Intended for healthcare professionals

Practice A Patient’s Journey

Through the wasteland: chronic depression

BMJ 2011; 342 doi: (Published 11 April 2011) Cite this as: BMJ 2011;342:d93
  1. Jackie Hopson, patient1,
  2. Jeremy Holmes, retired consultant psychiatrist 2
  1. 1North Devon, UK
  2. 2Visiting Professor of Psychotherapy, University of Exeter, UK
  1. Correspondence to: J Hopson
  • Accepted 20 November 2010

The patient first manifested chronic depression in 1972 when she attempted suicide. She was admitted to a county asylum, where the conditions and treatment she received coloured her subsequent lifelong depression

There is now a wasteland where the county asylum I was first admitted to once stood. My feelings about the closure of these huge hospitals are ambivalent; for me they were places of fear, punishment and long incarceration. Contact with doctors was rare. I saw a doctor once in the first two months of my stay. He told me I was very ill and would remain in the hospital for a long time, and said little else. Treatment was electroconvulsive therapy twice a week for everyone on my ward. There was medication but no occupational therapy, and no leaving the ward except for electroconvulsive therapy. The hospital’s response to escape attempts (I made two via windows accidentally left open) was the padded cell, followed by a locked ward and three doses of chlorpromazine a day, in addition to the usual drugs. Conditions in the county asylums in the early 1970s are too well known for me to add more details here. However, they were the only refuges available for many, including me at times.

This inpatient admission coloured my subsequent life-long depression. It seemed that I was to be punished for my illness and sedated if I made demands. Escape from illness meant escape from mental healthcare. My mother reinforced this by telling me (with no irony at all) that, some years earlier, I would have been hanged for my suicide attempt.

In the early 1970s I was an undergraduate and my college and the university medical officer were supportive. I was asked to leave college until “well” but returned because it was my only home. In order to …

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