The Colony of Gheel Effects of War and Present Problems
- Author:
RADEMAEKER, M.D.
Medical Director Gheel, the town of lunatics
To the outsider Gheel is the town of lunatics. Here they go about freely, they can roam as they please, without any interference on the part of the public. The people of Gheel have a happy way of dealing with them and nobody objects to their presence. In fact they live and dwell with the families of Gheel, who take charge of them, as they give them board and lodging.
This popular picture of the Colony is essentially true, although it needs to be completed. Since motoring and sightseeing have become an asset of modern life, it is no exceptional event, especially in the summer, to see touring cars stopping on the Market Place. Large groups of visitors can be watched, pouring out of them. Of course they want ” to see the lunatics ” and how they get along. The medical staff of the Colony does not encourage such visits which are too often inspired by mere curiosity, but they cannot guard against them, nor keep visitors from interviewing patients in the streets.
Therefore, if the visit has been announced beforehand, one of the nurses, or even one of the doctors will take charge of the group and show them around the town.
Visitors will then get acquainted with the history of this unusual and original community. They will be told the story of Dymphna, the Irish Princess, who long ago took refuge in this place and was beheaded by her “possessed” father. They will see St. Dymphna’s Church, with the relics of the saint and her treasures of old art; also the ” sickroom “, an annex of the church, where the insane, who came to Gheel as pilgrims in the Middle Ages, had to stay for prayer in expectance of their cure.
In the meantime they will learn that a lunatic is not necessarily the wildly gesticulating, noisy, boisterous or raving individual, whom they are looking for; that a lunatic is to be considered as a sick person, who besides is often physically ill and that mental disturbance does not mean that the person afflicted with it, will never get well again; that malady of the mind is the most pitiful of all and should never be laughed at; that most mental patients are absolutely harmless, if they are treated with understanding and some consideration; that many such invalids need not be confined and that their suffering can be much relieved in a regimen of properly supervised freedom.
Finally visitors will be allowed to enter a few of the foster-homes so they may realize that, besides the more conspicuous type of patient who is occasionally met with in the streets, there are living in Gheel many others, leading an active and useful life. On superficial examination, they can hardly be distinguished from the ordinary inhabitant, or from any other normal person. It is sometimes difficult indeed to say who is who ! Even the medical director himself, who does not personally know all his patients, may occasionally be somewhat embarrassed. He may have to take certain precautions, as he does not wish to offend people whom he is addressing !
When the time comes for them to leave, visitors may have learned something about the real nature of mental disease; they may have lost some of their preconceived judgements about insanity and, what is still more important, they will have caught a glimpse of the work of charity that is being done in a community of simple and kind hearted people for the most unfortunate and the most destitute of their fellow creatures.
Therefore the doctor or nurse, who has conducted the visit, will not regret the time thus spent, although more urgent work has sometimes to be postponed on this account.
Some hundred years ago Gheel colony had only 700 patients. Since the development of psychiatry as a medico-social science, the system of organized family care has been acknowledged as a method of treatment for a considerable proportion of the mentally ill. Being supported by public authorities, as well as by the medical profession, the system has prospered and been widely extended. In the last fifty years the colony has also been much visited by psychiatrists, nurses and social workers. A new sort of pilgrimage has come into being. This, in return, has stimulated the development of family care in other communities. In some instances and in various countries, these efforts have proved successful, regardless of the many difficulties involved in this kind of work.
The Effects of War
At the International Congress of Mental Health held in Washington in 1930, Dr F. Sano, former Director of Gheel Colony, was able to make the following statement: ” In Gheel 3,000 patients live under supervised family care.” In later years this number still increased so as to reach 3,750 in * Paper read at Specialist Meeting organized during International Congress on Mental Health by Association of Mental Health Workers.
August, 1939. Since the outbreak of the second world war however, the population of the colony went down rapidly, at the rate of 200 a year. But near the end of the war, in December, 1944, the number had risen again to 2,600 patients. From an inquiry, made in 1945, about the status of similar institutions in France and Holland we gathered that they had also lost about one-third of their patients.
As yet the fate of family care in Germany and other states of Central Europe is still unknown, but we can safely assume that losses there have been even more severe.
It has been demonstrated, as one might expect, that war conditions are most unfavourable to family treatment. The manner in which war events affect the living conditions of a Colony for mental patients is evident from our own experience in Gheel.
The effects of War Events and Military Operations When the Germans invaded Belgium, in May, 1940, about one-half of the inhabitants of the town of Gheel fled for safety. Some families took their patients with them to various parts of the country. Some went even as far as Southern France, where they stayed as refugees for several weeks or months.
