Conflicts in the Control of Fear: from the Archives of the New Zealand Mental Hospitals Department.

Rebecca McLaughlan

Abstract In 1923 a popularly held belief was that madness was contagious and that admission to one of New Zealand’s mental hospitals would condemn a patient to a lifetime of insanity.1 The New Zealand Herald informed readers that patients committed to these institutions became ‘asylum-made lunatics… treated as incurable – and so are made incurable.’2 The fear of insanity dissuaded patients from seeking voluntary treatment, despite medical advice that only an early admission could secure a full recovery. This fear also made staff recruitment difficult. This paper will critically examine the press releases created by the Mental Hospitals Department for the nations major metropolitan newspapers, in the 1930s and 1950s, in order reduce the fear surrounding these institutions. More specifically, how this agenda was compromised by historic conflicts that, instead, perpetuated the fear of New Zealand’s mental hospitals. Key Words: Fear, insanity, mental illness, mental hospitals, management, conflict.

***** 1. Reducing Fear in the 1930s

In 1925 Doctor Truby King likened the public attitude toward institutional psychiatrists in New Zealand to the type of distrust a child might show toward his dentist.3 With a view to keeping ordinary people out of mental hospitals the public had made subsequent requests for halfway houses for the treatment of ‘nervous afflictions,’ making clear that these were to be disassociated from mental hospitals in every way and were not to be staffed by institutional psychiatrists.4 Two years earlier The [Christchurch] Press had labeled mental hospital care ‘cruel, dangerous and costly,’5 while the New Plymouth Daily News asserted that ill treatment was endemic to these institutions.6 In 1931 we see the first instance of New Zealand’s Mental Hospitals Department actively utilizing popular media in order to convince the public that their institutions were not places to be feared but scientific establishments, committed to modern treatment and humane care. This would not be easy given that this ‘modern treatment’ was then being delivered within four, outdated, nineteenth century asylums whose very presence on the landscape sustained tales of a custodial era (image 1).

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Image 1: Sunnyside Lunatic Asylum, Christchurch, as published in The Press, 10 January 1931.

Buoyed by the efforts of the International Committee for Mental Hygiene, who

promoted prevention over cure and sought to educate the public to seek early treatment for mental afflictions, Doctor Theodore Gray instructed the medical staff of New Zealand’s mental hospitals to prepare articles suitable for publication within local newspapers.7 Epidemic Encephalitis, a disease known colloquially as ‘sleepy sickness,’ featured in three of the five articles published by the department. The first article explained that some mental diseases occurred as complications from a physical illness. Sleepy sickness could arise from something as commonplace as catching the flu.8 The second article informed readers that encephalitis became prefixed with the term ‘epidemic’ owing to ‘its frequency in epidemic form’ and that certain countries, ‘like Japan,’ remained at risk from serious outbreaks. The article acknowledged that this disease was ‘of interest to those concerned with problems of contact’ but no further information was given regarding how this disease may be contracted or avoided.9 Both this article and the one that followed directed the readers’ attention to the specific effects of this disease on adolescents:

a young patient who was in every respect normal and well behaved before his illness may become a social pest. The bad behavior may be so extreme that parental control soon finds itself helpless … The conduct is subject to emotional outburst of great severity, associated with extreme restlessness and often even violence. The general character, too, is changed, and a

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truthful, obedient and good-tempered child is turned into a lying, perverse and precocious delinquent.10

The third article discussed two case studies, of males aged sixteen and nineteen.

This illustrated the devastating consequences of a disease that rendered patients ‘social[ly] defective.’ The first young man began to fall asleep continually and was no longer able to hold down a job. He became quarrelsome and irritable and was eventually ‘committed to the Borstal for vagrancy.’ The second found himself in prison owing to his behaviour as ‘a rouge and a vagabond.’ Both were transferred to mental hospitals following eventual diagnoses of sleepy sickness. Parents were advised that patients suffering from this illness could no longer reside in the family home where ‘emotional ties’ would ‘aggravate their already unstable character.’ Instead they required the ‘firm but kindly discipline’ of the hospital environment: ‘the treatment of these cases may be summed up in protecting the patient from his environment, and the environment from the patient [emphasis added].’11

Let’s try to digest this information from a lay perspective. Here we are faced with an illness that can be acquired from simply catching the flu, whose very name threatens the possibility of contagion. While Merriam-Webster’s Medical Dictionary defines the term epidemic as ‘affecting … an atypically large number of individuals within a population, community, or region at the same time,’12 the Random House Dictionary includes the description ‘spreading from person to person in a locality where the disease is not permanently prevalent [emphasis added].’13 Adolescents faced the greatest risk from this disease, for which no treatment was available and life within a mental hospital would result. Yet we are given no information about how to safeguard oneself or ones children from this socially debilitating illness.

