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Pilgrim, D. (1988). Psychotherapy in British Special Hospitals: A case of failure to thrive. Free Associations, 1(11):58-72.

(1988). Free Associations, 1(11):58-72

Psychotherapy in British Special Hospitals: A case of failure to thrive

David Pilgrim

This is after all a hospital… (Norman Fowler, Minister for Health and Social Security, justifying the apparent conditions of comfort in Park Lane Hospital at its official opening)

But this is a prison: look at the bars and locks…(Maria Giannichedda, a leading member of Psichiatria Democratica, when visiting Broadmoor Hospital)

It is difficult to communicate to those outside the four British Special Hospitals (Broadmoor, Park Lane, Rampton and Moss Side) something of the peculiar ethos which permeates their functioning. They have all the appearance of prisons. Everywhere is locked and the nursing staff dress like prison officers (except at the newest Special, Park Lane). The only recognized trade union for the nursing staff is the Prison Officers' Association. All staff are constrained from discussing their work or the regime they work in by the Official Secrets Act and Civil Service Regulations. Most of the attempts to evaluate the therapeutic value of the hospitals have led to conclusions which are highly critical (Hospital Advisory Service, 1971; Butler Report, 1975; All Party Parliamentary Mental Health Group, 1980). At best they are custodial, keeping residents segregated for years on end with little or no indication of rehabilitative impact (Norris, 1984); at worst they are ‘inhuman and degrading’ (European Commission of Human Rights, 1981). When he reviewed the organizational features of psychiatric and mental handicap hospitals subject to official inquiries as a result of neglect or abuse of residents, Martin (1984) described the Rampton inquiry (Boynton, 1980) as being ‘of crucial importance, for it involved allegations of brutality on a larger scale than at any other hospital’.


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