Paddington Day Hospital was an important nexus in the UK radical psychiatric community, a ‘space of convergence’ of various progressive counter-cultural forces that were a feature of the period, bringing together radical mental health workers who were attracted to therapeutic communities as an alternative to the conventional psychiatric hospital, ideas of anti-psychiatry, and key figures in the emerging patients’ movement. According to Helen Spandler, Paddington’s story contains “both the possibilities and limitations of the radical psychiatrist as an ‘agent provocateur’ within psychiatry… That the history of Paddington Day Hospital was so clearly riddled with these tensions and paradoxes marks it as an important moment in history. Not only did patients and staff struggle to collectively defend the progressive elements of the day hospital, they were also vociferous in resisting its practices when it failed to meet their expectations.”
The Paddington Clinic and Day Hospital opened in 1962, replacing the Camden Clinic which closed. It was one of the first NHS units to provide psychoanalytic therapy.
The Clinic and Day Hospital were located in a new 3-storey building next to a petrol station on the Harrow Road, adjacent to the Westway motorway. The building also housed the Child Guidance Clinic, transferred from the St Marylebone Hospital for Psychiatry and Child Guidance.
Most of the ground floor was occupied by the Day Hospital, which had been established initially as an out-patient facility for the rehabilitation of patients discharged from Horton Hospital. The cafeteria and the Art Therapy Room on this floor were shared with the other departments in the building. In 1965 an Out-Patients Department opened to provide psychotherapeutic treatment for adults.
In the same year a ‘therapeutic community’ was established in the Day Hospital by a consultant psychiatrist who did not believe in ‘organic’ means of treatment, such as E.C.T. or chemotherapy. The community was run democratically by both staff and patients and the days were filled with group work and activities, comprising community meetings, shared decision-making and group therapy.
In 1970, Julian Goodburn took over as medical director on the unit, and began to introduce more libertarian methods into the Day Hospital. A conventionally trained psychiatrist and psychoanalyst, Goodburn tried to develop a more informal, egalitarian and libertarian approach to treating patients. He was often associated with famous ‘anti-psychiatry’ figures like R.D. Laing and David Cooper, because of his increasingly radicalised thinking and ideas, though he had little contact with them.
Goodburn aimed to challenge accepted psychiatric, psychoanalytic and therapeutic community thinking at the day hospital; not only questioning the ideologies of the medical professions, but also tackling patients’ own perceptions of themselves in relation to the world and their place within it.
Rather than seeing individuals as victims of ‘mental illness’, Goodburn saw patients as exposing wider social tensions: “There is a correlation between the contradiction, or disquiet that they’re experiencing, and the contradiction or disquiet that everybody ought to be experiencing a propos some factor of society at large, which, you know, they are, through circumstances of their particular experience, the bearer of—the victim of, you might even say—and will subsequently manifest this as if it were something solely going on in them, when in fact it is going on in them, but as a consequence of the fact that these issues are not resolved in the world at large, and it just happens that they are the person standing on that particular street corner at that particular time who’ve copped it, as it were.”
He challenged his own accepted role of the Medical Director (the consultant psychiatrist) in a psychiatric setting, refusing to take ‘medical’ responsibility for the day hospital and carry out official mental health assessments, give out diagnoses, hand out palliatives or sign their medical certificates which would designate patients as ‘mentally ill’. “Not wanting to perpetuate their role as helpless victims and as ‘mental patients’, staff challenged their need to be designated ‘sick’. As a result the staff queried the need to sign medical certificates. Goodburn had a confrontational therapy style, pushing issues to their limits in an attempt to force personal and political awareness. Some of this style was developed from his long-time association with the group psychoanalyst, Henry Ezriel, although Goodburn radicalised Ezriel’s approach in the more politically aware context of the day hospital, following a politicised campaign to save it from closure. Humour was an important and often under-recognised trait of both Ezriel and Goodburn, who presented their ideas and experiences with case studies, stories and selfmocking jokes…. Goodburn used psychoanalytic interpretation and humour in an attempt to reveal underlying interpersonal, social and political dynamics which were impacting on the situation at Paddington… On one occasion Goodburn was reported as being found under a table refusing to make decisions on behalf of the patients, forcing them to take responsibility for their own lives and actions; on another occasion as barricaded into one of the therapy group rooms for refusing to sign patients’ medical certificates.”
This last incident reveals some of the tensions that Goodburn’s approach though up. Questioning the meaning of ‘mental illness’ is one thing – but patients depended on doctors’ signing medical certificates for daily survival, dealing with the dole etc. So refusing to sign them was not always helpful. But the double-edged nature of the ‘anti-psychiatrist’ went even deeper.
