WHEN COLNEY HATCH ASYLUM opened in 1851, it was considered a Victorian marvel. The largest asylum in Europe, Colney Hatch was unprecedented in scope. Set up as an enlightened institution, it had its own work farm, cemetery, and chapel, and it aimed to provide the moral treatments then in vogue among the most advanced sectors of psychiatric care. The building itself, built in an Italianate style, had lovely designs built into the front, its larger artistic characteristics designed to signify that Colney Hatch was no Bedlam, no place to shovel the poor and undesired.

When Barbara Taylor — then a young scholar, now arguably our leading historian of feminism and the Enlightenment — entered the asylum in 1988, Colney Hatch was known as Friern Mental Hospital. It was no longer at the vanguard of psychiatric care. In fact, it was in its last days. Friern closed in 1993. Today the buildings and grounds have been remade into a gated community for those with the money and desire to withdraw from the hullabaloo of London’s streets and noise.

Barbara Taylor’s The Last Asylum is, among other things, a description, from the point of view of a patient, of Friern’s last days. But it is much more than that. Taylor provides a gripping (often painful) account of her own experience of madness, a fascinating description of her psychoanalysis, a historical reflection on the role asylums played for inmates and the implications of their demise, and a meditation of the interrelationships between care and cure. The book is unsparing in its discussion of her own history and generous with the histories of others. For Taylor, Friern was indeed the last asylum. But it was able to be that only because it was one node in a wider web of care and relationship that included her friends, her psychiatrist, and her psychoanalyst. It is not only the asylums that are gone now. Our society has done its best to eliminate the relationships as well.

I

As Taylor recounts, she had her first serious bout of mental illness in 1981 at the age of 31. Born in Canada, she had moved to England to attend graduate school. Having written a dissertation (which would eventually become the award-winning Eve and the New Jerusalem) and taken up a teaching job, Taylor found herself overwhelmed with inner demons and self-medicating with alcohol. Fortunately for her, left intellectuals in 1980s London were keen on exploring psychoanalysis, and with the help of friends, Taylor found herself an analyst to work with. As she soon discovered, psychoanalysis was not the self-indulgent process it is often portrayed to be; instead, her analysis — excerpts from which Taylor includes as a core thread of her memoir — led her to a deep and painful encounter with her past. In this encounter, Taylor was forced to confront her own self-deceptions and the self-hatred that accompanied them.

Taylor’s description of her analysis makes for harrowing reading. As she and her analyst reconstructed her past, it became clear that she bore the burdens of multiple histories — of her parents’ successes (there were many) and failures (especially of parenting), of their projections and demands on her, and most importantly perhaps of her mother’s depression and her father’s history in the Spanish Civil War and his long history with women beside his wife. As a child, Taylor constructed what the British psychoanalyst Donald Winnicott would have called a “false self,” compliant to her parents’ wishes and hopes for her rather than to her own inner spontaneous desires and needs. As an adolescent, some of this false self cracked open, leading to heated shouting matches with her father. But she never seemed able to escape from the histories she inherited or the desires her parents had for her — especially the desire that she become a writer.

Central to Taylor’s inheritance of these histories were the young Mennonite women who came to serve as housekeepers and to help Taylor’s mom with Taylor and her sister. These young women were themselves outcast, sent from the countryside because they were pregnant; they would care for the Taylor siblings until it was time for them to give birth. At that point, they would leave. The first, named Rose, was marked indelibly in Taylor’s unconscious only to emerge in her analysis as a symbol of the possibility of both loss and renewal. But they all became, in some way, temporary surrogate mothers. Both their presence and their inevitable departures would shape Taylor experience and expectations.

Her childhood, then, was marked by a series of withdrawals connected to childbirth (and creativity). The first was her mother’s post-partum depression, followed by the replacement mothers who always left to give birth. Her father, both the emotional focus of the family and yet always involved elsewhere, did not pick up the slack. Instead his charisma only increased the struggles between mother and daughter over the father’s attention. These failures do not make her parents bad people; they, too, were struggling with their own histories and responsibilities, and they were remarkably successful in navigating their world — he an attorney and she a judge. But as parents, it is hard to sympathize with them, as we watch the young Taylor repeatedly experience the trauma of withdrawn care.

