Abstract
Names are powerful symbols which contribute to internal and external perceptions of an individual or institution. This paper discusses the names given to Regional Secure Units established following the Butler Report, and discusses some of the reasons underlying the choice of name. Understanding the derivation of names can assist understanding of the development of forensic psychiatry as a separate specialty and awareness of its history.
Introduction
Names, both of individuals and of places, are powerful symbols which, as well as serving as practical identifiers, carry multiple layers of meaning. A well-chosen name can convey considerable information about history, ethnicity, religious or political affiliation, or social background. As one commentator notes 1 ‘a short word, often of one syllable only, is able to encode enough information to “stand for” an entire ethnic tradition’. Falk 2 reports the case of a man whose decision to change his family name resulted from his need to separate from an ‘overpowering’ father, and concludes that ‘the emotional value of names is an indication of the deeper psychic implications of names and name changes’. Names influence the way an individual is perceived by others – something from which not even psychiatrists are immune. 3
Names of places are also infused with complex meanings. They can reflect political or military control, often changing with regime change. Many British place names reflect their Roman, Anglo-Saxon, Norse or other origins. History can be seen clearly in some names, while others reflect geographical, occupational or economic features.
Between the Hutton Unit in 1981 and Brockfield House in 2009, more than 30 medium secure units covering the whole of England and Wales were opened. Initially these covered all or part of the former Regional Health Authority areas, and were known as Regional Secure Units (RSUs). Various aspects of that programme have been described; 4–6 the same period has also seen the development of low secure units, medium secure units covering smaller areas, specialist secure services in areas such as learning disability and adolescent psychiatry, and provision of secure care by the private sector. RSUs were almost invariably built within the grounds of existing psychiatric hospitals (in some cases utilising existing buildings) but many have since seen the closure of their parent institutions, leaving them as self-contained units. This paper describes some aspects of the names chosen for the various units.
Method
Twenty-four units were identified from the Forensic Directory (
Details of units contacted
*No detailed responses received
Each unit was contacted by means of a letter to a senior clinician, enquiring about the derivation of unit and ward names. In some cases this was supplemented by personal contact, and all non-responses were followed up by telephone on at least two occasions. In addition a general request for information was posted on the MSU Quality Network discussion group, and further information sought from hospital websites and other reference material. Additional information, including illustrative anecdotes, was encouraged.
Results
Responses were obtained from 23 of the units contacted, although the information and the amount of detail provided varied considerably. For those units where no response was received, some assumptions have been made based on the name itself.
Signifiers
The commonest choice of signifier was ‘Clinic’, chosen for nine of the units. Respondents felt that this helped ‘to emphasize hospital orientation’ or ‘denotes health care’; one other unit, initially designated a Clinic, recently dropped the term, which was perceived as ‘too clinical’. One unit has adopted the name ‘Hospital’, in order to ‘reflect a therapeutic purpose’: this may be seen as more appropriate now that many units are self-contained, but most RSUs were initially built in the grounds of larger hospitals, and did not seek a separate identity.
Four units are styled as ‘Centres’. Responses indicated that this was a deliberate choice to emphasize the regional function of the units and to ‘symbolize a central service reaching out to a wide area’.
Five of the units are identified as ‘House’ (‘Ty’ being the Welsh equivalent). In one case this was explicitly chosen to encourage a ‘smaller, domestic-scale environment’. One response indicated that the name was inherited from an existing hospital villa-style ward that had been converted as the service's Interim Unit, the name being retained when a purpose-built unit was opened.
Other signifiers were ‘Unit’ (5), ‘Lodge’ (4) and two units had no explicit identifier. One response said that ‘Unit’ was rejected as ‘non-descript’. In the case of the Caswell Clinic it was suggested that the name ‘sounded better’ than alternatives, presumably because of the alliteration. No other responses reported considering the sound of the name when making a choice.
Unit names
With regard to the substantive part of the names, the commonest theme was for geographical names: 15 units were variously named after local towns (4), rivers (3), fields (2) or woods (2), with one each being named after a bridge, road, local parkland, and one after a bay on the nearby coast. The Norvic Clinic takes its name from the Anglo-Saxon name for Norwich.
In each case where the name of a local town was adopted, this followed the practice of naming wards in the unit's parent hospital. The only two units which reported selecting a name after a staff vote (Bamburgh and Edenfield) both chose a local town for a name, and both followed the practice of their parent hospital: possibly such a traditional approach was more likely to attract votes than something more radical, where support might have been more divided, or perhaps the choices were constrained by the general naming policy. Ravenswood House was the name of an existing ward on the Knowle Hospital site, which was converted to a secure unit, the name being retained when a new unit was built some years later. Newton Lodge also adopted the name of an existing ward in its parent hospital, although ‘Lodge’ seems to have been a new addition.
The newly opened unit in Essex has been named Brockfield House, reflecting badgers in fields close to the site chosen for the building. Its predecessor functioned for many years with no specific name, other than that of the hospital in which it was situated. Ashen Hill took its name from a field name close to the site of the unit, marked on old maps pre-dating the building of Hellingly Hospital.