Others, before their flight, brought their patients to the Central Hospital. For some time this hospital was heavily overcrowded, as it had to accommodate more than 1,000 patients, whereas its normal capacity is only 200.
No outstanding events occurred in 1941 and 1942, but later on, in September, 1943, the larger part of the Hospital was taken by German S.S. troops, who stayed in it for a whole year. Most of the patients had to be moved to smaller quarters in the town, or to ” closed ” institutions elsewhere. In September, 1944, the town of Gheel, which is situated near the Albert Canal, occupied a strategic position. A battle went on for more than two weeks between British and Germans. There was shelling and street fighting for several days. As a result of this, 140 civilians were killed, amongst whom were 35 patients. Some 200 foster-homes were destroyed and several hundred damaged. The Central Hospital itself suffered considerable damage, equally the Church of St. Dymphna and her annexe ” the sickroom” which was completely wrecked. From the standpoint of tradition and history, this is to be regretted as a loss. The Effects of unfavourable Conditions accompanying war These conditions can be summarized as follows; the shortage of all necessaries, such as food, clothes and fuel, as well as various discomforts and hindrances resulting from the state of war, furthermore the instability and insecurity in every respect. The consequences were even more important than those of war itself. From the beginning of the war the food was severely rationed. Official food rations were cut to 1,200 calories. Supplementary ” black market food ” had to be paid for at ten to twenty times its normal price. Fees to fosterfamilies were not calculated to meet such enormous expenses. Therefore many families, unable to keep their patients any longer, had to bring them back to the Central Hospital. From here they were forwarded to the “closed” institutions.
The lack of fuel was particularly severe in the cold winters of 1941 and 1942. It had a cumulative effect, together with the food shortage, so as to produce a high rate of bodily disease and an increased death rate. This went up to 10 per cent, instead of 4 per cent, as it is normally. The frequency of infectious diseases as a result of under-nourishment and cold was noted, especially tuberculosis. In normal conditions this disease is comparatively rare amongst our patients as they live in the open air and are provided with plenty of healthy food.
Some twenty cases of hunger oedema were observed; most of them had a fatal issue. In the struggle against starvation, many patients had to be moved from the central part of the town to the more distant farmhouses. Here accommodation was less comfortable, but food supplies less critical. The effect of this shifting is still noticeable now, as there are comparatively more patients to be found on the outskirts, than in the town itself. For the farmer families, producing their own food, it was of course less difficult to keep their patients, when other classes of society had to dismiss them. Another reason for this was their ability to make a better use of the patient’s handy work. In this period of hardship the farmer class has been indeed the backbone of the institution.
In a densely populated Colony, fast and easy communication between the foster-homes and the Centra! Hospital is essential. Our service of motor ambulances, worn out and lacking fuel, had to be cut out. It was replaced by a horse and carriage, as used some fifty years ago ! A shortage of accommodation in the fosterhomes was experienced, because of the influx of refugees, as well as an increase in the local population. This was aggravated by war destruction and the housing problem continues to remain unsolved. The emotional stress of war events, the feeling of insecurity, the restriction of liberty, the new regulations of all sorts imposed by war, were other handicaps. Affecting the foster-families, as well as the patients, they were a common cause of maladjustments on both sides, producing as a final result the dismissal of the patient.
Our Present Problems
Since the end of the war the population of Gheel Colony has remained unchanged, about 2,600. The downward movement of wartime has come to a standstill, but as yet there is no progress. The rate of admission of new patients, which varied from 400 to 500 a year in normal conditions, is markedly reduced. In the meantime the ” closed ” institutions in Belgium have regained more patients and they have thus largely made up for their war losses. As they are taking charge of about 23,000 inmates, they show a definite tendency to overcrowding. Present conditions remain unfavourable to family care, chiefly because of economic difficulties.
(a) Allowances for foster-families are insufficient Many families, especially those of the working class, refuse to keep patients, because the fees are too low to meet the expenses. Allowances for an ordinary patient now vary from 13.50 francs to 20 francs a day. The difference depends on whether he is able to do some work, or not, or whether he requires any special attention.
Fees have been doubled as compared with the pre-war period, but living expenses have increased much more. No official index-number of the cost of living is being issued as yet, but this can be safely estimated at four times its pre-war rate. As mentioned in a recent paper {La Libre Belgique, 30 Juin, 1948) this number would now be 396, instead of 100 before the war. Some two years ago, the cost of maintenance of an ordinary normal person?a labourer for instance?or a domestic servant?was officially stated to be 35 francs a day. This included only board and lodging, regardless of all other necessaries, such as clothing, etc., but since then prices have again gone up. Meanwhile the families of Gheel are being asked to keep mental patients for half as much. This seems quite unreasonable and somehow or other the interests of both patients and their foster-families have been overlooked. We may assume that public authorities have been busy in attempting to solve other perhaps more urgent problems in this postwar period, e.g. the restoration of the pre-war rate of production, as well as the desire to satisfy the social needs and demands of the normal population. Still in any well organised society the welfare of the mentally ill should equally be kept in mind : the manner in which the sick are cared for is indeed to be taken as a measure of the degree of culture which prevails in that same community.
