Holloway, House of Correction

This is an extract from, ‘When the Gates shut’ by Joanna Kelley, May 23 1910-12 April 2003, Governor of Holloway from 1959 to 1966.

What this illustrates most fully is how so often we consider the past to be better, grander and perhaps more civilised than our present. One does not have to read between the lines to catch a glimpse of what society and conditions were like for so many women in the middle of the Twentieth century and before. Naturally, of course, we understand that the people in those times did not have the many pleasantry’s that we, in the West, now currently enjoy and take for granted, but it takes a somewhat detailed examination, such as is before you, to fully place the living conditions of some into context.

In reading this, one understands that perhaps entering Holloway for some was not such a trial. Not a holiday camp certainly but perhaps a place where rest could be achieved and health restored.

Medical work at Holloway falls into three parts: the observation, at the direction of the courts, of women, whether on remand awaiting trial or on remand after conviction, for the purpose of making medical reports to court; the treatment of the physical condition of those undergoing sentence; and the treatment of their mental condition.

The preparation of reports is immensely important. The courts have come to attach great weight to medical reports, and this has led to an increasing demand for them: over 1,100 are completed in Holloway each year. Of course the court is not bound by any observations or recommendations made in reports and conflicts may occasionally arise; for while the maker of the report takes a doctor and patient view of the woman remanded, the court has to balance her interests against the need for the protection of society. A woman sentenced to imprisonment who is found to be in need of medical or psychiatric treatment which cannot be given in the prison hospital can, on the authority of the Secretary of State, be removed to an outside hospital; the Mental Health Act makes provision for the removal of prisoners who are found after sentence to be mentally ill to the care of an outside hospital. The courts have powers under this Act to make a hospital order instead of imposing a sentence of imprisonment in cases where they consider this to be the more appropriate way of dealing with an offender.

Compiling these reports is the main occupation of the four doctors at Holloway. Every prisoner who is remanded in custody for a medical report is admitted to hospital for observation, either in a ward or in a single room, as seems best, with suitable instructions regarding the degree of observation necessary, the risk of suicide, the need for drugs and like matters. The observation is thorough; it is seldom completed in less than two weeks and may take three. The psychological tester conducts three tests: progressive matrices, vocabulary tests and the I.S.B. test. Women who seem seriously disturbed are also given the Wechsler test. There are at least two interviews with a medical officer, sometimes of considerable length, and subsequent interviews may take place if time permits.

Reports may also be required from a visiting psychiatrist and the gynaecologist. There are telephone calls and interviews with probation officers and doctors who have treated the woman previously. School, police and probation reports must also be obtained. In appropriate cases arrangements must be made with hospitals and clinics for possible future care as in- or out-patients. Further work is required in the case of psychotic women requiring mental hospitalisation: in 1964 a hundred and five women were certified before sentence and five after sentence. Rather more than a hundred women each year are sent to special hospitals managed by the Ministry of Health such as Broadmoor, Rampton and Moss Side following such reports; a smaller number are found unfit to plead to the indictment and are sent to special hospitals. Apart from court reports, medical reports on sentenced women are often needed to help in assessing the most suitable form of prison treatment. Selection for the three recidivist wings or for an open prison depends on a woman’s physical and mental health as well as such factors as her age and criminal record. Borstal trainees are also sent to Holloway for psychiatric observation and for treatment if they seem to be seriously disturbed.

In addition to four full-time doctors, Holloway’s three hundred inmates are served by a psychologist, a psychiatric social worker, two part-time psychotherapists, a part-time physiotherapist, chiropodist, dentist, gynaecologist, venereologist and optician. Women needing the attention of an occulist are sent out for treatment. The hospital has the use one morning each week of the local mass radiography unit: all prisoners are X-rayed and about fifteen cases of tuberculosis are discovered every year. The hospital is staffed by about forty sisters and nurses: two of these are male hospital officers whose presence has made a great deal of difference to the discipline of the hospital; without apparent effort they are able to quieten and control the most difficult patients. The standard of medical treatment for Holloway’s inmates has radically improved in recent years. Undoubtedly conditions in the years after the war left much to be desired. One woman who was told to go to the hospital flatly refused and was put on report. She was then told that if she did not go to hospital voluntarily she would have to be taken forcibly, in which case she would lose seven days’ remission. She declared that she was willing to lose seven days’ remission if that must be, but that nothing would induce her to go voluntarily to hospital. Such fear of the prison hospital is much less common nowadays.

Complaints are still made, it is true, but this probably comes about because the medical staff does have to exercise some caution in dealing with a body of women of whom a large proportion are warped and thwarted. In prison, where time hangs heavily, it would be surprising if there were not a higher proportion of imaginary ailments’ than in the general population. It is not true, however, that prisoners reporting sick are automatically suspected of deceit until the contrary is proved, or that malingering’ is the most frequent diagnosis.

