State Institutions for Violent and Dangerous Defectives
- Author:
Ruth Darwin.
There is a class of defectives, fortunately a small one, described as ” defectives of violent and dangerous propensities,” for whose care special provision is made under the Mental Deficiency Act, 1913. Instead of being- dealt with locally bv the Authority responsible in each area for the care of the mentally defective, they are maintained by the State in Institutions under the direct management of the Board of Control.
On January 1st, 1927, there were on the books of the State Institutions at Rampton and Warwick the names of 325 men and 257 women distributed as follows :?
Men. Women. Total.
Rampton … … 324 … 207 … 531 Warwick … … ? On Licence … … 1 41 … 41 9 … 10 325 257 582
Five hundred and eighty-two is therefore the number of defectives of violent or dangerous propensities for whom the State is at present responsible, forming 2.09 per cent, of the total number of defectives in Institutions for the mentally defective in England and Wales, and 0.97 per cent of all cases reported to Local Authorities under the Mental Deficiency Act up to the beginning of this year.
The method by which these defectives are admitted to the State Institu- tions will show the sources from which they are drawn and how closely the question is connected with delinquency.
Figures taken over nine years (1916 to 1925) show that out of 590 admissions during that period :?
-11 per cent, were transfers from Reformatories, Borstal Institutions, Prisons and Criminal Lunatic Asylums. (Sec. 9, M.D. Act.) 10 per cent, were sent direct by, or at instance of a Criminal Court. (Sec. 8, M.D. Act.)
38 per cent, were transfers from Certified Institutions for the mentally defective or from Workhouses where they had become unmanageable. 11 per cent, were admitted at the instance of the Local Authority from their own homes.
It will be seen, therefore, that during these years 51 per cent, are known to have come through the courts, and, on investigation of the past histories of the 38 per cent, who have been transferred from other Institutions, a number of these also are found to have had frequent convictions and short sentences before their mental defect was recognised.
A marked change in the method of admission is shown in the figures quoted by Dr Rees Thomas, the Medical Superintendent of the State Institution at Rampton, in his report for 1926-27. Amongst 111 new admissions during that year, 29 per cent, were admitted from Certified Institutions and 38 per cent, from Poor Law Institutions approved under Sec. 37 of the Mental Deficiency Act. The remaining 33 per cent, were drawn, with very few exceptions, directly or indirectly from the Courts. These more recent figures are of interest as showing, firstly, the large proportion of cases admitted from Poor Law Institutions where the initial difficulty of managing this type of patient is often greatly increased by lack of trained staff or of proper facilities for employment, recreation and classification, and, secondly, the decrease in the proportion of admissions known to have come through the Courts. This decrease cannot at present be assigned to definite causes. It may be hoped, on the one hand, that the use of the powers given to Local Education Authorities under the Education Acts and the gradual operation of the Mental Deficiency Act may be preventing a certain amount of delinquency amongst mentally defective children and adults; on the other hand, there is reason to believe that through lack of knowledge or through a narrow interpretation of the terms ” feeble minded ” and ‘’ moral imbecile,” a number of mentally defective persons coming before the Courts may still be treated as delinquents and denied the permanent care, protection and training that they need as defectives.
Crime and delinquency, as well as pauperism, illegitimacy and disease, may be the direct outcome of mental defect, and where this is the case the recognition of the defect is of fundamental importance. It is useless to attempt to cure such symptoms without attacking the root of the disease. The criminal defective will not be cured of his defect by repeated periods in Reformatories and Prisons. Although his anti-social tendencies may fall into abeyance as long as he is away from temptation and in surroundings adapted to his needs, on release his powers will again be taxed beyond his strength, and the cycle of misery and active harm to the community will start again. The only humane and safe form of treatment for such cases is to make suitable provision for their care and control as defectives, not only whilst their anti-social tendencies persist, but as long as they show themselves unfit to manage themselves or their affairs in the world.
