Imagine if, on top of all your other worries, you started to go mad. Lena Dunham in Girls conveyed this well, when Hannah started counting footsteps and digging into her ears. Thoughts you have lived with for as long as you can remember no longer cause mere anxiety, but intolerable agony. Tics speed up and take over. People do their best to help you, but they aren't strong enough, and you wear them out. Who or what might be able to hold you while you work your way through this crisis? Is there any point in even trying to help, or is it best for everyone if society simply locks you up?
In 1983, Barbara Taylor was a young activist and scholar, the author of the prizewinning Eve and the New Jerusalem: Socialism and Feminism in the 19th Century and an editorial collective member at History Workshop Journal and the feminist paper Red Rag. But she was unhappy and self-destructive and felt herself becoming more so. And so she did what London intellectuals did in the 1980s and started on a course of full-on classical psychoanalysis with a Harley Street practitioner: the dreams, the leather couch, the works. She would not publish another book for 20 years.
To begin with, she writes, analysis only confirmed her sense of how special and unique she was: "I buzzed with my new-found status … I felt gorgeous," she writes. But then, childhood demons started to overwhelm her. She drank, she left her job, she necked pills "like a party drunk guzzling peanuts". She was admitted to Friern psychiatric hospital in north London in 1988 and was in and out of its revolving doors three times over the next few years. The late 1980s and early 1990s are now known to historians as "the twilight … of the Asylum Age", as the mental hospital went out of fashion and care in the community came in. Taylor moved from Friern to a hostel in 1992 and the hospital itself closed the year after.
The great Victorian edifice of Friern has been famous most recently as a star of Will Self's novel Umbrella ("the North Circular of the soul," Self dubs its legendarily long and sinister central corridor). But when it opened in 1851, the Middlesex County Pauper Lunatic Asylum was known throughout Europe as "a prestige institution to comfort and heal the human mind". "No hand or foot" was ever to be bound there. Patients would work in the hospital's fields and bakeries, finding relief and redemption in the bonds they made with staff and their fellow patients, safely held in the stability of asylum routine. This then-pioneering approach to madness was called "moral treatment". Since the anti-psychiatry movement of the 1960s it's most usually thought of as the therapeutic-community ideal.
In practice, sadly, life at Colney Hatch did not work out as the visionaries had hoped. Alarms were soon raised about overcrowding and poor sanitation, and the ban on straitjackets was soon lifted. The notorious "back wards" became a dumping ground for people with dementia and without family or friends to protect them – Sans Everything, to quote the title of a pioneering 1967 study of institutional abuse of elderly people. Taylor whitewashes none of this, but has warm memories nonetheless of her time there. "Cradled in Friern's unyielding embrace, I found myself surviving emotions that out in the world had felt unendurable." That safety was a constant, despite the bleakness of the environment and the frequently "attenuated" care.
Even at her maddest, Taylor could see that the mental health system was changing. New drugs controlled the more antisocial of patients' symptoms, allowing scope for less severely circumscribed ways of living – networks of hostels and halfway houses, therapeutic day centres and support groups, all of which Taylor has needed and all of which helped keep her on her feet. But the drugs could also be used to keep people quiet on the cheap, so they could be sent home to be looked after by their families, if their families had the wherewithal – or sent away to live on the streets if not. "The mental health system I entered in the 1980s was deeply flawed, but at least it recognised needs – for ongoing care, for asylum, for someone to rely on when self-reliance is no option." Whereas the care-in-the-community system that has replaced it offers only "individualist pieties and self-help prescriptions" – and of course the drugs.
Taylor's book is not a misery memoir, though as the author acknowledges, a lot of it is miserable. There aren't any sensational details of extreme cruelty, for one thing. Taylor spent her early life in Canada, the first child of a lefty legal family. "There is no victimiser in my story, or if there is, I am it." Her parents were flawed but plenty of people, her analyst tells her, have childhoods as bad as hers without breaking down like she did; he lists for her some of the paths she might follow. "You could decline into a psychoxsomatic illness from which you'd probably not recover. You could become a long-term psychiatric patient … Or you could descend so deeply into alcoholism that you'd never be retrievable." Or she might have died, by her own hand or by a proxy. Plenty of people with mental health troubles do.
Taylor is aware that her own opportunities were enhanced by her social privilege. "I thought I knew everything about extreme anxiety until I witnessed the agonies of a man at risk of losing his home because of a mix-up in his 'social care' payments … Anyone who thinks that madness is down to defective brain chemistry needs to look harder at the overwhelming correlation between economic deprivation and mental illness." And she's aware, too, that of all the treatments and people that contributed to her survival – doctors and nurses and friends and fellow sufferers – the biggest and most constant presence over the 30-year span of this story is the psychoanalysis: five 50-minute hours weekly, adding up to around 4,000 sessions over 20 years. Can it be that if you really want people with mental health problems to get better, this is just the amount of time and attention it takes? If so, how do we resource it? (Taylor is not explicit about this, but it appears that her parents paid for her.)
"The rites" of psychoanalysis "can look ridiculous", Taylor admits, outlining how her view of them changed over the decades. At first, she saw them as "cultic icons, symbols of the higher mysteries". Then, she "savaged them as cheap tricks". "And later still, much later, I came to see them as containers for the uncontainable, solid supports for emotional chaos." She writes well about the psychoanalytic process, which is to say, she's good at conveying its basic "pain and tedium", the penis dreams, the dead-baby dreams, the many dreams about roast chicken. She raged for years, she sulked for years, she did year-on-year of brattish tantrumming: "I am me, not some common or garden sicko," as she puts it at one point. Slowly and gradually, however, without even noticing, she is learning that there is nothing unique either about herself or about her suffering. "Sometimes, momentarily, the fog of fear and hate would thin and I would catch a fleeting glimpse of something new."
For nearly 20 years the former asylum at Friern has been known as Princess Park Manor, a development of luxury flats. Taylor, meanwhile, moved from her hostel room to a flat of her own in the 1990s, and got a job at the University of East London. She fell in love, gained a family and published a book about Mary Wollstonecraft. In 2004 she did up her house with reclaimed oak boards that had been salvaged, she was told, from an old mental hospital in north London. And so, "with much grizzling and many back-steps", she gradually found herself more stable and self-accepting, "living a life I wanted to lead".
But imagine, as she says, a young woman nowadays finding herself in trouble of the sort she had in the 80s. Even supposing she can fund psychoanalysis, what happens if she breaks down during that? "There is a complicated answer to this question and a very simple one. The complicated answer involves crisis teams, acute wards, recovery strategies, care plans …" Perhaps she would be lucky, perhaps not. "The simple answer relates to what I needed most: asylum, a safe place to be, a 'stone mother' to hold me as long as I required it." And what with the mental hospitals gone and the hostels all gone private, she wouldn't get it. "Would I make it? … It would be a tough call."