Intriguingly, in 1931, New Zealand had only sixteen diagnosed cases of encephalitis within a mental hospital population of six thousand; it affected only 0.2 per cent of patients.14 Even during the highest incidence of this disease, in 1919, epidemic encephalitis accounted for only 2 per cent of the mental hospital population. By 1931 this disease was recognized as being firmly in decline. In 1931 the Mental Hospitals Department had a clear agenda to improve the accessibility of mental hospital treatment to the wider population.15 But this would not be successful unless steps were taken to mitigate the fear that prevented suffers from seeking voluntary treatment within a hospital or an out-patient clinic. The department’s choice to focus on sleepy sickness, a frightening though uncommon disease, seriously compromised this agenda.

There is evidence to suggest that the Mental Hospitals Department may have prepared these articles in response to an existing fear of sleepy sickness within the public consciousness. Three years earlier the Auckland Star published an article on this disease in which it quoted Miss May-Atkinson of the British Medical Association. The article began: ‘we have to face a great problem. We shall have in

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the future an enormous number of children who will be called criminals…’ May-Atkinson suggested that a rise in the incidence of sleepy sickness would cause this situation to occur. Among the various effects of this disease she cited ‘thieving and lying… homicidal and suicidal tendencies.’16 While there is little doubt that this article would have been alarming to the public, it was still a single article published in a single newspaper regarding an illness that occurred in much smaller numbers in New Zealand than in Britain. It did not seem to warrant the distribution of three separate articles to all of the nations major metropolitan newspapers.

A second possible argument is that the Mental Hospitals Department were trying to reduce the stigma surrounding mental illness. Any normal, healthy person could catch the flu. Criminal or degenerate tendencies did not predispose someone to this illness. In respect of its origins therefore, sleepy sickness was a useful disease to reinforce the message that anyone could become afflicted with mental illness. The third article also made the point that adolescents afflicted with this disease should not be judged too harshly. They are sick and cannot be held responsible for their actions. These arguments do not fully explain, however, the Mental Hospitals Department’s inability to successfully execute their own media agenda. A protracted discussion of a frightening and sensational disease could not have helped to encourage the public to seek voluntary treatment. So how did such a clear agenda become so muddled in its execution? The answer lies in the conflicting agendas of the Mental Hospitals Department.

The first issue compromising this agenda was the departments’ awareness that they needed to try to overturn the assumption that their institutions were performing a purely custodial role. These articles promoted the idea that New Zealand’s mental hospitals were, conversely, making a valuable contribution to society. Institutional psychiatrists possessed specialised skills in diagnosing obscure conditions, like epidemic encephalitis, while the hospitals themselves were performing an important public service in protecting society from socially defective persons. They were, as one article plainly stated: protecting the patient from his environment, and the environment from the patient [emphasis added].17

The second issue compromising this agenda was a desire to reinforce links between psychiatry and the scientific practice of medicine. Psychiatry had long struggled to gain an equal footing with its general medicine counterparts. In his autobiography, Gray contextualised the relationship between psychiatrists and their colleagues in general medicine, recounting that the decision to take up psychiatry was regarded by ones peers as “evidence of eccentricity.” Believing that little could be done to help these patients, there was a serious lack of appreciation for the job institutional psychiatrists were trying to do. Gray recalled that “the recently qualified man who joined the staff of a mental hospital was regarded as having committed professional hari-kari.”18 All five of the articles published were heavily interspersed with medical jargon despite the lay audience these were intended for.

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An article discussing the malarial treatment of general paralysis, for example, included the following paragraph:

acute bodily illnesses accompanied by high fever sometimes produces an amelioration in the symptoms of a general paralytic and prolong his life. Wagner-Jauregg, in Austria, decided to produce a febrile condition artificially, and accordingly, inoculated these patients with malaria…. producing a series of feverish attacks on alternate days, a day with normal or subnormal temperature intervening.19

Dr Theodore Gray personally reviewed all five articles that were sent out for publication. The argument, therefore, that the doctors who contributed these articles were inept at breaking down complex medical ideas for a lay audience is negated by this fact. Gray’s own autobiography confirms that he was a man whose skills in breaking down complex medical ideas for a general audience were exemplary.20 Gray was both a perfectionist and an autocrat21; this cannot have been an oversight. So why did he choose to retain such highly specialised language for a lay audience who could not have adequately comprehended it? It seems that the opportunity to make psychiatry sound as scientific and complex as it was possible to do, within the medium of a daily newspaper, proved too difficult to pass up.

