2.2.6 Skills for the attendants
In the box below are the examination questions for attendants sitting the MPA's Diploma in 1893. Candidates were charged 2s 6d (approximately one tenth of an average weekly wage) and resits cost one shilling. Remember that at this stage, before the 1913 Mental Deficiency Act, asylums included many people with learning difficulties as well as those who were regarded as mentally ill.
Examination for attendants on the insane (1893)
Mention the causes of lung disease.
By what channels is the refuse or waste matter of the body drained from the circulation?
What symptoms would lead you to suspect that a patient is losing weight?
What symptoms would lead you to suspect that a patient is gaining weight?
What is a sensory nerve?
What is a motor nerve?
Name the special senses.
What is a drawsheet?
Explain how you would use it.
What are its advantages?
What observations would you make regarding the passage of urine and
the appearance of the urine?
Why is occupation important in the treatment of the insane?
What rules should be observed in promoting the occupation of patients?
What patients are most likely to escape?
What circumstances would make you suspicious?
How would you guard against escape?
In what way should attendants conduct themselves towards patients?
What do you understand by ‘showing a good example’?
What are the risks in treating cases in private houses compared with asylums?
What precautions would you take?
What are the difficulties with relatives in private houses, and how would you endeavour to meet them?
Activity 5 Skills for the attendants
Look at the exam questions in the box. What does it seem that the attendants’ main tasks might have been and what key skills did they need?
The first part of the paper, up to question 4, focuses on physical health or changes in the condition of patients. Then questions 5 and 6 might possibly be described as rudimentary physiology. These are followed by a question which seems to be more about control and security. There doesn't seem to be much about communication, or emotional or spiritual care, and there's only question 9 to suggest that the attendants or nurses might also need to know how to divert or stimulate patients mentally.
Question 13 is interesting for what it reveals about contact with patients' relatives. It seems to suggest that only staff working in the community were likely to have to explain themselves to patients' families about the treatment being provided.
The tasks might be summarised as: diagnosis, treatment, containment and protection.
As to study skills, this paper seems quite demanding in terms of the verbal and writing skills it expects in such a low status occupation. Just for your information it's perhaps worth adding that the written paper was followed by a practical part, held two or three days later. Both parts of the exam were marked by the attendants’ own superintendent and an external assessor who was also an asylum superintendent.
In 1920 the newly formed General Nursing Council agreed that those who held the MPA's Certificate and those who had gained the newly established Certificate for Nurses in Mental Subnormality, could be eligible to be admitted to the supplementary Register (Nolan, 1993, pp. 60–81). When Colin Sproul became an attendant at Lennox Castle he and his colleagues took the Royal Medico-Psychological Association examination to obtain a certificate in ‘mental deficiency nursing’. This was a lesser qualification, with State Registered Nurses (SRNs) occupying higher status.
Colin Sproul was to become a shop steward later in his career. Trade unionism among the asylum nurses made a number of attempts to get off the ground in the nineteenth century as attendants tried to break free from the discipline and harshness of the medical hierarchy running the asylums. The basis for successful organisation came with the National Asylum Workers' Union, set up in 1910. This was to change its name in 1931 to the Mental Hospitals and Institutional Workers' Union amalgamating with the Hospitals and Welfare Services Union in 1946 to form the Confederation of Health Service Employees (COHSE). In 1993 COHSE joined with two other public service unions, NUPE and NALGO, to form the giant union UNISON.
Institutions varied and it would be inaccurate to portray them all, and all their staff, as insensitive custodians. However this particular form of provision had some dominant characteristics which meant that, as far as the general public was concerned, it was something to be avoided. Why were institutions perceived in this way?
We've looked at Goffman's characteristics of life in institutions and we've seen that, although they were never the main form of care, institutions dominated the landscape and language of care provision. What was the nature of their domination and what did it mean for the reputation which they had in society generally?