Wednesday, 8 February 2012

Origins 4: My First Caseload

Part 4 of an occasional series

Within a couple of weeks of starting as an unqualified generic social worker in Charwood in the Autumn of 1976, I began to acquire a caseload. It was quite a mixture. Being a complete novice, I did not question their histories, assuming they were “normal for Charwood”, but when I look back now, I realise how extraordinary some of these people and their life experiences were.

First, there was Benjamin. Private Benjamin. He was my very first mental health client. Benjamin had been a young man during the 2nd World War, and had been called up to serve in the Army. He had previously spent his life in a village in the Charwood area, living with his parents and family in a large timber frame farmhouse, and working on the family farm. He had a fiancée, whom he had to leave behind when he was called up. She promised to wait for him until his triumphal return.

While in the Army, Benjamin was badly injured. It was not in active service. A munitions lorry backed into him in the Army depot, crushing him against a wall and damaging his legs and spine. He was medically discharged, returning to his village permanently disabled, and only able to walk with the aid of sticks. His fiancée, on seeing his injuries, promptly left him, and married another.

Broken in heart and body, and no longer able to work on the land, he retreated to the family farmhouse, where his parents still lived with his sister and her son. He took over the attic rooms, and became a complete recluse. His mother would leave food and the daily local newspaper at the top of the steep attic stairs, he would take it once she had left, and return the empty plates to the landing when he had finished.

He continued to live like this for the next 20 or more years. No-one in the household ever saw him, although they would hear noises emanating from the attic from time to time, so they knew he was alive.

It is unclear how social services came to be involved with him. Perhaps the noises in the attic became more disturbing. Perhaps his family began to get concerned that they had allowed this crippled ex-serviceman to isolate himself in this way. Whatever the trigger, in the mid 1960’s an assessment was carried out under the Mental Health Act 1959.

The Mental Welfare Officer, his GP and a Psychiatrist climbed the steep stairs to the attic and entered the attic room in which he had lived unseen for over 20 years. The entire space was taken up with a warren made of old newspapers. They picked their way through these narrow corridors until they eventually discovered him, huddled in a nest of old newspaper. His hair and beard had grown down to his waist, his fingernails were several centimetres long, and worst of all, they discovered that, because he had not used his legs for decades, and had instead negotiated his warren by shuffling along on his bottom, his legs had atrophied under him and were completely immovable.

He was detained under Sec.25 of the 1959 Act, which was the equivalent of Sec.2, and admitted to the local Victorian asylum for assessment. He was diagnosed with paranoid schizophrenia and detained under Sec.26 (the equivalent of Sec.3), for the next 10 years.

When I took Benjamin on, it was with the specific purpose of facilitating his move out of hospital and back into the community. Although still physically disabled, physiotherapy had restored use to his legs, and he was again able to walk with the aid of sticks. His mental illness was in remission, and there was a project under way to decant the long stay patients from the hospital and back into the community.

It was not considered a good idea for Benjamin to return to the family farmhouse, where his elderly and frail mother now lived alone, and there was nowhere else in his village where he could live, but I did find a place for him in a hostel in Charwood, where he had his own room, his meals were provided, and he had company.

He was content with this for a year or so, until his elderly mother died, and the farmhouse was sold. He received a considerable share of the proceeds, and decided to leave the hostel and travel around the county, looking for a suitable place to buy a bungalow and settle down. As he was mentally capable, I could not stop him. He bade farewell, and left Charwood, and my caseload.

I thought I would never see him again.


One day nearly 30 years later, I was asked to assess an inpatient on the older people’s psychiatric ward. He had been detained under Sec.2 and they wanted to further detain him under Sec.3.

It was Benjamin.

Since I last saw him in the late 1970’s he had spent over 10 years wandering around the county, staying in bed and breakfast accommodation, until being allocated a local authority flat in Charwood about 10 years previously. He had had no involvement with mental health services for 30 years.

I was the only professional who actually knew his history.

Over the previous few months, he had been refusing food, and had become emaciated and very frail. When assessed at home, they found him living in a warren of newspapers.

When I interviewed Benjamin in his room on the ward, I found a very elderly and frail man. He was by now in his 90’s. I asked him if he remembered me from the best part of 30 years ago. He did.

There were no significant signs of dementia, but he was displaying clear symptoms of psychosis. He was paranoid about food, and objected to the ward staff forcing him to eat. He thought they were poisoning him with food and medication. He wanted to go back home so that he did not have to eat or take any more medication.

There was no option. He needed to be detained under Sec.3.

He recovered. His nephew, his sister’s son, who had known him as “the mad man in the attic”, when he had been a child, and who had reconnected with him when he had settled again in Charwood, offered to accommodate him in his own home. Benjamin was his last living relative.

Benjamin agreed to this, and he was discharged.

Next time: more choice cases from my rooky caseload.


  1. Fascinating story

  2. Why exactly wouldn't it have been a good idea to return to the family farmhouse when his mother was frail and elderly? And just out of curiosity: what would have happened if instead of being out of touch with reality and with atrophied legs, he was found in a surprisingly normal condition?

  3. I think this is what I like best about your blog. Although the what's, the why's and the where fors are interesting. It's the way you tell your cases and the way that mental health effects peoples lives and those around them that has the greatest impact.

  4. I had actually asked my question seriously but I can't help imagining the somewhat unlikely but not impossible scenario of that person being perfectly happy and reasonably healthy and well-groomed in an apartment of sorts, with furniture, books, an old grandfather clock, china figurines, a carpet, etc., some simply old and broken but others possibly quite valuable as antiques nowadays. Where would that come from? The attic, of course. Even better, the mental health people or somebody else would give him or his family members the idea that some of that stuff is worth lots of money. Instead of him ending up in hospital, he and his relatives would become rich and everybody would say that he was smart to take an interest in those objects and take care of them, and that he helped his family more than a so-called normal person would have. People would wonder what's more insane, anyway: living in the attic or working hard for little money (like his relatives were probably doing) while a treasure is in the house? Even better, he could have saved up for many years (or not received but then gotten it retroactively) some sort of pension for being a war veteran and that money, too, would be nice to have. I realize that I'm dreaming, but such a story would be fun to see and even more unlikely things do happen.

  5. Hi Monica. Actually, I think his story was at least as unlikely as your imagined scenario.
    To reply to your other points:
    1. If he had returned to the family house, there would have been a distinct possibility that he would have isolated himself again and relapsed. His mother had also become trapped in a pathological parenting pattern which had allowed him to be untreated for many years.
    2. If on assessment he had been found not to have had a mental disorder, then he would not have been detained -- although, in the circumstances, a detention at least for assessment might still have been justified. There are many occasions when I have assessed people who, although living well outside society's norms, especially in regard to domestic squalor, do not have mental disorder and are not detained.
    3. One last point -- this was a long time ago and practice has changed enormously -- we do not have long stay hospitals any more, for one thing, and rehabilitation is much more to the forefront. Also, I was an unqualified, inexperienced social worker, and therefore was more likely to be guided by my seniors. And lastly, I was giving the facts of this story -- I am not suggesting this was an example of best prqactice.

  6. Thanks for answering my questions. I have noticed throughout the blog that you seem to be surprisingly willing to just let people be rather then round them up for questionable "help" even though the hospital would release them very soon.