These articles sought to reassure readers that New Zealand’s mental hospitals were professionally staffed places of science that were performing an important public service. However, in utilizing column space to reiterate the devastating nature of this uncommon illness they simply reinforced their traditional role as custodians of societies’ outcasts, helpless in the face of an incurable disease. A clear failure in an exercise intended to reduce the fear of New Zealand’s mental hospitals.

2. Reducing Fear in the 1950s

In the 1950s this department, now titled the Division of Mental Hygiene, embarked on its second significant media campaign. During the war and post-war years staffing levels in New Zealand’s mental hospitals had become critical. In 1942 mental hospitals were declared an ‘essential industry’ but with little success; attempts to force young women to work in these institutions was met with horror. Kate Prebble observed that this work was ‘perceived as dangerous, dirty and isolating’; even the manpower committees were ‘loath to pressure women into occupations that could be detrimental to their primary responsibility as wives and mothers.’22 To give an indication of this fear, ‘several young women’ directed to work at Seaview Hospital ‘fled on the morning train before taking up duty.’23 Arthur Sainsbury’s book Misery Mansion: Grim Tales of New Zealand’s Mental Hospitals (1946) didn’t help matters by suggesting that hospital environments were

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so unbearable they actually caused insanity.24 In 1948 the Division was operating with a staff capacity of only 66 per cent for a resident patient population of over eight thousand.25 They embarked on a series of recruitment campaigns aimed at improving the publics’ perception of these institutions.

Articles drafted in the early 1950s outlined various mental illnesses, their symptoms and treatment. They stressed the indiscriminate nature of these diseases and implored the public not to engage in the prejudice that dissuaded sufferers from seeking help.26 While several articles were submitted to local newspapers, few were accepted for publication. In the mid-1950s the Division altered its strategy, focusing instead on physical upgrades to hospital environments. The Nelson Evening Mail, Rotorua Post, Northland Times and Waikato Times all commented on the modernity of New Zealand’s mental hospital buildings. The Ngawhatu villas were ‘of modern construction,’ Kingseat boasted the ‘most modern group of buildings in the Auckland region’ and Tokanui had some of ‘the most attractive and modern [buildings] in the country.’27 Dormitories at Tokanui were described as ‘bright and well adorned,’ while sitting rooms were ‘well furnished and comfortable.’28 In addition to the articles prepared by the division, superintendents were encouraged to invite local journalists to tour their hospitals. The sentiments expressed by independent journalists made clear that their hospital tour guides had been well versed in the new media strategy. The New Zealand Women’s Weekly noted that the dormitories at Auckland had been ‘brightened with … chintz window curtains… flowered bedspreads and wooden bedsteads.’29 The New Zealand Herald reported that ‘the ugly old bathrooms’ had been ‘decked out in glistening cream tiles and chromium plate,’ while hospital walls ‘glow[ed] with the pink, blue and gold tints of the home decorator’s brush.’30 Honing in on motifs of domesticity tied into an existing cultural milieu. As Prebble observed, in the immediate post-war years the ‘ideology of domesticity was paramount.’31 In establishing similarities between these institutions and the family home, mental hospital patients, and by extension the environment itself, could be portrayed as relatively normal and thus harmless. The clear disadvantage to this strategy was that it elevated architecture over science. These institutions still strove to provide modern medical treatment but this message was obscured by the discussion of fresh paint and new furniture.32

In 1967 the NZBC filmed a critical piece on the current state of New Zealand’s mental hospitals, questioning the divisions’ on going construction of new buildings at existing, rurally isolated locations. Experts in psychological medicine from the University of Otago claimed the divisions’ expenditure on new buildings flew in the face of all expert opinion. Financial resources should be used to attain quality staff not bricks and mortar, and certainly not in remote locations inaccessible to the communities they served.33 The Division did press ahead with new construction projects however the construction of new facilities was both necessary and overdue. Throughout the depression and wartime minimal funds were available to

