Case Study IV (1959-1986)

Female patient 8076 entered the DCMH in 1960 as an ‘informal’ patient. A widow living in care, she had been slowly deteriorating for two to three weeks, a process that was attributed to her advanced age. This lady forms part of a patient group that increased significantly under the NHS – patients, in particular females aged sixty and over, many of whom had been looked after in care homes, but could not remain there due to their dementia and ‘dirty habits’, i.e. incontinence or failure to attend to their personal hygiene. The need to treat the elderly was soon recognised and from 1963 the Exminster branch of the then Exe Vale Hospital developed into a psycho-geriatric unit specialising in the care of elderly patients. As was common with elderly patients in the 1950s and 1960s, extremely little can be gathered about her history, but her admission documents state that she had never before required psychiatric treatment. She was referred by her general practitioner (GP) who described her as ‘confused, refus[ing] to eat or drink and taking her clothes off’. He suggested admission as ‘it seem[ed] not possible to supervise her 24 hours / day’. The hospital doctor diagnosed her condition as ‘senile psychosis’, but the case notes emphasise that there are ‘no marked signs of senile dementia’.

Her progress notes are brief and primarily administrative. She seemed to have seen by a doctor only twice. The first entry describes her as ‘a pleasant personality’ and states that she was to be transferred to a different ward ‘which would be a more suitable milieu for her’. The nurses’ notes confirm this impression, describing her as ‘no trouble, clean and eat[ing] well’ – a clear contradiction to her GP’s description. Concerning her treatment, her medicine card shows only evidence of the barbiturates Sodium Amytal and Nembutal, the first one given at night the second one prescribed during the day. The second entry in the doctors’ notes, made only about ten days after her admission, is concerned with the preparation of her discharge to the care of her daughter and the continuation of her medication. A copy of a letter to her GP is attached to the last entry.

She left the hospital ‘relieved’ and it was noted that she was not willing to be visited by a social worker, i.e. to accept after-care. Finally, her discharge letter addressed to her daughter states that ‘she is showing no untoward mental or physical symptoms other than those normally to be expected of one of such advanced age’. It was recommended that she ‘have consistent companionship and mild nursing care, assisted by some regular gentle sedation’.