On that first morning, Maitland explained the regimen he had devised. ‘The aim is to maintain narcosis for at least twenty-one hours a day. Every six hours, patients are woken up, taken to the lavatory, washed, and given drugs, food and vitamins. ECT is administered weekly. Careful records are kept of blood pressure, temperature, pulse rate and respiration; fluid intake, urinary output and bowel function are also noted. Due to the risk of paralytic ileus, regular laxatives are used and abdominal girth measured daily. Enemas are given immediately if there is any suspicion of failing bowel activity.’
Maitland walked from bed to bed, examining the charts, and making comments. ‘All of the patients receive six-hourly chlorpromazine: one hundred to four hundred milligrams. Lower doses are given if the patient is sleeping well, higher doses if the patient is agitated or not sleeping. In addition to chlorpromazine, the more agitated patients also receive sodium amylobarbitone. Because this drug has been associated with withdrawal fits, EEG measures are taken regularly to identify those who might be at risk.’ He indicated the woman with the wires sprouting from her scalp.
I asked Maitland about the patients’ diagnoses and he replied, ‘Schizophrenia and schizophrenia with depression.’ When I pressed him for more details, particularly concerning the individual cases, he was not very forthcoming. ‘They are all very sick,’ he said, in a tone that suggested the severity of their psychopathology made discussion of specific histories irrelevant. ‘Treatment is our priority.’
It transpired that one of the patients was due to receive her ECT. ‘We might as well do it now,’ said Maitland, running his finger down the chart. ‘I’ve made a few practical modifications to the standard procedure which might interest you.’
The patient was young, probably in her late teens. Her mousy hair had been cut short and her nose and cheeks were lightly freckled. She looked quite boyish.
Maitland rolled a trolley to the bedside. The flex that trailed across the floor tiles connected an electric shock machine to a wall socket. It was an old unit – older than I had expected. The outer case was made of a dark, reddish wood, and when the lid was lifted I saw a control panel of black plastic. White lettering identified each switch, two of which were surrounded by circles of ascending numbers. Through a crescent-shaped window it was possible to monitor the mains voltage. Bulky electrodes – Bakelite handles with rounded metal termini – were stored in a side compartment.
I was wondering why the nurse wasn’t summoning her colleagues. Maitland registered my expression and said, ‘I’ve invented a simple expedient which means that we will only be needing one nurse.’ He drew my attention to a bolt of material suspended under the bed. He crossed the patient’s arms and unrolled a canvas sheet, pulling it across the sleeping girl before securing it tightly so that no movement was possible. ‘You see, it does the work of four nurses!’ I looked at the patient’s chart and saw that her name was Kathy Webb. The nurse was cleaning the girl’s forehead. ‘Of course,’ Maitland continued, ‘the great advantage of administering ECT while patients are asleep is that they experience no anxiety – which means one can prescribe longer and more intensive courses.’ He picked up some lint pads and soaked them in a saline solution. He then deftly enclosed the electrodes in the pads and offered them to me, his hands raised slightly. There was something almost ceremonial about his attitude.
‘Would you mind?’
‘No. Not at all.’
I took the electrodes and positioned them on the girl’s temples. Maitland rotated the mains switch and the needle in the meter window moved, tracing an arc from one extreme to the other. I noticed that the ‘voltage’ and ‘time’ controls had been set at their uppermost limits. When I remarked on this, Maitland replied that ‘difficult cases’ required a ‘greater stimulus’. While we conversed, the nurse was inserting a rubber gag. This was done in order to prevent the patient from swallowing or biting her tongue.
‘Are you ready?’ Maitland asked his helper.
The nurse gripped the girl’s jaw and nodded. Maitland then looked at me. ‘Ready?’
‘Yes,’ I replied.
He smiled and his eyes directed my attention to a particular switch on the unit which could be flicked from left to right, between the words ‘safety’ and ‘treat’. The switch moved easily and made a soft click. At which point, the needle in the meter window suddenly dropped and the patient grimaced. Maitland turned the machine off and I replaced the electrodes in their compartment.