On the contrary, the medical care of those in Holloway probably compares very favourably with that of the population outside, if only because there is, to a degree, constant observation both of the sick and those who are apparently well. Medical facilities are close at hand and constantly available, and no one need neglect an opportunity of medical treatment because of the demands of a family or job. Every inmate has the right to see the doctor on any day of the year: few people outside prison are so fortunate in this respect. Every woman serving a sentence longer than six months has to be given a periodical routine examination and prisoners who are in Holloway ‘sine die’ must be examined and reported on monthly.

Prisons in fact, however surprising it may seem, are healthy places, as is borne out by their curious resistance to epidemics of various kinds. More often than not imprisonment leads to an improvement in health, which often becomes apparent after a woman has passed through the initial settling down period. Regular hours, adequate diet and a proper amount of sleep probably have much to do with this. One woman made an application to see the governor so that she could change her work. Her job in the laundry, she complained, was getting her down; she felt that her health would improve if she could work in the open air. Only when pressed did she admit that her real reason for wanting to work in the gardens was that she was due to be released in a few weeks and that she thought she would be able to make a better start if she looked at and sun-tanned when she left prison. Her request was granted. There is a notable absence of illnesses arising from stress conditions, such as gastric ulcers, high blood pressure and coronary thrombosis. There is also a low incidence of acute infection, such as inflamed throats, whitlows, boils, chest infections and the like. A hundred of the women donate blood regularly.

At open prisons, where conditions are more favourable, women are often enthusiastic about improvements in health, again after an initial period, which may be distasteful to townspeople, for whom life in the country may have some of the horrors of the unknown. “I must confess that personally I have never enjoyed better health,” wrote one woman, “and I am delighted to be able to relate that I have lost those extra inches which I badly needed to lose”

For some women there are special health advantages in prison life. Drug takers improve after withdrawal of the drugs. Alcoholics seem to be relieved of their desire to drink with the knowledge that none can be obtained. Drug addicts and alcoholics, unfortunately, often lapse quickly after being released from prison. The ‘old drunks’, indeed, sometimes seem to regard their periodic short sentences as inevitable and not too undesirable ‘rest cures’ between alcoholic bouts. Many of the women who come to prison, too, have led lives that are wretchedly marred by anxiety and tension: an enforced rest may often be highly beneficial for them. A high proportion of the women who come to Holloway are in a poor state of physical health on admission. Often things are wrong that can easily be put right, but which have been neglected.

Teeth, eyes, feet, veins all need attention. Many are anaemic or in need of gynaecological treatment. The part time dentist sees 17 cases a week; the optician visits about I7 times a year; the chiropodist attends to 16o cases a year; the physiotherapist has about 50 cases annually. About 6oo cases are sent to outside hospitals for outpatient treatment and 105 as in-patients: 49 of these are to have babies. In 1964 there were 6oo cases of nits, 6o of scabies, 250 of gonorrhoea, 6o of syphilis and 1,000 of non-venereal vaginal discharge. About 550 prostitutes passed through the prison, of whom one quarter had gonorrhoea. £6oo was spent on flagyl.

Tattoos are now being removed when the women request it, and this is often helpful. Many prostitutes say, “I must go back on the game. With all these tattoos I could never keep a respectable job.” Oddly enough, this may often be true, so self-conscious are the women about their tattoos. In one case, however, one of the doctors refused to proceed any further with his work of erasing tattoos from a girl whose arms and legs were covered with them : the girl, he explained, was busily re-tattooing the areas he cleared, using prison red ink and black ink, replacing the old names with new ones.

Between five and six thousand doses of medicine are dispensed each week to Holloway’s three hundred inhabitants, and there are two full-time dispensers. This might seem incredible, were it not remembered that all medicines have to be issued in single doses and in liquid form, to be taken under supervision. If aspirin and other drugs are issued as tablets, there is the risk that they are secreted and stored, perhaps coming to form part of the illicit ‘currency’ that circulates in every prison, with the consequent danger that stocks might be accumulated in quantities large enough to be dangerous.

Thus what at first sight appears to be an unnecessary and cumbersome procedure has sound justification but the result is that a woman needing to take a medicine four times daily must be dispensed twenty-eight separate doses every week. When one woman arrived her teeth badly needed attention: her face was swollen and she was obviously in pain. The teeth all had to come out, for many of them were abscessed. “I’ll say it to your face, I’ll say it to your back,” she said afterwards. “Kind is what you have been to me.” Another oId lady, an alcoholic, arrived with a broken leg and was glad that her sentence was long enough for the fracture to unite. A mother of five children complained that she was always tired, and unable to bear the noise and the wear and tear of family life. She was found to be very anaemic and to have a prolapse. She was suitably treated and left prison in a far better state to cope with her family and circumstances. Although these have been difficult she has not returned to prison.