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construct new accommodation, despite an ever-increasing patient population. Structural damage to large existing hospitals and post-war construction shortages further exacerbated this situation. In 1943 the department faced the loss of two of its largest facilities; the Seacliff Asylum was becoming increasing unstable owing to site instability while large portions of the Porirua Asylum had to be demolished owing to earthquake damage sustained a year earlier. Land already in hospital ownership, however remote, required no financial outlay. The construction of new facilities at existing rural locations could hardly be considered a choice given the financial limitations that New Zealand’s Mental Hospitals Department operated within. Yet the Division had set themselves up for the criticism dealt within the 1967 documentary. Their willingness to embrace motifs of domesticity, to promote this aspect of hospital life ahead of the medical tasks these institutions were performing, placed construction in the spotlight and further decreased their medical credibility. 3. In Conclusion

Conflicting agendas within the media campaigns pursued by this department resulted in serious compromises to their intended message. The lengthy discussion of sleepy sickness, a ‘sensational’ and statistically unremarkable condition, revealed a desire to reaffirm ties between psychiatry and general medicine that undermined the department’s success in reducing the fear of these institutions. While the division’s attempts to re-frame the mental hospital environment as normal and homelike, instead of dangerous and frightening, elevated the image of domestic quotidian above that of the hospital as a professionally staffed place of science. The perception that New Zealand’s mental hospitals were merely custodial and could do little to help anyone caught within the grasp of mental illness was inadvertently maintained by both campaigns, perpetuating the existing fear of these institutions.

Notes 1 ‘Halfway! The Borderland. ‘Twixt Madness and Sanity. Need for a Great

Reform,’ Auckland Star, 10 January 1923. 2 ‘Mental Maladies,’ New Zealand Herald, 10 March 1923. 3 New Zealand Appendix to the Journals to the House of Representatives [hereafter

AJHR],1925, H-07, 4. 4 AJHR 1925, H-07, 4. Halfway houses were also to treat those suffering from

‘incipient’ mental diseases – in lay terms, those suffering from the early symptoms of mental illness whose disease had yet to cross into a chronic state. Chronic was defined as lasting six months or more.

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5 ‘Mental Hospitals Report,’ The Press, 01 August 1923. 6 ‘Mental Patients,’ The New Plymouth Daily News, 02 August 1923. 7 Circular Memorandum for All Medical Superintendents from the Director-

General, Mental Hospitals Department, 13 January 1931, Subject: International Congress on Mental Hygiene. Mental Hospital Department records: ‘International Conference on Mental Hygiene at Washington, USA, and various correspondence, 1929-1936.’ Archives New Zealand reference: R16195641

8 Mental Hospitals Department, ‘Mental Illness: Physical Causes. Conflicts and Consequences.’ Evening Post, 27 February 1931 & Auckland Star, March 14, 1931.

9 Mental Hospitals Department, ‘Sleepy Sickness: Strange Affliction. Onset and Symptoms.’ Evening Post, 13 March 1931.

10 Ibid. 11 Ibid. 12 Dictionary entry for: epidemic, copyright Merriam-Webster Incorporated 2013.

Viewed 08 July 2013. <http://www2.merriam-webster.com/cgi-bin//apps/apache/docs/cobrands/cgi-bin/mwmedsamp>

13 Dictionary entry for: epidemic, copyright Random House Incorporated 2013. Viewed 08 July 2013. <http://dictionary.reference.com/browse/epidemic?s=t>

14 Mental Hospitals Department, ‘Sleepy Sickness: Illustrative Cases. Character Change.’ Evening Post, 24 March 1931. AJHR 1929, H-07, 1.

15 As part of this agenda out-patient clinics were initiated by Truby King and Theodore Gray introduced voluntary admission to mental hospitals. AJHR 1925, H-07, 4. Warwick Brunton, ‘Gray, Theodore Grant’ in the Dictionary of New Zealand Biography, last modified 30 October 2012. Viewed 21 January 2011. <http://www.teara.govt.nz/en/biographies/4g19/gray-theodore-grant>

16 ‘Making Criminals. Ravages of Sleepy Sickness.’ Auckland Star, 8 December 1928. 17 Ibid. 18 Theodore Gray, The Very Error of the Moon. (Ilfracombe, Devon: Arthur H. Stockwell Ltd, 1958), 76. 19 Mental Hospitals Department. ‘Mental Disorders. General Paralysis. Malarial Treatment.’ Evening Post, 6 March 1931. 20 Gray, Very Error of the Moon, 76. 21 The authors own archival research is consistent with the conclusions drawn by