As anyone who, as a child, lost a parent (or had them disappear emotionally) is well aware, these abandonments play havoc with a child’s sense of self and of the world. Taylor was no exception. As she tells us in The Last Asylum, her adolescence and early adulthood were marked by a series of excessive loves and hates. Taylor lived a life filled with self-loathing, obsessions about filth, recurrent problems with alcohol, sex, and medicines, and haunted by fears of her own badness.

Her childhood also marked her psychoanalysis which, as Taylor demonstrates in her reconstruction not only of particular sessions but of the analysis’s overall trajectory, reactivated her capacity for love and hate in her relationship with her analyst and even more importantly revealed how difficult it was for her to take care, to actually allow herself to accept what her analyst was offering. Despite the scorn that much of our contemporary world places on the length of analyses, in Taylor’s case, it was her analyst’s (referred to by Taylor as V) ability to work with her for years that enabled her recovery, precisely because he didn’t withdraw care. Time was of the essence.

II

Of course, as any student of psychoanalysis knows, the reactivation of childhood experiences goes by the name of transference and is part of any therapeutic encounter. But what makes The Last Asylum so important is Taylor’s capacity to place her own analytic experience within a larger historical and psycho-historical context. Two contexts seem particularly important. The first was the feminist milieu of 1980s London. The second was the final days of the old asylum-based mental health system in England.

Central to The Last Asylum, and indeed to Taylor’s life in the 1980s, were her many friends, especially her female friends. Given that Taylor makes clear that her younger self was unreasonably demanding, the support of her friends is nothing less than remarkable. They suffered her abuse, took turns caring for her, provided her with places to stay, ensured she made it to appointments, and returned her demand for love with love. It is easy now to look back at the Feminist-Socialism of the 1970s and 1980s as naïve. But no one reading The Last Asylum will be able to keep that knowing stance for long. Her friends, many of whom were writers and historians like she was, were able to translate their political commitments into a living ethic; from their pens came important works of scholarship, from their politics the creation of new institutions of knowledge and practice, and from their values an abiding willingness to support Taylor through her madness.

Equally fundamental was England’s mental health system. One of the most surprising aspects of Taylor’s history was the extent to which Friern, and then a series of hostels and day hospitals, provided Taylor with a form of asylum. Taylor was fortunate to find a female psychiatrist (Dr. D) who not only allowed her to continue her analysis while in Friern, but provided additional therapy as well. And while we should not fool ourselves into thinking that Friern provided adequate aid to its patients (there was little to no real therapy, the facilities were rundown, there was an ever-present threat of abuse and violence, staffing and resources were inadequate) it did provide a holding space, an asylum in the most literal sense of the word, for Taylor and her fellow patients, as did the day hospitals and day centers that followed. Taylor describes her journey through this psychiatric archipelago without nostalgia. But it is clear that for her, at the very least, these experiences not only helped hold her psyche together, but actually expanded her life as she learned to empathize with her fellow inmates. Some of the most compelling passages in The Last Asylum concern Taylor’s asylum-mates: Rajat, Magda, Fiona (all pseudonyms), and others. Taylor offers depictions of them worthy of an 18th-century character study. But they offered her something else: a widened psychic horizon and the possibility of friendships where you would least expect them.

It is no exaggeration to say that if not for Taylor’s friends (both in and out of the asylum) and for Dr. D. and V we would not have The Last Asylum to read, because it is doubtful she would have been in a condition to write it. Taylor’s madness was violent and destructive, yet The Last Asylum is written in a lovely and compassionate tone and style. Despite years of painful madness, she created a new and flourishing intellectual and emotional life for herself. That she is now able to write with such compassion about herself and about those around her is itself one of the most powerful messages embedded in the book. And that she was able to transform what was clearly a childhood burden — her parents’ demand that she become a writer — into a source of inner satisfaction and a source of enrichment for others reveals the tremendous creativity that she found in her exploration of her own psyche.

Her experience also throws new light on the history of the anti-psychiatry and decarceration movements in England and elsewhere. That the critics of psychiatry were pointing to something fundamental is undeniable: the overuse of surgery and drugs, the warehousing and dehumanization of long-term confinement, the denial of the humanity of the mad that always haunted the old asylum system and much of 19th- and 20th-century psychiatry. But Taylor’s description of her own descent into madness, and her description of her friends and acquaintances within the world of the asylum, make clear the terrible reality of mental illness. Although madness could simply be a label, it wasn’t always. At that point, it deserved care.

