the history of the treatment of the mentally ill. It seems obvious, that if you are going to discharge patients from these systems into the community, it is absolutely essential that you provide the necessary framework of support to give them a feeling of security, of knowing that they fit in, of knowing what the rules are, of knowing how to negotiate the system to satisfy their needs. This involves an awful lot more than just the provision of basic outpatient servi
ces and medication regimes.

  One needs to construct specific social systems which fit the needs of these people, who in many ways had their breakdowns because they were unable to negotiate effectively the system we like to think of as normal. For them it was not normal, for them it was hostile, destructive, and not something they could usefully be part of. There is a need to establish extended families, whanaus, neighbourhood groups to replace the unsatisfactory ones which they knew of and rejected and were badly wounded by.

  We are only just starting to grapple with the complexity of this problem, let there be no misunderstanding. If these social structures are to be established and are seen as utterly essential for the proper healthy development of community psychiatry they will cost money, they will need to involve a lot of people. They will need to involve at least as much money and as many people as have been involved in creating and maintaining the old institutions. To do anything less will be false economy of the cruellest kind. Only when this is done properly will we have true community psychiatry.

  You might be thinking that mental health was not my concern, it was Fraser’s life. But it was the environment I was living in, it was the place from where I was looking. Environment and experience change an artist. I find it fascinating that Lucian Freud, the English painter, was a refugee and just what the war years must have meant to him, and his subsequent painting. Then there is the experience of van Gogh living among the potato eaters; or those skilled and intelligent upper-class American women painting in Paris in 1890, who returned to Boston and New York and never painted again. London changed Freud, the potato eaters changed van Gogh, but sadly Paris only changed those women for a while.

  Max was my brave companion during this time at Carrington: Max, son of Lily, my tragic Samoyed from Kingseat. A few months after Lily’s death, a Dutch couple came to the house. They had, three years before, bought Max from that bunch of Lily’s four boys which I named after Roman emperors. Maximus was a true son of Lily and the Dutch couple loved him inordinately. Giving him up broke their hearts, but they were, for compelling reasons, obliged to return to Holland.