(b) The rise of the standard of living of the Community as a whole In the last forty years the standard of living of the foster-families has been rising steadily, not so much because they have had boarders, but more so on account of the increase of wages. In comparison to this, the advantage of keeping patients has been getting smaller progressively.
This is to be illustrated as follows: In 1910 an ordinary unskilled labourer was earning two francs a day. If at the same time he had two patients, at one franc a day for each, this meant doubling his income. Now this same labourer earns about 100 francs a day. If he keeps two boarders, his income will be increased by only 40 francs, which is even less than half of his salary. So there is considerably less advantage in keeping boarders than there was some forty years ago. Allowances to foster-families should be reconsidered on this basis, while also taking into account that the patient, who is the guest in the home, equally partakes of the improvement of living conditions of the family as a whole.
The lack of any regulation as regards the distribution of the mentally ill
Another difficulty with which we have to contend is the lack of any rule or regulation as regards the proper distribution of the mentally ill among the various institutions throughout the country. Most mental hospitals in Belgium are private and they are run by religious orders. Patients are admitted directly, without any previous observation or sorting in a general hospital. As a consequence therefore, many quiet and peaceful invalids remain confined, instead of being sent to the Colony. Private interests seem too often to predominate. This consists in keeping the ” good ” patients, which means those, who are able to undertake some work constituting a profit to the institution. The interest of the patient should be the only guide in choosing the place where he is to be sent. Therefore it has been suggested that they should be sorted beforehand. It is convenient to do this sorting in the psychiatric services connected with general hospitals, such as already exist in Brussels and in Antwerp. Such sorting centres should also be created in the other larger cities.
These are the main problems, which are our share in this post-war period. We are convinced that they will be solved, as conditions gradually become more normal.
In this respect a hopeful event has been the recent transfer to the Department of Health of everything connected with the mentally ill. By a curious anachronism, mental patients had stayed until then under the supervision of the Department of Justice, together with delinquents and vagrants. This change, which took place on January 1st of this year is indeed to be considered as an advance and a result of a movement which has steadily gained ground in Belgium in the last fifty years. More freedom is advocated for the mentally ill and also their assimilation to the ordinary hospital patient. This implies a revision of the law on lunacy, as well as simplifying the legal procedure of certifying the patient, and restricting this procedure to those cases, where it can not be avoided. Are Traditional Standards of Family Ethics losing their value?
A final point remains to be discussed briefly. This concerns the psychological or rather the moral aspect of family care. To be performed successfully, such work requires a special environment, a particular atmosphere, in which a high ethical standard should predominate. On the part of the fosterfamilies the desire to assist, the willingness to deal with other peoples’ misfortunes, the acceptance of some inconvenience or some discomfort on behalf of the patient, are important requirements. Tolerance is needed, also patience and understanding; in other words, the spirit of charity is essential. In Gheel this spirit is an inheritance of the middle ages; it is backed by an old tradition, based on religious belief. This is embodied by the Church of St. Dymphna and her annexe ” the sick room “. Unfortunately, both of these were badly wrecked, the latter even being completely destroyed. Are these ruins to be taken as a symbol of an old belief, which is disintegrating ? It has been argued that tradition is weakening, that the patriarchal spirit is fading, that family ties are loosening?that modern man is less concerned with ethical or spiritual values than with his own material interest, and that the idea of ” serving ” others has lost its value. If so, the time might come when the people of Gheel would stop their humane work.
As stated in one of the preparatory bulletins of this Congress, ” the breakdown of family ties and standards is a common observation in many nations It should be no surprise, indeed, that the present Congress has made this phenomenon a topic for study and discussion.
Even in a country town like Gheel, the signs of regression should not be overlooked, especially since the war, although they are undoubtedly less marked than in the larger towns and cities. If this moral impairment is to spread further and to affect still larger numbers, it may of course become a serious, and probably also, the only menace to the future of this institution. But in the meantime the work is being carried on with the aid of those families, which have remained loyal and are maintaining rigid standards of ethics. It is our good fortune to be able to declare that there are still living in Gheel many families of this type; so that as yet there seems to be no reason to despair.
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