A tendon stood out on the side of the girl’s neck and she made an involuntary grunting sound. I could see the mounds of her knuckles beneath the canvas as she clenched her fists. After about ten seconds, there was some rhythmic twitching around her eyes, and both of her feet, which were poking out from beneath the sheet, began to jerk. The seizure lasted for at least a minute, during which time none of us spoke. When the girl’s twitching and jerking had subsided, Maitland unfastened the canvas cover and wound it back onto its drum. Finally, he checked the patient’s respiration and pulse.
‘Good.’
The nurse returned to her station and Maitland and I walked to the door. Before leaving, something made me stop and I turned to look back.
‘How long have they been asleep?’ I asked.
‘Some of them have been asleep for a few weeks, others for several months.’
‘And how long will the treatment last?’
‘At least three months. Possibly four.’ I had never heard of sleep being artificially prolonged for that length of time. My surprise must have shown, because Maitland gave me a hearty slap on the shoulder and said, ‘New ground! That’s what we’re doing here at Wyldehope, breaking new ground!’ An echo returned his final word to us from walls that receded into shadow. One of the patients sighed and the nurse looked up. ‘Now,’ said Maitland, ‘let me show you upstairs.’
There were two wards on the ground floor, one for men, the other for women, and all of the patients were accommodated in separate rooms with large windows. Unfortunately, the iron bars in the casements were rather ugly, dividing the otherwise fine view of the heath into mean, narrow segments. Both wards were very quiet, and when we reviewed the patient records the reason for this remarkable calm was immediately apparent. Maitland believed that if a patient did not respond to medication, then the dose should be doubled, and if there was still no improvement, the dose should be doubled again.
I had assumed that the ward patients would be less sick than those in the sleep room. If they were, it was only by a small margin. They had all been diagnosed with chronic forms of psychosis and depression and almost all of them had either contemplated or attempted suicide. While we were looking through the files, Maitland said: ‘It’s humbling to consider what these poor wretches must go through every day of their lives: the demons they must struggle to overcome, the abject terror, the appalling anguish.’ Naturally, I agreed, and he continued, ‘Have you ever known a patient, suffering from a physical illness, to be in so much pain that they killed themselves to escape it?’ I hadn’t. ‘Can you imagine? To be in so much pain that putting your head in a gas oven seems to be the only solution? That is why our work here is so very important.’
In due course, I would become accustomed to such ardent asides, but on that first day I was somewhat taken aback. It was as though Maitland had been wearing a mask, and that it had suddenly slipped, revealing an altogether different person: a more emotional, compassionate person. I saw the ‘doctor’ rather than the bluff radio personality, or the social engineer who had made it his mission to eradicate mental illness by the end of the century. In years to come, I would hear cynics say that these impassioned speeches were calculated, all part of his ‘act’, but that isn’t true. I think they were genuine and exposed a facet of his personality that he usually chose to conceal. He was a complex man – more complex than the obituary writers ever credited.
After we had finished our business on the wards, Maitland took me to the kitchen and dining area. I was introduced to Mrs Hartley, a plump, frantic woman, who was washing up pots and pans with a young assistant. She dried her hands on her pinafore, compressed my fingers in a raw, red clasp, and asked me about my culinary preferences. She seemed to approve of my likes and dislikes, and said with solemn pride, ‘You can’t beat Suffolk pork, doctor. Best there is!’ As we were leaving, Maitland asked her to prepare some corned beef sandwiches and a pot of tea. She didn’t quite tug her forelock, but she made a gesture that came very close to it.
When we reached the first floor, Maitland showed me a suite of rooms that had been set aside for ‘outpatient’ consultations. He was anxious to stress, as he had done in my interview, that we were only obliged to provide the local community with this service on an occasional basis. He wanted to reassure me that I would not be overworked.
Further on we came to a shiny black door. ‘Just a moment,’ said Maitland, halting to remove a key from his pocket. ‘My office.’ I heard the bolt retreat and Maitland pushed the door open. ‘After you,’ he added, gesturing for me to enter ahead of him.
I stepped into a room that combined the dusty serenity of a museum with the ostentation of a royal apartment. The decor was high Victorian: a marble fireplace, stuffed birds beneath domes of glass, and a massive ox-blood Chesterfield; there were oil paintings, standard lamps, and clocks festooned with silver and gold foliage. The only incongruous feature was a drab grey filing cabinet. On his desktop, Maitland had placed two photographs. One was a formal portrait of an attractive woman in her mid to late twenties – an old photograph, taken before the war. The other showed Maitland standing with three men of a similar type in front of the Statue of Liberty. I guessed they were American colleagues.
