REVIEW by John Barnie

NWR Issue r26

Up Top: From Lunatic Asylum to Community Care: A Century of the Mid Wales Mental Hospital

by Hugh Purcell, with Margaret Percy

One of my most vivid memories as a child growing up in Abergavenny in the 1940s is of Pen-y-val Asylum which towered the other side of the River Gavenny at the bottom of our street. The tall windows were all barred, and there was a high retaining wall. From a neighbour’s front garden it was possible to look over that wall into an exercise yard where prisoners (as a six- or seven-year-old I thought of the patients as prisoners) walked to and fro in their grey dress, some talking to themselves, others screaming or moaning, others sitting listlessly on the benches of a shelter. This scene made a deep impression on me, so isolated, so different from my own world. It was a brooding place of fear that was always there when you played in the street.

By the beginning of the twentieth century, Pen-y-val had reached capacity, and in 1903, the Brecknock and Radnor Joint Asylum was opened at Talgarth, the other side of the Black Mountains, to relieve the pressure. Hugh Purcell, together with photographer Margaret Percy, spent several years researching the history of the Talgarth hospital from its foundation to its closure in 2000. In the process, he interviewed former staff and scoured county archives and archives as far away a London, a significant number of which have never been accessed before. The result is a fine history of ‘Up Top’ as the hospital was known in the village, which is illustrated by well chosen and well reproduced period photographs.

Like Pen-y-Val, Talgarth hospital was designed to be as self-sufficient as possible, with its own power supply, heating system, water supply; its own butcher, baker, tailor, carpenter etc; and a farm which grew most of the produce consumed by patients and staff. Patients who were capable, helped on the farm and in the gardens as an early form of occupational therapy, and since many patients came from rural backgrounds, they had useful skills.

Because of its rural location, most of the staff, doctors aside, came from Talgarth, and for a century it was the most important source of employment in the area, the hub, in fact, of the town’s economy. Up Top tracks this symbiotic relationship across the decades, as well as the ways in which treatment of patients changed with changing fashions in psychiatric theory and practice. In this way, it is both a contribution to local history and a history-in-miniature of mental health provision in the last century.

The First World War came to the hospital in the form of shell-shocked soldiers; the Second affected it more profoundly in that a large part of the hospital became Camp 234, housing POWs from Germany and Italy who had a variety of mental health problems, including many affected by what we would now call post-traumatic stress disorder. British troops were treated there as well, and many civilian patients were moved to other hospitals to accommodate this influx of military casualties.

Hugh Purcell chronicles changes in treatment, some of which, while no doubt well intentioned, seem barbaric now, such as frontal leucotomy, severing the frontal lobes from the rest of the brain, which, more often than not, left patients infantilised. Not much better, in my opinion, was/is electroconvulsive therapy (ECT) which calmed down agitated schizophrenics and manic-depressive, but at the expense of short-term memory loss and listlessness. Some of the ‘wonder drugs’ of that period had similar effects. A manic depressive I knew in Abergavenny came to dread ECT, though he was subjected to it on a number of occasions. It repressed his symptoms, but neither that nor drugs affected a cure. And perhaps that is one of the lessons of Up Top – that psychiatric medicine is fashion-driven and, despite its increasing sophistication in the latter half of the twentieth century, crude and rarely more than a holding mechanism for patients with severe mental illness.

In the end, the Mid Wales Hospital succumbed to changed thinking about mental ill-health. From the 1960s there was a drive to treat as many patients as possible at out-patient centres, with stress on ‘care in the community’. A major problem at Talgarth had always been the number of bedridden elderly patients with dementia, and increasingly it was felt that a psychiatric hospital was not a suitable last home for them. Gradually the Mid Wales was run down until finally it was closed, with consequences for the people of Talgarth socially and economically. Today, the buildings of the Mid Wales are falling into ruin.

Up Top is a model history of its kind, and a deeply moving one.

John Barnie’s latest book is a collection of poems, Departure Lounge, published this year by Cinnamon.

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