When I switched from clinical psychologist to author, I couldn’t help taking some of my professional life with me. But I didn’t draw directly on my experience of the mental health system until my third novel. Matilda Windsor Is Coming Home, recently published by Inspired Quill, is set in a long-stay psychiatric hospital scheduled for closure.
I’m not completely sure why I fictionalised my former workplace. Perhaps I wanted to counteract the stereotype of the madwoman in the attic in Charlotte Brontë’s Jane Eyre. I’d read other novels with more sympathetic portrayals of emotional distress, but none accurately portrayed the transition to community care.
At the beginning of the twentieth century, the county asylums of England and Wales housed over 100,000 people. At the beginning of this century, those Victorian institutions were extinct. Resettlement was a colossal endeavour. By illustrating the process, I could debunk the myth that vulnerable people were dumped on the street.
A novel can educate, but it must entertain. Readers need an intriguing story to keep turning the page. Matilda Windsor Is Coming Home is about a brother and sister, separated for fifty years, and the ardent young social worker who seeks to reunite them. What has kept them apart for decades? Will they reconnect?
Janice, a newly-qualified social worker, represents the idealism, enthusiasm and uncertainty of the hospital closures. We believed it would improve the quality of life of former patients, but how could we know? This was new territory for everyone.
When author and mental health advocate Martin Baker read an advance copy of the novel, he identified with Janice’s relentless optimism. He also found a sobering note in the consequences of her compulsion to set the world to rights.
The novel also highlights how the institution has eroded the residents’ individuality and autonomy. I remember the shock of seeing staff serve tea with the milk and sugar already added to the pot. But that was standard practice. Rehabilitation attempted to revive lost skills, including the basics of choosing and making a hot drink. This resonated for another early reader, Veronika Jordan, whose mother had this ‘choice’ imposed on her in a psychiatric hospital like Ghyllside in the novel.
We had a lot to learn, back in the early 1990s, about proper partnerships between staff and service users. Janice questions customary practice, but change is sluggish in the psychiatric system. Even she succumbs to institutional assumptions.
One such assumption that affected my professional role was that psychological skills and understandings would be more usefully deployed in other settings. During my clinical psychology training in the mid-1980s, the profession was carving out new territory in primary care, abandoning those given diagnoses such as schizophrenia and manic depression to psychiatry. In fact, the only reason I accepted a post in a long-stay hospital was that it was combined with several sessions in community mental health. Yet a couple of years later, I was happy to work in (what was then termed) psychiatric rehabilitation full-time.
Part of the attraction for me was the teamwork. I had some wonderful colleagues, particularly nurses and social workers, with a powerful drive to improve the residents’ lives. Of course, we had our differences; in the novel, I depict the power battles between psychology and psychiatry in terms of who has the tallest case-note tower.
There was great scope for creativity, to an extent that would be barely credible to the micro-managed clinicians in today’s NHS. It was both a privilege and a daunting responsibility to contribute to the design of new services. How could we facilitate ordinary valued lives for vulnerable adults without leaving them unprotected? In Matilda Windsor Is Coming Home, I show the tension between over-control and negligence that we never quite surmount through countless reforms of mental health care.
The biggest change I witnessed wasn’t in the location of mental health care but in our response to emotional disturbance and distress. Admittedly, people given a psychiatric diagnosis still find their perspective discounted, but at least some of those paid to support them try to really listen, sometimes. Contrast that with the message from my training that the content of voices was irrelevant. That we should ignore seemingly irrational statements. Don’t reinforce delusions was the mantra, as if a person’s cherished beliefs could disappear like an unhealthy habit.
I mock that notion in Matilda Windsor Is Coming Home through staff’s misunderstanding of my main character. Matty, a seventy-year-old woman who hears the voice of her deceased mother, has a rich and coherent internal life.
Matty’s insistence that the hospital is her family’s grand country house has helped her tolerate fifty years’ incarceration. When she says her mother married a prince, staff dismiss her words as a grandiose delusion. But, as the reader discovers, this is the source of her difficulties. Matty wants to tell her truth, and the staff want to listen, but they operate on different wavelengths.
Shown the logic behind her beliefs, readers have taken Matty into their hearts. Although her situation is tragic, and her worldview unconventional, she’s a lovable character. In her quirky humanity, she’s an ambassador for mental health.
Even though I made her up, I realise I wrote this book for her, or what she represents. For those who kept their personalities, despite psychotic experiences, the deadening effect of major tranquillisers and a stultifying regime.
Once a book is published, the author must step aside. So I’ll conclude with a quote from another reader: “The light wins in this novel, which manages to be warm, uplifting and surprisingly funny for all the sadness and injustice portrayed.”