State of mind: How the Royal Edinburgh Hospital helped change attitudes to mental illness

Mackinnon House, part of the Royal Edinburgh Hospital. Picture: Neil Hanna
Mackinnon House, part of the Royal Edinburgh Hospital. Picture: Neil Hanna
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THE Royal Edinburgh Hospital celebrates its bicentenary this year. Dani Garavelli looks back on how it has helped change the treatment of mental illness and attitudes to it, but hears how its work is far from complete

ROBERT Fergusson had already carved himself a reputation as a talented poet when he bumped into the Scottish preacher John Brown in Haddington Cemetery in 1772. Fergusson, the 22-year-old copyist and author of Auld Reekie, had until then been a convivial man, at the heart of Edinburgh’s literary and social scene. But soon after encountering the theologian, he became gripped by “religious melancholia”. He shunned the limelight, preferring to stay at home and read his Bible, and his works took on a gloomy air. Then, a year after predicting he might share the fate of John Cunningham, a poet who had died in a mental asylum in Newcastle, Fergusson suffered a brain injury in a fall.

Andrew Duncan

Andrew Duncan

With his mother struggling to look after him, he was committed to Darien House, part of the city’s Bedlam asylum, on Bristo Place, where those with mental illnesses were offloaded. The conditions were terrible – food was in short supply and the use of restraints was commonplace.

Within weeks Fergusson was dead. His brutal end deprived Scotland of another potential bard (Robert Burns, who was inspired by his verse, erected a memorial on his unmarked grave in Canongate Kirkyard). But it also had a second, more positive legacy.

Among those shocked by his plight was Edinburgh-based physician Andrew Duncan. Having visited Fergusson at Darien House, Duncan was all too aware of the inhumane treatment meted out to those who suffered any kind of mental breakdown. With support from 18th-century notables, including the Duke of Buccleuch, he pledged to set up a better institution for the mentally ill, one that would draw on best practice from all over the world and would focus on rehabilitation.

Now that institution, the Royal Edinburgh Hospital in Morningside, is preparing to celebrate its 200th anniversary. Today, hundreds of patients a year benefit from its services. Set within large, landscaped grounds, it has units specialising in alcohol and substance abuse, eating disorders, brain injuries and forensic psychiatry.

Darien House

Darien House

The hospital has led the way in many fields particularly in the treatment of post-traumatic stress disorders, where pioneering work with First World War veterans suffering shellshock, at nearby Craiglockart War Hospital, led to the formation of the Jordanburn Nerve Centre in 1929 and the Rivers Centre in 1997. The hospital was also instrumental in setting up Veterans First Point, a support group for former soldiers.

About to embark on a massive redevelopment programme, the REH owes its success to the tenacity of Duncan, who led a 40-year fundraising campaign to make his vision for a more humane attitude towards those with mental illnesses a reality.

Back then Darien House and other asylums did little more than control the inmates’ outbursts, often in the most barbaric fashion. “You wouldn’t have found many doctors there and the attendants relied heavily on mechanical restraints – straitjackets, metal harnesses and chains,” says Dr John Crichton, the REH’s clinical director. “There were all sorts of horrific management strategies, so for example if an attendant was bitten it was common practice for the patient to have all their teeth taken out.” By the late 18th century, however, the issue of mental health was rising up the political agenda, not least because King George III was at that time suffering bouts of insanity.

Across Europe there were pockets of good practice: in France, psychiatrist Philippe Pinel rejected the use of restraints and bleeding, purging and blistering in favour of talking to and observing patients. The Retreat in York, founded by Quakers in 1792, also treated the mentally ill with sympathy and respect.