Warwick Brunton. Refer: ‘Gray, Theodore Grant – Biography.’ 22 Catherine Mary (Kate) Prebble, ‘Ordinary Men and Uncommon Women: A History of Psychiatric Nursing in New Zealand Public Mental Hospitals, 1939- 1972’ (PhD diss. University of Auckland, 2007), 66. 23 Warwick Brunton, Sitivation 125: A History of Seaview Hospital, Hokitika and

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West Coast Mental Health Services, 1872 -1997 (Hokitika: Seaview Hospital 125th Jubilee Committee, 1997), 46. 24 Arthur Sainsbury, Misery Mansion: Grim Tales of New Zealand Asylums

(Auckland: Wright & Jacques Ltd, 1946). 25 Brunton, Sitivation 125, 51. AJHR 1948, H-07, 1. 26 Division of Mental Hygiene, Draft Press Releases, various titles, 1950-1954.

Division of Mental Hygiene records: ‘Publicity, recruitment of nurses, 1951-60.’ Archives New Zealand reference: R16195751.

27 ‘More Psychiatric Nurses Are Needed in Nelson.’ Nelson Evening Mail, 19 February 1958. ‘Psychiatric Nursing is a Rewarding and Interesting Career,’ Rotorua Post, 23 February 1957 ‘Northland has Considerable Interest in Kingseat Hospital,’ Northland Times, 22 February 1957.’Psychiatric Nursing A Satisfying Career: “Bad Old Days” Gone,’ Waikato Times, 23 February 1957.

28 ‘Northland Has Considerable Interest in Kingseat Hospital,’ Northland Times, 22 February 1957.

29 Joyce Halstead, ‘Are they the Forgotten People?,’ New Zealand Women’s Weekly, 24 June 1954.

30 ‘Our Mental Hospitals, 2 – The “New Freedom” Comes To Avondale, City’s Oldest Mental Hospital Is Living Down the Past,’ New Zealand Herald, 07 September 1954.

31 Prebble, ‘Ordinary Men and Uncommon Women,’ 69. 32 For an expanded discussion of this media campaign refer: Rebecca McLauglan,

‘Post-rationalisation and Misunderstanding: Mental Hospital Architecture in the New Zealand Media,’ Fabrications: The Journal of the Society of Architectural Historians, Australia and New Zealand, 22:2 (2012), 232-256.

33 New Zealand Broadcasting Commission, ‘Compass: Mental Health,’ 1967. Television New Zealand Archive reference: P48593.

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‘Making Criminals. Ravages of Sleepy Sickness.’ Auckland Star, 8 December 1928.

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‘Mental Maladies.’ New Zealand Herald, 10 March 1923.

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Mental Hospitals Department (New Zealand), ‘Mental Disorders. General Paralysis. Malarial Treatment.’ Evening Post, 6 March 1931.

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Mental Hospitals Department (New Zealand), ‘Sleepy Sickness: Strange Affliction. Onset and Symptoms.’ Evening Post, 13 March 1931.

Mental Hospitals Department (New Zealand). Mental Hospitals Department records: ‘International Conference on Mental Hygiene at Washington, USA, and various correspondence, 1929-1936.’ Archives New Zealand reference: R16195641

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McLauglan, Rebecca. ‘Post-rationalisation and Misunderstanding: Mental Hospital Architecture in the New Zealand Media.’ Fabrications: The Journal of the Society of Architectural Historians, Australia and New Zealand. 22:2 (2012), 232-256.

New Zealand Broadcasting Commission. ‘Compass: Mental Health.’ 1967. Television New Zealand Archive reference: P48593.

Prebble, Catherine Mary (Kate). ‘Ordinary Men and Uncommon Women: A History of Psychiatric Nursing in New Zealand Public Mental Hospitals, 1939-1972.’ PhD diss. University of Auckland, 2007.

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Sainsbury, Arthur. Misery Mansion: Grim Tales of New Zealand Asylums. Auckland: Wright & Jacques Ltd, 1946.

Rebecca McLaughlan is a Registered Architect and PhD Candidate at Victoria University of Wellington. Her doctoral research, titled ‘One Dose of Architecture, Taken Daily,’ examines New Zealand’s history of mental hospital architecture from 1878-1959.