Stone Mother

On a recent Friday afternoon I had a desperate phone call from a local vicar. He had no idea what to do with a patient he’d found weeping inconsolably in his empty church. I knew her well. Her life had caved in recently when some devastating family secrets had broken dramatically at the worst possible time triggering a breakdown which neither I nor several contacts with the Crisis Team had done anything to help. All I could say to the bewildered priest was that she really needed asylum — in it’s kindest sense. She needed to go away to a safe place.

Asylums generally have a grim reputation with both the public and professionals. In her book The Last Asylum: A Memoir of Madness in our Times Barbara Taylor, Professor of Humanities at Queen Mary University of London, writes powerfully of how asylum was crucial in her recovery from severe mental illness. She was a successful academic before having a severe breakdown in the 1980s resulting in several admissions to the Friern asylum in North London. I recognised her vivid description of life inside, as I had trained at a similar large hospital; St Bernards in West London.

She tells the story of her own descent into madness unflinchingly. Yet this is not a clichéd misery memoir, it is wonderfully written: it kept me engrossed and made me care about what was happening to her. Her analysis of mental health services flows naturally out of this narrative, giving it a much greater authority than any dry academic analysis on its own would. Care was far from ideal but it did at one level fulfil some fundamental needs: ‘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.’

But this was at the time the big asylums were being closed, mental health services were being radically reorganised, and care in the community was going to be the Brave New World. Would she have survived today, with crisis teams, care plans, and acute wards without a ‘stone mother to hold me’? ‘It’s a tough call ’, she concludes.

The book stands alone as an enjoyable read and has a happy ending as she does find stability, love, and a new family. For a GP it is an eye-opening view of mental illness from the patient perspective. It also helped crystallise eloquently my jumbled thoughts and unease at the way current mental health services seem to focus on preventing admission at all costs: the last approach some of our most disturbed patients need.

• © British Journal of General Practice 2014