We carried on talking and after ten minutes or so the kitchen girl arrived with our sandwiches and tea. While we were eating, Maitland handed me a typed manuscript. It was an as yet unpublished theoretical paper that sought to explain why prolonged sleep was therapeutic. ‘I’d be grateful if you could read it,’ he said, still chewing. ‘If you think any of the arguments are weak, then please say so. There’s no need to rush. Take your time.’ I was flattered. When we had finished eating, Maitland announced that he had some administrative work to complete and that he would be driving back to London at four thirty.
He sought me out before his departure and I accompanied him to his car: a Bentley. The body shell was gleaming and our reflected images were distorted by its sleek curves. Maitland shook my hand and said, ‘Delighted to have you on board. Any problems, feel free to give me a call.’ As he opened the door I detected the mellow fragrance of soft leather and cigars. The car rolled down the drive and bounced a little where the track became uneven. I raised my hand. He must have been looking at me in his rear-view mirror because he responded by sounding his horn. The ground dipped and the car disappeared from view.
I had not been outside all day and paused to take in my surroundings. Wyldehope was situated on a bleak heath that stretched away to the horizon. There was nothing to see, apart from heather, gorse bushes and a few stunted trees. The ground to my immediate left descended to a wide grazing marsh, interspersed with reed beds that rippled in the breeze. An elevated bank followed the coastline, beyond which was a rough, churning sea. It was not blue, but a peculiar shade of brown, like ditch water. I registered some outbuildings: stables that had been converted into living quarters and a lonely whitewashed cottage. To the east, a low-lying seam of black cloud trailed delicate tendrils of rain. I might have dallied there longer, had it not occurred to me that I was now the only doctor present, directly responsible for the care of twenty-four patients. This sudden realization produced a curious mix of anxiety and pride: I had been judged capable of taking charge of Wyldehope by Hugh Maitland, the most influential psychiatrist of his generation. Turning abruptly on my heels, I hurried back inside.
I spent the remainder of the afternoon on the wards, introducing myself to the patients, or at least as many of them as was possible. The majority were either asleep or unresponsive. One of the exceptions was a man called Michael Chapman, who I found pacing around his room, raking his hair with his hands and mumbling distractedly. His notes informed me that he suffered from hallucinations and delusions of persecution.
‘Mr Chapman,’ I said. ‘Is something troubling you? Perhaps I can get you something to calm your nerves.’
He marched over to one of the windows and gripped the bars tightly. Staring out onto the heath, he said, ‘I want to go home, doctor. I want to go home.’ His voice was thin and pathetic.
‘I’m sorry. That isn’t possible, Mr Chapman.’
‘Please, doctor. I want to go home.’
‘But you are unwell, Mr Chapman. You must stay here until you are feeling better. Now, let me get you something to help you relax.’
‘I don’t like this place.’
‘Why ever not?’
He turned to look at me and his lower lip began to tremble. He was like a frightened child. ‘I want to go home,’ he repeated.
I went to his side and eased his fingers from the bars. Then I led him back to his bed. He didn’t resist and submitted to my ministrations without a word of protest.
‘Please sit down, Mr Chapman. You’ll feel better in a minute.’
I called the nurse and told her to prepare a syringe of sodium amytal.
‘Something bad is going to happen,’ said Mr Chapman, wringing his hands.
‘What do you mean? Something bad?’
He shook his head. ‘I can feel it.’
‘Feel what, exactly?’
The poor fellow simply frowned and continued muttering. When the nurse returned, we helped Mr Chapman back into bed and I gave him the injection. ‘You’ve had this drug many times before,’ I said. ‘It may make you feel a little dizzy.’ He produced a heavy sigh, the first outward sign that the sedative was starting to take effect. I had expected him to breathe more deeply but, interestingly, this did not happen. Instead, his respiration continued as before – shallow and fast. I told the nurse to keep an eye on him and to call me if he became agitated again.