Having- said so much on the general question, I can only give a very brief account of the difficulties experienced and the aims and methods employed in the treatment of violent and dangerous defectives in England. From the facts already given it will be seen that State Institutions are the dumping-ground for the dregs of humanity and for the rejects of other Institutions. From Prisons and Borstal Institutions we receive defectives convicted for various offences, such as theft, murder, inebriety, arson and sexual offences, who are transferred, sometimes after prolonged trial, having proved themselves unamenable to discipline and reform. From other Certified Institutions cases are admitted whose violence and degraded habits make them unmanageable and unfit to associate with the ordinary well-behaved defective. Violence to Nurses or to other patients, attempted suicide, repeated ” smashing up,” uncontrolled or perverted sexual impulses, may all be put forward as a claim to admission to the State Institution.
The difficulty of dealing with over 500 defectives of these propensities in one Institution is obvious, but this difficulty is enormously increased by the fact that symptoms of violence occur in defectives of widely varying intelligence. 1 he patients at Rampton range from the imbecile, unable to read, write or do any but the simplest manual work, whose violence is purposeless and uncon- trolled, to the high grade feeble-minded, who is unstable, restless, hysterical, emotional, morbid, romancing, often actively mischievous, but, intellectually, sometimes not far below the average. Added to these are the cases where some form of psychosis is super-imposed on a defective mentality, resulting often in ideas of persecution and grievances, aggression and recurrent periods of mania and depression. Some of these latter are transferred to Mental Hospitals, but although the symptom of violence may be cured, the fundamental defect and lack of control remains and demands some form of permanent care. Aims and methods of treatment have, therefore, to be devised suitable for the widely varying grades of mental defect.
As far as possible, the State Institution at Rampton is looked upon as a Hospital; attacks of violence and excitement are treated as symptoms requiring preventive treatment and not punishment. This atmosphere is difficult to introduce amongst the patients owing to the fact that detention is compulsory, that locked doors are to a certain extent necessary and that they themselves are generally incapable of recognising the nature and origin of their^ disordered behaviour. The staff required is much larger than that required in ordinary Institutions for defectives, and the accommodation required is also different. Single rooms, instead of dormitories, are found to be indispensable for about 00 per cent, of the patients. Violence is catching and will spread like wildfire from one excited patient in a dormitory to the rest. Seclusion is constantly necessary, especially amongst the women, and the need for solitude and quiet is shown by the fact that “they themselves frequently ask permission to go to their own rooms when they feel irritable or unable to control a mood of passion or excitement.
The most definite form of treatment, however, lies in the daily handling of the patients by the Medical Officers and the Nurses and in the arrangement of the daily routine. Varied and interesting occupation, healthy exercise, and plenty of recreation are the only means by which it can be hoped to alter their attitude of mind and to form a more hopeful outlook and better habits.
On the male side the favourite employment is work on the garden and farm ; there are also flourishing shops for bootmaking, tailoring, brush-making, upholstering and weaving, where excellent work is done in spite of the erratic moods of the workers and of the fact that those most capable of skilled work are often those who cannot be trusted with tools. The girls also do some gardening, and chicken farming promises to be a wholesome and popular employment; the majority work in the laundry and kitchen or at sewing, weaving, raffia and leather work, lace-making and rug-making.
Lectures have been organised for the higher grade patients; there is a troop of Scouts on the male side; physical drill, outdoor games, a weekly cinema show during the winter, and a weekly dance, where men and women meet in the Recreation Hall, take place regularly, and a considerable number of selected patients are given parole in the Institution grounds. Escapes occur every year and must be looked upon as inevitable unless the place is to be turned into a prison. In commenting on this question in last year’s Annual Report, the Medical Superintendent says : ” I think the impulse to break away is becoming less marked, which is perhaps a sign of increasing contentment and attachment to the Institution. A former patient, a man with 15 convictions for housebreaking and burglary, escaped from another Institution to which he had been transferred, and crossing on foot from the West of England, presented himself for re-admission with the proud boast that he had not broken into a single house?although he had been sorely tempted by the carelessness of householders.”
Amongst the different grades of patients described above, little can be done for the older imbecile class beyond protecting them against themselves and providing them with a comfortable life. The following is a typical case, described by Dr Rees Thomas, of this low grade of patient :?