In addition to the local geographical names, Bridge House and River House in London adopted similar names but without a specific local connection: River House was said to be chosen ‘to suggest movement and recovery’, and Bridge House may have similar connotations. These were the only examples of units choosing names reflecting abstract concepts or aspirations.
Most (9) of the remaining units were named after specific individuals: some brief biographical details can be found in the Appendix. Four of these were named for psychiatrists (Thomas Arnold, Denis Hill, Peter Scott and Trevor Gibbens), of whom three were near contemporaries with the unit, although none were living at the time of opening. Lord Butler chaired the Committee on Mentally Disordered Offenders in the 1970s that led to the RSU programme (Home Office, 1975), and Sir Denis Hill was also a member. None of the other non-psychiatrists (Henry de Bracton, John Howard, Lord Shaftesbury and Llywelyn Fawr) were 20th century figures, and all but Llywelyn Fawr had some connections with mental health or penal reform.
Where individuals were commemorated in unit names it usually seems to have reflected the esteem or respect in which an individual was held. There seems to have been less concern to reflect a local connection: Thomas Arnold, Denis Hill and Trevor Gibbens all worked in the area of their eponymous units, and John Howard was born in Hackney, but both Bracton and Shaftesbury would have had more connection with the southwest than with the area of their units, while the unit in the southwest in fact chose the name of a politician (Butler) linked primarily with Essex. The unit in Essex might have laid claim either to Lord Butler or to Peter Scott (who trained at the hospital where the Essex unit was situated), but the Scott Clinic on Merseyside seems to have chosen the name of a colleague with little connection to that area specifically.
For several units it was commented that naming units after members of staff, particularly those who had died while a unit was being commissioned, was considered but rejected. Generally this seems to be something which is often proposed when a respected colleague dies, but it is usually felt that a unit's name needs to be something with more historical or long-term significance. One recent exception (not included in the primary data of this survey) is the renaming of the Orchard Unit in Luton (itself named to perpetuate the name of the interim unit built in a former orchard at a previous hospital) as the Robin Pinto Unit, to commemorate the founding consultant, who died in 2007. However one unit (Ravenswood) used the names of founding members of staff for ward names in a later redevelopment, as did Arnold Lodge when naming a new development after Jim Earp, and at the Scott Clinic a subsequent rehabilitation unit was named for the service's first senior nurse, John Parry.
Only two units seem to have been named for something other than a geographical feature or specific person. ‘Norvic’ was the Anglo-Saxon name for Norwich, and is used by various local organizations: the Bishop of Norwich also signs his name ‘Norvic’. Guild Lodge in Preston was named to commemorate the Preston Guilds – important trade associations in the medieval period and a well-recognized part of local history.
Few comments were returned about alternative names that had been rejected. The Humber Centre was initially planned to have been called the ‘Humberside Centre’, the name changing when local government reorganization abolished Humberside, apparently to considerable local approval. The name of the Norvic Clinic was chosen after an earlier (unrecorded) proposal had been vetoed by a member of the Hospital Board who did not want his similarly-named business affected by the negative association with a forensic unit! Alternative names were considered for Three Bridges, possibly to commemorate an eminent local psychiatrist, but the name chosen, marking a local engineering landmark designed by Isambard Kingdom Brunel, was perhaps more imaginative. Bracton Clinic might have been called ‘Meadow View’ had that not been considered to be ‘a bit twee’, and who would argue with that?
Ward names
More variety is evident in the choice of ward names, although geographical themes still predominate. Rivers are used at three units, in each case continuing the theme of the unit name. Local towns again feature in several units, tending to follow a hospital tradition, but other choices have included castles and mountain ranges. Newton Lodge has wards named after famous local people, the Bamburgh Clinic has chosen Northumbrian saints, and the Shaftesbury Clinic wards are named after members of the 1844 select committee on lunatic asylums. One unit (Scott) has named wards after trees, chosen because their names represent positive qualities such as strength and hope, although I recall that in the early 1990s the wards were unimaginatively known as ‘1, 2 and 3’. Only Wathwood has adopted the utilitarian approach of wards identified as ‘assessment’, ‘rehabilitation’, etc., without further naming. Two units reported naming wards by the result of staff vote: names of local woods and parks were chosen at Bracton, and at the Norvic Clinic new wards followed previous practice of being named for suburbs of Norwich, but staff chose the specific names.
Wards at the Caswell Clinic are named after bays in the Welsh coast, following the theme set by the unit name. Apparently it was suggested that wards be named after collieries in the local coalfields, but the connotations of secure unit wards named after ‘deep dark holes in the ground’ counted against this.
The naming of a secure unit
My only direct experience of the naming of a secure unit was as the forensic psychiatrist involved in commissioning Ty Llywelyn in the late 1990s. The descriptor ‘Ty’ (‘house’) was chosen partly to promote a therapeutic ethos in what was planned as a small unit with wards on a domestic rather than institutional scale, and partly to minimise negative external perceptions of a custodial unit seen as divorced from local needs. At the time the name was chosen a medieval palace occupied by Llywelyn Fawr, Prince of Gwynedd, had recently been discovered and excavated near to the site of the unit, and the name was felt to reflect both that local connection and the unification of North Wales as a whole. Thought was also given to the translation of ‘secure unit’ into Welsh, the original designation of ‘Uned Sicr’ being changed to ‘Uned Diogel’. Both ‘sicr’ and ‘diogel’ would be translated as ‘secure’, but diogel has connotations of safety and protection, whereas sicr has connotations of rigidity and confinement, which were felt to be unhelpful.