Breaking the Iaw and being sent to prison, no less than alcoholism, drug addiction or suicide, or suffering a ‘nervous breakdown’ and becoming mentally ill, may often be a method of escape from what is felt to be an intolerable situation. Ill-health in many cases may be an important contributory factor in producing such breakdowns and the resultant ‘failure situations’; taking advantage of a woman’s enforced absence from home to improve her physical health can be one of the most useful pieces of rehabilitative work.

It is of course tragic that the mentally ill should ever be sent to prison. That it does happen is partly because it is often extremely difficult to draw the line between ‘badness and madness’, the more so when the patients concerned are aware of what is at stake and may be tempted to practise deceit. “I look in the mirror and I am not me”, a young prostitute told the doctor. “My face is mental so I must live on my body. I must be common and wear black.” This girl had been brought up in a children’s home after the death of her mother; she had borne a baby when she was nineteen and undergone a period of mental illness in hospital before becoming a prostitute.

Another young woman had a habit of running needles into her breasts. She also had the habit of suffering (often quite genuinely) the ailments of others; if someone sprained an ankle or got a black eye or had an arm in a sling, Phyllis’s ankle would soon be bandaged or her eye covered with a shield or her arm in a sling too. Often the complaint might be different, but the affected part would be the same. During one sentence she had a long and painful illness and nearly died; for many, many months she was devotedly tended in an outside hospital. When she left it the hospital authorities found that she had succeeded in extracting money and goods from both nurses and fellow patients by various false pretences.

All receptions are now given psychological tests on admission. Certain women, on the recommendation of the senior medical officer, are seen by a psychotherapist. These are generally more intelligent women who are able to understand and co-operate in such treatment.

The prison psychotherapist, of course, is confronted with a population consisting of society’s misfits; there is ‘something wrong’ with them all in the sense that they have failed to conform to the accepted standards of social behaviour, and that in at least one chapter of their lives they have come to disaster. Yet clearly not all are mentally ill in any of the accepted senses. The artificial nature of prison society itself makes for further difficulties in diagnosis. Prison is one of the few environments which society provides for anyone who wants to be totally dependent. The woman who seems best adjusted to prison life may be far worse fitted to cope with ordinary life than another prisoner who finds captivity unendurable.

The fact of imprisonment also creates problems of treatment. So often the work of the psychotherapist is one of liberation, but mental liberation is not easily compatible with all the surroundings symbolically and actually representing captivity. There are rules, security, differences of opinion about what is being done, and often resentment at the psychotherapist’s intrusion. In the face of all these adverse circumstances, the prison psychotherapist cannot expect to accomplish too much and it would be unrealistic in the conditions of a closed prison to look for many cases of dramatically improved mental health, achieved by the application of the usual methods of psychiatric treatment. At first the prison staff expected the psychotherapists to cure all their patients within a reasonable time, and turn them out well-balanced and sensible women. It was necessary to learn that this is not always possible.

There are many whose personalities have been much too damaged ever to reach normality, for whom the most one can hope is some limited progress and increase in maturity. Some are psychopathic and have almost no insight. One notices that many who show these tendencies when young do seem gradually to adjust themselves to life: it is as if they grow up very, very slowly. Girls who are violent and quite uncontrolled in their teens and early twenties, in their thirties seem to settle down; sometimes outside prison, and sometimes, although they continue to need the security and support of prison, becoming less anti-social and more sensible in these surroundings. They often make good prisoners and display loyalty to the establishment, which may be the only home they know.

Some need, and would respond to, psychotherapy but their sentences are too short: when they are discharged they have to be transferred to a National Health Service psychotherapist, and so it may be better for the prison psychotherapist not to begin treatment. Others, of course, have no intention of co-operating and it would be a waste of time to try to treat them. Others again want treatment, but expect the therapist to put them right, as a surgeon sets a broken limb, and are extremely disappointed when they find that they have not been transformed without any sort of effort on their own part.

There are, of course, some who do respond to treatment and can be helped by individual psychotherapy in prison. But in Holloway the psychiatrists seem to find that the best ways of helping the patients are by group therapy and though the discipline staff.

Each psychotherapist takes specialised groups and guides the prison officers and assistant governors in the group work that they undertake. They attend staff meetings to discuss some of the problems with the officers, and try to give them further insight and training in the nature of their work. These are the ways in which the psychotherapists have been most useful at Holloway, and their work is of inestimable value.

A fascinating report from the 1960's