” A ” is a woman aged 44, said by her sister to have been weak-minded from birth and for many years to have suffered from attacks of violent temper, in which she smashed the windows of her own home and those of neighbouring premises. She was always inclined to wander and sleep out in the streets. She first became known to the Police and was recognised as feeble-minded in 1906. Between 1906 and 1916 she was convicted on 17 occasions for burglary, wandering, drunkenness, begging, etc., and was well known as a drunkard and a prostitute.
In 1916 she was sent to the State Institution. She is a low grade feeble-minded woman (mental age about eight years), very vain and boastful, responsive to flattery, and regards herself as rather attractive. She is slow and slovenly in her work and, as a rule, obedient, but any criticism upsets her, with the result that she becomes noisy, turbulent and foul-mouthed, and would often smash or threaten to smash windows. Every two months or so she suffered from attacks of excite- ment, during which she would retire to her room and crouch in a corner or roll herself up on the bed with her head covered, remaining thus for several hours unless disturbed, when she would become violently abusive and threatening. On the rare occasions on which she offered physical violence, she apologised after it was over with a smile of joy at the recollection of her misbehaviour.
In 1917 she ceased to break windows and her behaviour has slowly improved. She now regards her ability to refrain from breaking glass as the sole criterion of her suitability for discharge. A few years ago she begged the Medical Officer to go to her room, and there she showed him a pane of glass accidentally cracked, which caused her great sorrow. When, at her urgent request, the pane was replaced, she became her old self again and declared that nobody would “bring her down ” now that ” her piece of glass ” had been replaced.
She will now work in the rug room, sorting or cutting wool, or will do rough washing or scrubbing. She is still easily upset and has frequent attacks of bad temper and sulkiness, but she is at least comparatively happy and no longer suffers from outbreaks of such uncontrolled excitement and violence.
In dealing with the higher grade, however, many of whom are capable of a partial appreciation of their position, we are faced with a harder problem. What hope can be put before them as an incentive to better behaviour? No one can strive perpetually without some goal in view, and yet experience shows that absolute freedom, the only goal that will satisfy this particular type, is certain in all but a very small percentage of cases to lead them again into depths of degradation and misery. Is it fair to put before them a goal, which, with very few exceptions, they are inherently incapable of attaining?
A solution of this problem amongst the women has been attempted at Warwick. Fifty of the better behaved and higher grade younger women have been transferred from the main Institution at Rampton with a view to ascer- taining whether, after more specialised training, some may not prove fit to live happier and more useful lives in less restricted surroundings. The scheme is a progressive one. Selected cases from Rampton are promoted to Warwick, from which they can proceed through a Hostel to daily work outside, and, if they should prove fit, to licence with a responsible person away from the Institution.
The only building available for this experiment was the Infirmary and the Chaplain’s house of the disused prison at Warwick. The disadvantages of such accommodation from the point of view of the girls, at a moment when one wants them to feel that they are getting away from bolts and bars, are obvious; the advantages are that each has her own cubicle bedroom and that the Chaplain’s house was available and has been adapted as a Hostel for eleven of the most trustworthy girls who are employed on daily work outside the Institution. This Hostel has been made homelike and comfortable and is run as far as possible on the lines of a Hostel for normal women. Girls who show sufficient improvement in the Institution, both in their conduct and in their work, are promoted to the Hostel, and after a period of further domestic training in the Superintendent’s house, they are placed out in daily service. They are allowed to go out for walks and to the cinema in batches of two or three, and there are no locked doors, but their leisure time and recreations are carefully supervised by the Superintendent.
One of the difficulties of the scheme lies in finding mistresses who are both able and willing to take these girls and to put up with their moods and vagaries, but these difficulties are as nothing in comparison with those that arise from the unstable, uncontrolled and potentially violent temperaments of the girls themselves. Disappointments are frequent; a girl who knows that her future promotion depends on her behaviour for the next months and who is placed with a kind mistress to whom she is, in words at least, grateful, will suddenly commit senseless thefts. Another will, after some mild reproof, smash up or will return to the Institution and refuse absolutely to return to her post. The following are typical examples of some, of the girls who have been tried at Warwick.