Thomas Clouston

Thomas Clouston

Nevertheless, it was only when the British government handed over £2,000 from estates forfeited during the Jacobite rebellion that Duncan was able to buy the site in Morningside which was to become East Wing, the hospital’s first base. In 1807, a Royal Charter was granted by George III himself and in 1813 the hospital opened its doors for the first time. Known at that time as the Edinburgh Lunatic Asylum, it at first took only those who could afford to pay. But by the 1840s, enough money had been raised to build the West Wing – the part of the hospital that still stands, and the first non-paying patients were accepted, allowing Darien House to close at last.

At roughly the same time, the hospital, which had, up until then, relied on visiting doctors, began to appoint forward-thinking physician superintendents, starting with William Mackinnon, who forged the hospital’s reputation for pioneering treatment.

He was convinced of the therapeutic benefits of labour, a concept which underpins much of modern-day psychiatric care. Under his leadership, patients were encouraged to undertake the work they had done in the outside world. Land was set aside for pig farming, poultry-keeping and vegetable-growing; inside, patients took on carpentry and basket-weaving.

“Mackinnon was really keen on maintaining the professional skills of the people who were detained,” says Crichton. “If you were a cobbler then he wanted you to continue your trade as far as you could in order to help your recovery. You can hear the echo of this in work that’s going on today.

“Last week our Orchard Clinic had a harvest barbecue and we enjoyed some of the vegetables patients have been growing in the old orchard of the old hospital.”

As in Stoke Mandeville during the Second World War, the REH promoted sports as an aid to recovery, setting up curling and bowling clubs, as well as encouraging art and music. Most innovatively, it brought in a printing press and published the Morningside Mirror, a magazine which carried stories of the hospital’s activities alongside poetry and art works.

But it was Thomas Clouston, who took on the role of physician superindentent in 1873, who was responsible for treasure trove of patients’ letters and drawings now found in the Lothian Health Services Archive at Edinburgh University.

Realising that those who are mentally ill often struggle to talk about their problems he hoped to glean an insight into their condition through their writing and art – and indeed the letters reveal symptoms of many different types of mental illness, including schizophrenia.

Clouston was also interested in the impact of physical environment on mental health, experimenting with various architectural styles and layouts in an attempt to create surroundings that were both stimulating and therapeutic.

Under his influence Craig House estate was purchased and the magnificent, new neo-Gothic building of Craig House Hospital, with its great hall, dining room and billiard rooms was opened for paying patients in 1894. The 6th Duke of Leinster, Maurice FitzGerald, lived in his own villa on the site for 15 years, attended by a butler, until his death in 1922.

The asylum, renamed the Edinburgh Royal Hospital for Mental and Nervous Disorders, continued its cutting-edge work throughout the 20th Century; as well as the Jordanburn Nerve Centre, it opened one of the country’s first child psychiatry clinics in 1931, and the dawn of the new millennium saw the launch of the Orchard Clinic, Scotland’s first medium secure unit for mentally disordered offenders.

To celebrate the REH’s bicentenary a series of lectures on mental health is being held, kicking off tonight with a look at changing perspectives from the beginning of the 19th century. The talk by Andrew Scull, professor of sociology and science studies at the University of California at San Diego will be held at Edinburgh City Chambers. The Lothian Health Services Archive is also launching an appeal for fresh documents connected to the hospital, particularly anything from the latter half of the 20th century.

Crichton believes that, while celebrating the REH’s past, the emphasis should be firmly on the future. He says awareness-raising exercises such as the See Me campaign have lessened the stigma surrounding mental illness, but there is still a long way to go: “I think the thing we as mental health professionals need to reflect on is our own attitude towards things such as peer support workers. We introduced peer support workers, previous service users, to work alongside psychiatrists at Veterans First Point and that has proved to be really innovative and helpful because they can speak with the authority of having been there themselves. Now we are looking at ways of introducing peer support in other parts of the hospital.”

The key to the REH’s success, he says, has been its willingness to adapt and grow. “We have different challenges to deal with now,” he says. “But the primary focus of recognising the humanity of people with mental health problems and responding to that humanity in a really positive way – that’s what our forefathers gave us – and it continues today.”