A century after it first opened its doors in 1852, Powick Mental Hospital became the leading centre in the U.K. to pioneer an experimental new form of psychotherapy using the drug LSD.
The hospital, originally built to accommodate 200 patients, started its life as Worcester City and County Pauper Lunatic Asylum, its design modelled on Pentonville Prison.[i] By 1952, there were around 1000 patients, 400 of whom were living in the four large wards of the annexe, impersonal and poorly insulated structures added to the asylum site in the 1880s.
In an unpublished memoir written by Dr Betty Eisner, an American psychotherapist who visited Powick in 1958, she remarks that ‘burned’ into ‘her memory [were] the worn steps of the hospital at Powick, concave at their reddish centres from the generations of patients who had patiently trod them almost hollow’.[ii] It could be said that the memory of 100 years of the hospital’s existence was burned into those steps, an intangible indicator of the volume of human traffic that had passed through its doors.
Other visitors to the hospital in the mid-twentieth century commented on how the building possessed a rather forbidding air due to its austere appearance. An American journalist who came to Powick in 1963 remarked that on arrival with his wife, ‘the hospital loomed before us, gray and dismal, its stones piled upon one another in monumental unimaginative weariness […] Here were all the schools, orphanages and prisons of Charlotte Brontë and Dickens wrapped into one. Here was the English “institution” bleak and somber’.[iii]
A similar perspective from closer to home is found in a report of the Berrow’s Worcester Journal from 1962, which stated that ‘most people know Powick only from the outside – its gaunt brick buildings (much like a prison and a memorial to undistinguished Victorian planning and cheese-paring) are repelling’.[iv]
The experimental new therapy at Powick, which the American visitors had come to observe, involved the use of a potent chemical that had found its way to the hospital almost by accident, after Powick’s Deputy Superintendent had chanced upon the substance on an organised study tour of mental hospitals in Switzerland.
On this study trip, one of the places Dr Ronald Sandison was taken to visit was Sandoz Pharmaceutical Laboratories in Basel, where he learned of the research being conducted there with lysergic acid diethylamide (LSD). Unlike the other psychiatrists from England with whom he had travelled, and despite not having heard of it before, Sandison was filled with great excitement at what he saw at Sandoz, so much so that on his return flight from Switzerland, he carried with him in his luggage 100 ampoules of LSD, with which he would begin clinical trials towards the end of 1952.
LSD is a derivative of ergot, a fungus which grows on rye, first synthesised in 1938 by Sandoz biochemist Albert Hofmann and first investigated as a potential circulatory stimulant. After initial investigations for that purpose the substance was shelved, until five years later Hofmann got the idea that it may be worth another look. It was then that Hofmann accidentally ingested some of the drug and discovered its remarkable mind-altering properties. Following further investigation and testing on volunteer subjects and psychiatric patients in Switzerland, it was suggested by Sandoz, somewhat paradoxically, that the drug may prove useful as an aid to psychotherapists in the treatment of neuroses, and/or as a ‘psychotomimetic’, that is, as a madness-mimicking drug which could be taken by psychiatrists to attain an insight into what psychosis was like for their psychotic patients. ‘Normal subjects’ or ‘healthy volunteers’ could be given LSD, allowing psychiatrists to study certain psychotic phenomena.
From the Worcester Evening News 15 January 1968 (Courtesy of Worcestershire Archive and Archaeology Service)
Powick was the first hospital in the U.K. to introduce LSD therapy and many professionals from around the world visited to observe how the pioneering combination of this unusual drug treatment and psychotherapy was employed there. Whilst the development of the LSD therapy programme spanned nearly two decades, putting Powick on the map as a global centre for the clinical use of the drug, this was but one of many transformations the place underwent in the 1950s and 1960s. Years later, Sandison would reflect that ‘LSD treatment succeeded at Powick because it formed part of a much wider programme during which the hospital was transformed from a dilapidated state which degraded the patients into a vibrant therapeutic community’.[v]
In this blog, the first part of the story is told of how the hospital was transformed in that period and why it required such root-and-branch reform. This account draws on documents from the Sandison collection at the Wellcome Library, along with other primary and secondary sources, providing a picture of hospital life as seen through the eyes of one of the most significant figures in its history. The story continues in a series of follow-up blogs, which will delve deeper into how the arrival of LSD, among other changes, reshaped hospital life at Powick during the post-war era.