” B” is a very pretty, childish girl of 28. She writes poetry, is over-emotional and morbid and prone to violent friendships and as violent dislikes. Her mother died when she was a baby and she was sent to an Industrial School at the age of 13. Three years later she was sent out to service, lost four situations in one year, stayed out at night and returned to the Industrial School till she was 18, when she was discharged and again went into service and was convicted of theft. At the age of 19 she was again convicted and sentenced to three years’ detention at Borstal. At the Borstal Institution she attempted suicide, was said to be emotional, unintelligent and wanting in moral control, and at the age of 21 she was certified as a moral imbecile and transferred to the State Institution. After five years she showed some improvement and was transferred to Warwick. She went through the Hostel and had i daily post, where she proved undependable, but, as a very good situation was offered her in the house of people who knew her failings and were prepared to protect her, she was sent out on licence. She was very happy and did well for six months, and then a telegram arrived asking for her immediate removal. She had become depressed and had attempted suicide by swallowing a bottle of some house-cleaning mixture. She returned to Rampton, where she soon regained such mental balance as she can ever be said to possess, and she is now out again in the same situation on licence.
” C ” was an illegitimate child and was brought up by Sisters in a Home where she always gave trouble on account of temper and dishonesty. At the age of 16 she went out to service, but could not keep her places, got into trouble by staying out at night, and at the age of 18 was certified as a moral imbecile and sent to a Certified Poor Law Institution. Here she gave endless trouble, was sullen, abusive, irresponsive, insubordinate, romancing on sexual subjects and showing no sense of shame. After a few monchs she was transferred to another small Certified Institution, where everything was done to help and influence her, but she proved utterly shameless, passionate and a subversive influence, and she was transferred to Rampton at the age of 18. She was a pale, discontented looking girl, with a constant grievance and very poor intelligence. At the age of 23 she was transferred to Warwick, where she was found to be lazy, bad-tempered and quite unfit to earn her own living. Her mental age was said to be that of a child of ten years. After a period of good behaviour she was transferred to an Institution nearer to her friends, where she had always asked to go. Before she had been there three months we were asked to remove her as she had been striking Nurses and threatening to kill them and inciting insubordination amongst the other patients. In writing to me after her return to Rampton, she makes a remark which I must quote, as it seems to me to throw light on the mentality of many State Insti- tution patients. After telling me in her letter how the trouble arose, she adds: “So, natural enough, I got pondering with my thoughts and smash a window and was very obstreperous. I no it is of no credit to me, but still.” This is a typical attitude of mind ; the natural and immediate result of pondering with your thoughts is to smash a window, and although, theoretically, you know it is no credit to you, and each time it happens you repeat and believe that you have learnt your lesson and all will be different in the future, no amount of rational teaching and no amount of suffering will prevent its recurrence or supply the higher mental qualities of judgment, foresight and reasoning which are inher- ently lacking.
Disappointments and failures are inevitable, but there has been also some measure of success. During- the year twenty girls have been in situations, and at the beginning of the year there were six living in their situations on licence and two in their own homes. Two have also been discharged, who, after having passed through the graduated scheme, had proved able for a year to maintain and to behave themselves in situations.
It may be said that the successes are small in proportion to the failures, but the opening of the Institution and of the Hostel has made a radical change in the outlook of the girls. An atmosphere of greater contentment, arising from the return of hope, self-respect and less distrust of those in authority is marked and is perhaps the greatest measure of success that can be hoped for amongst this type of patient, the vast majority of whom will always require institutional care.
Mental defect, as far as our present knowledge goes, is incurable, but I am convinced that much may be done to prevent the mentally defective person from joining the ranks of the ” violent and dangerous.” Only by early recognition of defect, both in the schoolchild and in the juvenile offender, and by fuller operation of the Mental Deficiency Act, will it be possible to provide for the unstable and feeble-minded person the training, care and protection he requires from childhood upwards, and only by the provision of this early care can we hope to decrease the number of violent and dangerous adults in State Institutions.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.