“Whilst the radical psychiatrist… can be seen as a positive force for change in contributing to emerging radical mental health movements, it inevitably expresses a number of limitations and problems. Indeed, radical psychiatrists occupy a ‘paradoxical space’ in which they simultaneously subvert, and yet often also reproduce, prevailing power relations… even though the radical psychiatrists frequently used ‘alternative’ psychiatric discourse, they ultimately had more power to do so than patients, or other workers. Their ‘alternative’ could still be considered in the broader lexicon of the ‘psy’ disciplines, which tries to impose particular forms of expert psychological knowledge”.(Helen Spandler)
Some patients and staff at Paddington believed that psychoanalytic interpretation were being imposed, however seemingly democratic… Other commentators viewed Goodburn’s regime as manipulative and ultimately dangerous, with the staff applying “implicit psychoanalytic rules which acted as a coercive regime of truth in the day hospital”. The pursuit of these ideas led to a ‘anarchy, chaos and tyranny’… a situation in which some patients felt neglected, mistreated, eventually leading to an official enquiry and the eventual sacking of the medical director and the closure of the day hospital.
The Day Hospital had little in the way of furniture or ornamentation, and its floors were bare. The main group meeting room was a large L-shaped room marred by a central pillar. It contained a sagging sofa and a variety of armchairs of varying degrees of comfort. Rather surprisingly, the room lacked heating, which was often a source of complaint during meetings.
The consultant felt it was the responsibility of the patients to tidy up after themselves rather leave it all to the cleaner, so the Hospital became increasingly unclean and untidy. Patients occasionally used materials from the Art Therapy Room to paint graffiti on the walls to express themselves and their opinions about the Hospital. These were left on the walls so that they could be discussed by the group. The appearance of the Day Hospital thus contrasted strongly with the more aesthetic environment of the rest of the centre, where it was becoming increasingly viewed as ‘different’. It was becoming estranged from the traditional psychiatric establishment.
The Day Hospital accepted patients who had been assessed as psychologically unsuitable for psychotherapy. Its ‘open door’ policy means that people could attend when they wanted. Staff began to refuse to diagnose psychiatric conditions or to prescribe medication, or even to keep medical records for their patients. Initially the Day Hospital had received patients from its catchment area, but soon took on those from other areas who had heard of the therapeutic community and self-referred themselves. Since few records were kept, it was not known where patients came from, but some had come from as far away as Ipswich in Suffolk. The patients were mainly white, well-educated, young adults, although a number from the local African Caribbean community also attended. Most patients remained at the unit for about one to two years.
Some patients shared a commune, living together in cheap accommodation. The Day Hospital supported this, so that the intense group dynamics could continue for 24 hours a day.
In December 1971 the staff and patients formed a protest group, after the impending closure of the Day Hospital and its transfer to the newly opened psychiatric unit at St Mary’s Hospital was announced by the Area Health Authority. At this time the Day Hospital had 50 members of staff and 80 places for patients. The new facility at St Mary’s Hospital had 60 beds and 80 places for day patients.
The Paddington Day Hospital protest became symbolic of the anti-psychiatric movement; public awareness of mental health issues and resistance to psychiatry was growing at this time, and there were interesting initiatives sprouting around the world. The campaign’s slogan was Paddington Day keeps madness at bay.
On 25th February 1972 patients and staff invaded a meeting of the Regional Hospital Board to force a discussion of the planned closure. This was followed by a packed public meeting at Sidney Webb College, ‘Madness, A Choice of Treatment’, to protest the closure, organised by the action group opposing the move. The meeting was attended by 700-900 people.
The protest was successful – on April 11th 1972, the action group learned that the closure and transfer had been abandoned. A planned demo turned into an impromptu celebration in the street. The Day Hospital remained open, at a time when similar units around the country closed.
In March 1973 about 100 people, mostly patients or former patients, met at the Day Hospital to discuss forming a union for mental patients. Following this, the Mental Patients Union was established, with full membership reserved for patients and ex-patients.
In 1974 the Clinic and Day Hospital were renamed the Paddington Centre for Psychotherapy.
In January 1976 the patients called for an inquiry into the functioning of the Day Hospital and its lack of shared decision-making. This provoked an investigation by the Area Health Authority, which led to the Medical Director being dismissed.
Although the new Medical Director attempted to re-establish a therapeutic community, it failed to gel, and the Day Hospital began to be wound down through 1978, and the patients discharged.
The Clinic and Day Hospital closed in 1979. Services moved to the Parkside Clinic in Lancaster Road.
Interestingly though the old Day Centre building is still in use, by St Mungo’s Housing Association, providing hostel accommodation for 41 homeless men aged over 50, many of whom are mentally ill. Breakfast and an evening meal are provided, and residents are permitted to drink alcohol in their rooms and in two communal lounges (another lounge is a designated ‘dry’ area).
An entry in the
2017 London Rebel History Calendar – check it out online.