In the decades prior to the arrival in 1950 of the hospital’s Medical Superintendent Dr Arthur Spencer, Powick had earned the ignominious reputation of being one of the cheapest run mental institutions in the country.
In 1951, Spencer appointed Sandison as a consultant psychiatrist and his new Deputy. At the end of his first year, Sandison signed up for the trip to Switzerland organised by fellow Scottish psychiatrist Dr Isabel Wilson, hoping to learn from psychiatric colleagues there. The new leadership was looking for inspiration to breathe new life into Powick. Prior to the trip, Sandison hoped to meet his hero, the famous Swiss psychiatrist and analytical psychotherapist Carl Gustav Jung. As it turned out, he never got to meet him, but Sandison was encouraged by the prospect that LSD could potentially assist in the creation of a programme of psychotherapy at Powick.
The austere conditions at Powick at the beginning of the 1950s had been allowed to develop under the stewardship of the previous Superintendent, Dr Henry Felix Fenton. According to Dr Peter Hall, under the Fenton regime (which lasted thirty years, from 1920 to 1950), ‘the utmost economy was exercised’.[vi] A Yorkshire-born Edinburgh graduate and ex ship surgeon, Fenton came to work at the hospital in 1907 as assistant medical officer, and by 1920 he had the top job. In his account of the hospital’s history, Hall, a former psychiatrist at Powick, writes that from the interwar years onwards the asylum became increasingly overcrowded, the atmosphere more and more repressive [...] The asylum had stopped being a hospital, and had become a kingdom over which the medical superintendent held sway, managing it with justice and economy, using administrative, or in modern terms, managerial rather than clinical skills.[vii]
Hall heard ‘from more than one member of staff at the time that much of the time the food consisted of milk and bread’.[viii] When Sandison came to Powick he was told that it was considered that patients would become too strong and could overpower the staff if they were provided with proper nourishment. Sandison told Hall that patients ‘were not allowed cutlery and sucked this pap up into their mouths from bowls’.[ix] But there was another reason for the provision of such a diet: many patients during Fenton’s time had all their teeth removed, the reason for which will soon become clear.
The Fenton regime at Powick had been heavily influenced by the theories, clinical practice and administrative power of a dominant figure in British psychiatry at that time. Dr Thomas Chivers Graves was not only Superintendent at two Birmingham mental hospitals simultaneously, Rubery Hill and Hollymoor, he was also, from 1926, Chief Medical Officer to the City of Birmingham Mental Hospitals Committee, giving him supervisory powers over all other mental hospitals controlled by the City of Birmingham.[x] Graves was also the longest serving President of the Royal Medico-Psychological Association (forerunner of the Royal College of Psychiatrists), from 1940 to 1944. His occupancy of such authoritative offices in the region meant that he was in charge of thousands of patients, ‘ensuring that his views on psychiatric therapeutics were implemented on a broad scale’, and his election to the presidency of the national professional body for psychiatrists implied that his administrative abilities carried some weight amongst colleagues.[xi]
Fenton adopted Graves’ idiosyncratic view of focal sepsis, according to which mental and emotional disturbances are the outcome of chronic septic processes infecting hard tissues, especially in connection with the jaws. According to Graves, this called for ‘excision by the surgeon’s knife’ of any potential sites of infection, which could ‘leach toxins into the lymphatic system and the bloodstream and poison the brain’.[xii] This meant that suspect sinuses, tonsils, teeth, stomachs, gallbladders, colons, cervixes, seminal vesicles, among other body parts, could be removed.[xiii] Graves was said to be a frequent visitor to Powick and his influence over Fenton meant that most patients had tonsils, gallbladders and most of their teeth extracted on admission to the hospital.[xiv] When historian Andrew Scull interviewed Graves’ son Frederick, he was told that Fenton was ‘a mouse of a man’, completely intimidated by T.C. Graves, ‘who kept him up to the mark’.[xv] Graves was virulently anti-Catholic, to the extent that he virtually disowned his son when he had the presumption to marry an Irish Catholic nurse; whilst Fenton was a prominent local Freemason, a Past Master of the Worcester Lodge.[xvi] Had they been in charge when the young Roman Catholic Edward Elgar sought musical employment at Powick, as he did successfully in the 1870s, he may not have been welcome. But, as Scull remarked, ‘how these prejudices may subsequently have affected T.C.’s actions as head of mental hospitals which contained large numbers of Irish Catholics we simply do not know’.