Three stories in the media in recent weeks have looked at how young people in the 1960s, 1970s and early 1980s experienced psychiatry.
On Saturday 30 July the Guardian newspaper featured a story, taken from the ITV series Long Lost Family about a woman who was re-united with her daughter after nearly fifty years. In 1967 Susan Webb gave her baby up for adoption, then became depressed and was given ECT. Susan said the ECT left her with memory loss so she had no recollection of the occasions on which she had been able to see her baby while she was in foster care for six months awaiting adoption.
“Although a few photographs, taken by her mother, were a crucial solace that proved there had been an early bonding with her daughter, they were also a bitter reminder of how the ECT had robbed her of those memories. ‘I get so frustrated and angry that I can’t even recall feeding and changing her.’”
When Susan Webb had ECT in 1967 or 68 she was on one of probably about 50,000 people in the UK who underwent the treatment that year. That is about ten times the number of people who undergo it every year currently. Also, in those days, young people made up a much greater proportion of ECT patients. It is hard to explain these changes in scientific terms, and indeed psychiatrists don’t try to. Fifty years ago psychiatrists had anti-depressant and other drugs and various psychotherapies so it was not the case that there were no alternatives in those days. Some people claim that nowadays ECT is less likely to cause memory loss than it was in the past, but if that was the case why then have younger people become less and less likely to be given ECT than older people (at least in most Western countries)?
The variety of drugs at the disposal of psychiatrists in that era was highlighted by an item on the news on 13 July about the publication by the Diocese of Rochester of a report into Kendall House children’s home, Gravesend (Report of a review of Kendall House, Gravesend 1967-1986, prepared for the Church of England Dioceses of Rochester and Canterbury, S. Proctor, S. Cohen and R. Galloway, June 2016).
Originally Kendall House had been a mother and baby home for unmarried mothers but in 1967 its purpose was changed to a home for girls aged from 11 to 16 and the principal, Doris Law, was sent off to Birmingham to do a course in social work. The report explains why girls were sent to Kendall House:
“Girls who were placed there were aged between 11 and 16 years and often had serious behavioural or emotional problems. Many had been to a succession of children’s homes and had very troubled and difficult backgrounds…. Why were girls placed at Kendall House? A variety of reasons were identified. For some it was deemed a place of safety; others were on remand after committing offences such as theft, violent acts or for antisocial behaviour. Some had very troubled, fractured or violent family backgrounds; others had psychological or behavioural problems and were felt to be in need of a secure and structured home placement. Placements ranged from a matter of weeks to over four years.”
Some of the girls who were resident at Kendall House were prescribed psychotropic medication (major and minor tranquillisers, anti-depressants, etc.) often in high doses or PRN (‘to be given as needed’) with staff at the home deciding when to administer the drugs. The drugs were prescribed by a child and adolescent psychiatrist from Stone House Hospital, Dartford. Dr Marenthiran Perinpanayagam, who visited the home at weekly intervals, and also worked at a Borstal Institution. In 1977 the British Medical Journal published a letter from M.S. Perinpanayagam and Robin A. Haig, “Use of depot tranquillisers in disturbed adolescent girls”. The authors wrote:
“We have been treating girls in a secure home for disturbed adolescents with the intramuscular depot preparations fluphenazine decanoate [Modecate] and flupenthixol decanoate. Most of the girls admitted to this home have already been in care, all come from broken or severely disrupted homes, and all the girls have been uncontrollable in their previous situations. Many have been in conflict with the law. The environment of the home is extremely caring but with firmly defined limits of what is acceptable and what is not… Over the past year 10 of these girls who were extremely disturbed, violent, and aggressive and who were not influenced by tender, lover care or by psychological strategies were started on depot tranquillisers….The girls on this regimen benefited, their disturbed behavior subsided, they became more approachable in a psychotherapeutic framework, and were alert, co-operative, and psychologically more stable… We would be interested to hear of any other doctors’ experience in this field.”
The use of drugs at Kendall House attracted the attention of those, such as Professor Laurie Taylor, who were concerned about such use of psychotropic medication in children, and in 1980 the regime at Kendall House was criticised in the Daily Mail and in a TV programme. The home however weathered the storm: the Royal College of Psychiatrists issued a supportive statement:
‘Children may be acutely mentally disturbed with a variety of mental illnesses, some associated with brain disease. Their nursing may pose a serious problem, especially if there is violence or repeated running away. For the most part such problems are handled by competent nursing staff in sufficient numbers. However, it is sometimes fully justified to give tranquillisers and/or sedatives and other drugs.'( Quoted in Kendall House report, page 79)
Dr Perinpanayagam, who had qualified in medicine in Sri Lanka, died aged 60 in 1988. An obituary in the Psychiatric Bulletin described “his distinguished career in psychiatry” and how “his charisma gave hope to those in distress”. It mentioned the annual study days at Stone House Hospital for sixth formers from local schools, his interest in the welfare of overseas graduates and his love of music. “He will undoubtedly be remembered for his formidable energy, enthusiasm and compassion” it concluded. (Psychiatric Bulletin, 4 August 1989, page 462).
The recent report came about as a result of campaigning by a former resident who is concerned that women who as girls were given high doses of medication at Kendall House went on to have children with birth defects, but this particular concern was not something that was discussed in the report.
BBC Radio’s File on 4 on 19 July looked at the use of abreaction therapy on children and young people at Aston Hall Hospital, Derbyshire, in the 1960s and 1970s. Dr Kenneth O. Milner would interview child patients after they were given injections of sodium amytal, in the hope of uncovering traumatic incidences. The programme included an interview with Sir Michael Rutter, professor of child psychiatry, who had been practising in those days. He said that he hadn’t been aware of the use of abreaction therapy on children. Would he have done anything had he known, he was asked? To which he diplomatically replied that he would have been concerned. The programme left it at that, but it is difficult to imagine what if anything would have been done if Dr Milner’s work had been more widely known about at the time, even if people were concerned. There was a rule that doctors didn’t criticise other doctors and I can’t off-hand think of a single occasion when a psychiatrist, thanks to the actions of other psychiatrists, has had to abandon even the most outlandish practices. This was highlighted in the Kendall House report, when, following adverse publicity about the drug regime at the home in 1980, the Church of England committee responsible for its oversight gave the staff a vote of confidence. There was just one member of the committee who was not convinced; they wanted to discuss the matter with a psychiatrist of their acquaintance. They were reassured, as the committee minutes document:
“(The member) having sought guidance from a local psychiatric doctor has now a clearer picture of the medical requirements of the girls and is confident that their present treatment is in the best interests of the girls”. (Quoted in Kendall House report, page 80)