Unperson

Following the internal reorganisation (sectorisation) of the hospital in 1973, several wards were given redesignations and had a new influx of patients. One ward, previously a long-stay ward, became an acute admission ward, but this notwithstanding, retained a couple of the incumbent “chronic” patients due to accident of geography, lack of accommodation in the appropriate ward or simply because those patients were no management problem and therefore less of a problem to move them.

One such patient was a fit, blond, man with a ruddy complexion aged about 40 who looked considerably younger than his years. He was part of the “outside working party” who laboured in the hospital grounds. He had been in the hospital for two decades and had a diagnosis of “simple schizophrenia”. I had seen him many times around the hospital in all weathers dressed in brown bib-and-braces, white shirt with sleeves rolled up, and black wellington boots (no other colour was available in those days). He always seemed to be pushing a loaded wheelbarrow or sweeping leaves.

I must have been a second or third-year student at the time, with much of my routine duties centred on the care of the more acutely ill, or fulfilling the tedious tasks necessary to enable the ward to function. I had little to do with this man who was only ever present for breakfast and supper as he was out all day. There were times when his duties called him away before breakfast and sometimes he only returned to the ward at 8pm. He took lunch (and breaks) outside of the ward and I believe that there was some kind of informal arrangement with Larch ward to provide sustenance to the outside working party during the working day. So, in my three-month placement on the ward I hardly saw him and he was no more than a name on the list of ward patients on the board on the wall of the charge nurse’s office.

One morning I came on shift to discover that this man had not returned to the ward overnight. This was unusual behaviour for him, and, after a morning where the nurse in charge liaised with other wards, the nursing office and the leader of the outside working party, it was decided to do a search of the grounds before notifying official authorities (including the police). It was thought that he might have had an accident or possibly succumbed to sudden illness and could possibly be lying unconscious or incapacitated somewhere. A number of nurses (including me) who could be spared by their wards were co-opted into a search party. We were each allocated an area of the hospital grounds to search and I was assigned an area of fairly dense woodland adjacent to the hospital farm. I was secretly pleased with this as I could take my time and have a smoke without anyone hovering over me before returning to my regular duties.

Consequently I ambled across the sports field and made my way to the wooded area. It was a warm day, so I jettisoned my white coat and made a cursory exploration of the undergrowth (mostly saplings and brambles). After a while I sat down at the foot of a tree and had a rest and a welcome cigarette. I gave it about half an hour before donning my coat and proceeding back to the Nursing Office to give a negative report.

Two days later I was called into the Nursing Office for a bollocking. It appears that this man had been found hanging from the upper branches of a tree in the area that I was have supposed to thoroughly searched! From the description provided by the Nursing Officer, it seems quite likely that I had walked underneath the suspended body, and even possible that I had enjoyed a surreptitious fag directly below him. The Nursing Officer queried why I had not used all my senses and not looked up, but in my defence, I was expecting to find a recumbent body in the grass and had not really considered the possibility of suicide. In my heart of hearts I knew that I had not been that diligent, I had searched half-heartedly and, to be honest, had little investment in this man who I had only fleeting contact with.

Back on the ward there was little debate about the death of this man. Nobody, both staff and patients, had any real relationship with him – in fact most didn’t even know his name. When reflecting on this I was tempted to give him a pseudonym, but after some thought (and given that I, too, cannot recall his name 50 years later), I decided it would be wrong to attempt to humanise or dignify him with a name, when, to all intents and purposes, he was anonymous, one of the forgotten. Naming him would detract from the underlying power and moral of this account, that to the institution he was unimportant, almost a non-person.

This feeling of mine was reinforced by what little discussion ensued. This man’s life and death were defined by his diagnosis. The ward doctor reported that suicide was a common outcome in schizophrenia which could not be predicted. Whether he said this to absolve us or make us feel better about the circumstances of this man’s death, I don’t know, but the blithe acceptance of fatal outcome as a consequence of this condition, in my opinion, is both misguided and contrary to clinical findings (even in the 1970s). There was no consideration of any potential changes or circumstances in this man’s life that might have contributed to the decision he took. The lack of contact or any sort of relationship meant that there was a dearth of evidence to go on. It was simply put down to the course of the illness. Whatever demons possessed him, nobody would know because nobody considered him worthy of consideration. His appeared to be a life devoid of dignity, respect, social contact or human warmth.