[xvii] Scull notes that Fenton used profits from Powick patients who were sent there by other local authorities—out-county patient costs being much higher than the actual cost, allowing a handsome profit—to underwrite the construction in 1937 of a treatment centre modelled on Graves’ set-up at Rubery Hill and Hollymoor.[xviii] The centre comprised an operating theatre and ‘treatment rooms’, including facilities for colonic lavage. Sandison also speculated as to where the money came from to pay for a collection of paintings by ‘old masters’ procured by Fenton, which hung on the walls of the Superintendent’s house, Bredon House, a late Victorian addition to the site which lay just inside the entrance gates to the asylum grounds.[xix] Although Fenton was at the helm at Powick during some of the most difficult times in modern British history—the aftermath of the First World War, the Great Depression, the Second World War and its immediate aftermath—there is no question that by the end of his reign, the hospital was in worse shape than at any previous time in its history.
When Sandison arrived at Powick in 1951, he found that ‘there was an air of poverty about the place’.[xx] He ‘was quickly to discover that it was a deeply dismal and anti-therapeutic place’.[xxi] Apparently no doctor had interviewed a female patient alone at the hospital for many years, and consequently this had become the norm on the male side also. He learned that ‘the hospital was deeply impoverished in every department’ and ‘the amenities were bleak in the extreme’, the heating system was ‘almost defunct’, the lighting in the wards was poor and many of the internal telephones did not work.[xxii] Patients suffered from the effects of cold, poor diet and inadequate clothing. Patients on the large, impersonal annexe wards had no privacy and at night the air was filled with the stench of cockroaches. Even ‘the farm, once thriving, had been neglected, the cider orchards which supplied the daily ration of cider to the patients had disappeared and the great cider presses lay derelict’, whilst ‘there was a dismantled gasworks, also a ruin’.[xxiii] On his first day Sandison remembers noticing that the old chapel at the hospital, ‘a small architectural gem in a hollow of ground above the cricket field […] was used as a store, and a sort of Victorian barn attached to the main building had been built to the glory of God’.[xxiv] As he went round the wards he ‘saw the effects of years of neglect and deprivation’ and much of his work at the beginning was ‘devoted to treating the effects of cold and malnutrition’.[xxv] During his first winter there, he and Spencer ‘worked out a plan for creating a modern hospital out of the slum it had become’.[xxvi]
Sandison arrived at Powick at the age of 35, having spent five formative years as a trainee psychiatrist at Warlingham Park Hospital in Croydon. Before that he had served as a physiologist in the RAF during the war. At that time Warlingham Park had a reputation for being a pioneering hospital, where a wide variety of therapeutic techniques were employed, including music and art therapy, and where, unlike Powick, the majority of the patients were admitted voluntarily. Although both hospitals served similar population sizes in Croydon and Worcestershire, Sandison noted that in the latter area the population was very much scattered and the range of occupations was quite different. Sandison was intelligently and affectively attuned to the contextual, cultural and environmental surroundings that could shape the contours of the mind and its disturbances, but also how they could impact upon provision of mental healthcare and attitudes of local people towards it. Despite the fact that he was well aware of ‘the deplorable state to which the hospital had descended’, regarding it as a ‘derelict and disorganised psychiatric slum’, he was drawn to the challenge of developing his own ideas at an institution in need of far-reaching reform.[xxvii] Spencer had suggested to Sandison on his appointment that he should take charge of clinical matters and Spencer would run the administrative side of the hospital’s affairs. They were encouraged that the advent of the National Health Service had brought ‘increased opportunities to the peripheral hospitals’ and had ‘brought psychiatric help to the doors of rural Worcestershire where none existed before’.[xxviii]
The pull factor for Sandison when he decided to join Powick Hospital in 1951 was not only to do with the prospect of undertaking a future-oriented reformist project, which would develop the hospital, improve care for patients and advance his therapeutic ethos, but it was also to do with the affective qualities the place possessed for him, the aura of enchantment and nostalgia which allowed him to dream of a return and a revival.
