This story is about mental illness and the beginnings of what we now call 'care in the community'.
In February 1978, I lived for two weeks with twenty long-stay psychiatric patients at Prestwich Hospital in north Manchester. Forgotten souls, most of them had been there for at least as long as I was old. I was twenty-six.
Brought together from all over the hospital, these patients were guinea pigs in an experiment.
Encouraged by what psychiatrists had discovered from the application of post-war psychopharmacology and more recently influenced by the behaviour modification theories of B F Skinner and R D Laing's 'politics of experience', psychologists at Prestwich established Clayton ward. Here they instigated a token economy scheme.
The objective was to enable patients to live 'out in the community'. First, though, they needed to learn how to behave in ways that would not upset or alarm people 'on the outside'. The prerequisite for a patient's inclusion in this experiment was that he (for it was mostly men who took part) should have an addiction, in this case tobacco smoking. 'Good' behaviour — engaging in 'verbal interaction', making your bed, wearing a tie, tucking your shirt in and so on — was rewarded with tokens. However tokens were needed to buy not just tobacco but also food and drink.