Of course, the question then becomes what sort of care. The Last Asylum implicitly points the way. Taylor’s history shows, in sometimes painful detail, the importance of providing those suffering from various forms of neuroses and psychoses with an appropriately holding environment — at least if you genuinely want them to be able to have a flourishing life. As she demonstrates in an epilogue, the current psychiatric fascination with drugs and short-term behavioral therapies — driven at least in part by the health care industry and supported by the misplaced scientism of our culture — may control symptoms at least for some types of neurotic behavior. But in the case of more serious madness, adequate support, more extensive commitments of time, and proper environments of succor are needed. It is one of the ironies of our contemporary fetishization of biology that it has turned its back on understanding the meaning of madness in individuals or recognizing our mutual responsibility for the mad. Disdaining long-term therapy and the creation of spaces of asylum, the health care system has turned its back on both truth and treatment. It is not something to be proud of.

III

The Last Asylum is a subtly theoretical book. Taylor, like many who enter therapy, reports that during the early days of her analysis she avidly consumed the writings of Freud and some of his most important followers. This practice does not seem to have lasted; by the time she was deeply engaged in remembering and reconstructing her own psychic history, this theoretical armature was less important. But it is clear from reading the book that this interest never went away. Taylor’s understanding of her own history, and her understanding of the proper aim of mental health care bear the marks of the English school of Psychoanalytic Object-Relations — most especially the work of Melanie Klein and Donald Winnicott. English Object Relations, as it developed from Klein and Winnicott, had at its heart the goal of preserving the capacity for spontaneous thinking against the destructive power of hate and the tendency to conform in order to survive. In Winnicott especially, the mother (or whoever was the primary care giver) assumed tremendous importance. It was the mother’s capacity to respond appropriately to the baby and thereby enable the baby to have enough security in the stability of the world — Winnicott’s famous “good enough” mothering — that secured for the child the inner confidence to act creatively in the world. For Winnicott, as for Klein, it was the mother’s ability to “hold” the baby, to absorb his or her destructive impulses and still be there that was crucial. It is hard not to see Taylor’s own history in this light — given her mother’s depression and the repetitive disruption of care that accompanied her pregnant Mennonite housekeepers. But it is also hard not to see Taylor’s therapeutic experience in this light as well: as V and Dr. D, and Friern and the day hospitals and hostels provided the sort of holding that enabled her to do the hard analytic labor needed to reconstruct her life. If there is a point to The Last Asylum, it is that we all have to take care if we want a flourishing society.

Of course, as Taylor makes clear, it is precisely this mutuality of care that England and the United States have now rejected. Instead, the merely neurotic have their symptoms controlled by drugs while the more seriously mad find themselves increasingly homeless or in prisons and jails. Whatever the hopes and dreams of the critics of the 1950s and 1960s — and they were many and often in conflict — none dreamt of the dystopia of denial that we find ourselves in today. Holding is out; hurrying is in.

Beyond its substantial accomplishments, The Last Asylum offers one additional gift to its readers. Taylor has, in effect, modeled a new relationship between psychoanalysis and history. Traditionally, scholars have assumed what we might consider the analyst’s position: they have brought psychoanalytical theory or writing to explain historical actors or unravel historical cultures and stood apart from and above the subjects they aimed to explain or understand. But Taylor writes from the position of the analysand, the patient. In one way, this point is banal: after all, she was the analysand in her analysis. But something deeper and more profound is at work, I think. In working outward from her analysis, and in trying to understand the psychiatric and psychoanalytic world she found herself inhabiting, Taylor uses psychoanalytic thinking to understand history as an analysand might use the psychoanalytic experience to understand herself. As she reconstructs the chain of meaning in her own life, she looks from inside that experience out to the history of madness in our time. Her experience guides her understanding of the history of care and its vicissitudes. Although her sense of what sort of care is needed derives from Winnicott, it is not that she “applies” Winnicott to history. Instead, she treats social history analogously to how she might treat psychic history: unraveling, layering, seeking out associations, understanding ambivalence. In her history as much as in her analysis, she links self-understanding to historical understanding; her engagement with psychoanalysis provides less a theory than a way of thinking through the past. There is no presumption of authority on Taylor’s part — she is embedded within the story that she tells — and by acting as analysand as well as historian, she opens up new ways to relate subjectivity, psychic experience, and history. It is an endeavor not only worth reading, but worth emulating.

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Michael Meranze is Professor of History at the University of California, Los Angeles.