Making reference to a cycle of poems by Worcestershire man A.E. Housman, Sandison gives an insight into what attracted him to Powick:
“I had left what might be called the London scene because I wanted to develop my own ideas and not be part of someone else’s domain. The region had some romantic associations which have always drawn me to places. The City of Worcester, lying on the River Severn, was ancient border country. The running stream of the river sang the lines of A Shropshire Lad, while the three great cathedrals, Worcester, Gloucester and Hereford, formed an ecclesiastical triangle redolent with memories of visits with my father in the far-off days when he was working with Ancient Monuments.”
There was for Sandison ‘even a sense of romance about Powick Hospital’.[xxx] He had been struck by the fact that it was built on 552 acres of ancient farmland known as White Chimneys and that the great composer Sir Edward Elgar had a long association with the hospital, being appointed bandmaster there in 1879. Although sited so as to render it invisible to local residents, out of sight and out of mind, the asylum did have an uninterrupted view onto the elemental landscape of the Malvern Hills, allowing staff, patients and visitors to marvel at the majestic scenery of the surrounding countryside.
Sandison regarded Fenton as ‘a man with no vision and very little humanity’.[xxxi] When he came to Powick he perceived that ‘under the dead hand of Fentonism the patients and staff had been firmly regimented and nearly all the life and romance had gone from the hospital’.[xxxii] Nevertheless, he found that while ‘Fenton may have stifled all therapeutic initiative during his reign, he failed to extinguish a rapport between staff and patient which extended back into the past of the hospital, long before his time’.[xxxiii]
It was this rapport that Sandison hoped to build upon as the foundation for the development of more flexible and humane forms of treatment and care for Powick patients in the 1950s. Unlike Graves and Fenton, for whom a somatic explanation of mental illness was favoured over a ‘childhood history of frustration’, Spencer and Sandison explored psychological and social sources of patients’ problems, in addition to somatic ones, including environmental stresses, early life experiences and traumatic events.[xxxiv] The change in approach signalled a shift towards developing therapeutic relationships, psychotherapy, social psychiatry, occupational and group therapies, art and music therapies, which were absent from the previous regime. But they were also entering the era of the pharmacological revolution, when a wide range of new psychotropic drugs became available and were thought to target specific psychiatric conditions and symptoms. Most of these new drugs would be used to treat patients at Powick. Clinical trials with two distinctive substances in particular would put the hospital on the international map, including an ancient plant remedy from India, and the new drug from Switzerland, LSD. While the early years of the new leadership still worked against a backdrop of shortcomings carried over from the old order, special measures were taken to provide emergency funds for the hospital, allowing for the replacement of boilers and heating system, an increase in staff numbers, the opening of empty wards, the creation of clinical teams and the establishment of out-patient clinics.[xxxv] It was this reorganisation which would facilitate the introduction of new approaches to treatment and care, consisting of an eclectic, pluralistic and pragmatic combination of different techniques and an emphasis on recreating a community atmosphere.
From Worcester Evening News May 1954 (Courtesy of Worcestershire Archive and Archaeology Service)
From Worcester Evening News May 1954 (Courtesy of Worcestershire Archive and Archaeology Service)
The partnership of Spencer and Sandison would prove decisive in turning the hospital around, demonstrating the extent to which the standard of care in those days was determined, not only by developments in medicine and psychiatry, and by (geo)political, administrative and economic realities, but also by the peculiarities of outlook of the hospital leadership, particularly the willingness of the Medical Superintendent and his Deputy to steer the ship in a given direction depending on what ideas they had about the origins of mental illness and its remedies.
This research was supported by a Wellcome Trust Research Bursary.
The next blog in the series will take a closer look at Spencer and Sandison and how their partnership worked; how disparate therapeutic approaches were combined in an attempt to create a mental hospital approaching as near as possible to the ideal of a ‘therapeutic community’; the part the arrival of an ancient plant remedy from the East, along with LSD, played in these new developments.
[i] Frank Crompton. 2006. ‘Needs and desires in the care of pauper lunatics. Admissions to Worcester Asylum 1852-72’, in Mental Illness and Learning Disability since 1850: Finding a Place for Mental Disorder in the United Kingdom edited by Pamela Dale and Joseph Melling. London: Routledge. p. 49.
[ii] Betty Grover Eisner. 2002. Remembrances of LSD Therapy Past. p. 83.
[iii] W.V. Caldwell. 1968. LSD Psychotherapy: An Exploration of Psychedelic and Psycholytic Therapy. New York: Grove Press. p. 92.
[iv] Anonymous. 1962. The Story of Powick Hospital. The Modern Attitude to the Problem of Mental Illness. Berrow’s Worcester Journal. Friday 6 July 1962.
[v] Ronald Sandison. In-Tide-Out: The Autobiography of a Psychiatrist and Analytical Psychotherapist. Unpublished autobiography, Chapter 6 ‘A Therapeutic Community and a LSD Unit Powick Hospital 1951-1964 Part 2’. p. 23. PP/SAN/A/1 (at the Wellcome Library (WL), all subsequent references to PP/SAN come from WL).
[vi] Peter Hall. 1991. ‘The History of Powick Hospital’, in The Closure of Mental Hospitals edited by Peter Hall and Ian F. Brockington. London: Gaskell. p. 47.
[vii] Ibid.
[viii] Ibid., p. 48.
[ix] Ronald Sandison, Letter to Peter Hall, 5 December 1989, PP/SAN/D/2.
[x] ‘Obituary Notice’, British Medical Journal, i, 1964. p. 1711.
[xi] Andrew Scull. 1996. ‘Focal Sepsis and Psychiatry: The Career of Thomas Chivers Graves, B. Sc., MD. FRCS, MRCVS (1883–1964)’, in 150 Years of British Psychiatry, Vol. 2, The Aftermath, edited by Hugh Freeman and German Berrios. London: Athlone. p. 517.
[xii] Ibid., p. 523.
[xiii] Ibid.
[xiv] Hall, ‘The History of Powick Hospital’, p. 48.
[xv] Scull, ‘Focal Sepsis and Psychiatry’, p. 535.
[xvi] Ibid., p. 531.
[xvii] Ibid.
[xviii] Ibid., p. 535.
[xix] Ronald Sandison, Letter to Peter Hall, 5 December 1989, PP/SAN/D/2.
[xx] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 4. PP/SAN/A/1.
[xxi] Ibid., p. 1.
[xxii] Ronald Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis. A Search for Integration. London: Jessica Kingsley, (2001), pp. 30-31.
[xxiii] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 6. PP/SAN/A/1.
[xxiv] Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis, p. 32.
[xxv] Ibid., p. 31; Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 7. PP/SAN/A/1.
[xxvi] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 7. PP/SAN/A/1.
[xxvii] Ibid., p. 6; Sandison. In-Tide-Out, Chapter 6 ‘A Therapeutic Community and a LSD Unit Powick Hospital 1951-1964 Part 2’. p. 5. PP/SAN/A/1.
[xxviii] Ronald Sandison. 1955. Group Therapy in a Provincial Out-Patient Department. International Journal of Social Psychiatry, Vol. 1, Issue 2. p. 28.
[xxx]Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis, p. 31.
[xxxi] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 1. PP/SAN/A/1.
[xxxii] Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis, p. 32.
[xxxiii] Sandison. In-Tide-Out, Chapter 6 ‘A Therapeutic Community and a LSD Unit Powick Hospital 1951-1964 Part 2’. p. 5. PP/SAN/A/1.
[xxxiv] ‘Obituary’, The Lancet, i, 20 June 1964. p. 1400.
[xxxv] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 3. PP/SAN/A/1; Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis, p. 32.