Options considered when the wards were named included local rivers (a popular choice in other units) and saints from North Wales. Finally, the names of three characters from the Mabinogion (Welsh folk tales) were adopted, the names being chosen of individuals who underwent various forms of imprisonment, redemption and transformation. Gwion, tasked to stir a magic cauldron, was splashed by the contents, which gave him the gift of prophecy. Pursued by its owner he changed form several times, finally becoming a grain of wheat, was swallowed by her, and then reborn, cast into the sea, but rescued, to become Taliesin, greatest of the Welsh bards. Branwen was a princess of Wales, married to the King of Ireland. Imprisoned by rival factions within the Court, she was rescued following a great battle between the Welsh and the Irish, and returned to her homeland where she died of a broken heart. Pwyll is the central character in the first tale of the Mabinogion. After offending Arawn, the Lord of Annwvyn (Hades), while hunting, he spent a year in the Underworld, where his honourable behaviour earned him not only his release but also the lifelong friendship of Arawn.
Conclusions
Names are powerful symbols that can both reflect aspirations and identity, and change internal and external perceptions of the bearer. All human cultures place considerable emphasis on the selection and use of names, which are often considered to have considerable power and significance. The RSU programme represented an opportunity for the developing speciality of forensic psychiatry both to assert its own identity, and to present an image to the outside world. What use was made of that opportunity?
At first sight, many of the unit and ward names referred to above seem to lack individuality or evidence that issues of identity had been considered. Although not totally inaccurate, I think that such a reading would be superficial. The decision to adopt names in line with existing hospital naming rules, even to adopt an existing ward name unchanged, is still a positive decision, and seems to reflect a young discipline, eager to ‘fit in’, rather than to assert an independent identity. A similar process is sometimes seen when immigrants adopt new names, typical of their adopted country, rather than celebrating their ‘otherness’ as reflected in an alien name.
In contrast, a significant subgroup of units seems to have chosen to adopt names that celebrate their different identity as ‘forensic’ units, by taking the names of prominent individuals linked with the discipline. Two of the very early RSUs, the Butler Clinic and the Scott Clinic, took this approach, perhaps conscious of a need to assert the arrival of a new form of clinical service. There seems to be a move away from the more ‘traditional’ hospital names over time, perhaps reflecting a growing confidence and sense of identity within the specialty, as well as the reducing influence of large parent institutions, now mostly closed or greatly reduced in size. This trend has culminated in new units such as Bridge House and River House, boldly reflecting values and aspirations within their names.
Several units have deliberately adopted names with no immediately apparent forensic or mental health connotations. The John Howard Centre was initially known only by its address (‘Crozier Terrace’) in a deliberate attempt to maintain a low profile, but the name subsequently adopted did have a definite forensic origin, albeit one that might not be obvious to the uninitiated. Ty Llywelyn was named in a deliberate attempt to promote local identification with the unit and to avoid specific forensic connotations.
Naming units after individuals presents a clear opportunity to identify with specific values or historical traditions, and it is perhaps not surprising that proposals to do so seem to have caused more controversy than other naming schemes. In contrast, geographical names may well be seen as more neutral, and, particularly where these followed established patterns of naming within a parent institution, may have been adopted to defuse or avoid such feelings. Naming after living or recently deceased staff working within a service has been particularly controversial, although this practice seems to be increasing in established services, as the first generation of clinical leaders move on.
The use of identifiers also seems to have changed over time, with early units often being called ‘Clinic’, showing their allegiance to a hospital and perhaps to a medical model of psychiatry, and a clear trend in more recent units to avoid this and, in the case of Fromeside, actively to drop the identifier previously used. ‘House’, perhaps reflecting a homely and welcoming atmosphere, and ‘Centre’, which seems to denote expertise and control of a wider service, seem to be the new preferred alternatives. With fewer clinical connotations, ‘Lodge’ was a popular choice in the 1980s, but now seems to be out of fashion.
The opportunity to name a new secure unit should be welcomed as a unique opportunity to identify values and aspirations that a service will carry with it for many years, and to denote the philosophy of a service to an outside world that may inherently approach forensic psychiatry with trepidation and stigma. Chosen well, a name can contribute to a therapeutic atmosphere for patients, a sense of pride and belonging for staff, and a perception of competence and confidence for the wider public. As the above examples show, they can also contribute to the ongoing history of forensic psychiatry, and enable us to remain in touch with our origins.
Footnotes
ACKNOWLEDGEMENTS
I am grateful to all the respondents who took the time to answer my enquiries, often in considerable detail. I would be very interested to receive further information, particularly about those units that I have not heard from, or about the ‘back stories’ behind the names. Herschel Prins provided additional background information and helpful comments.
Appendix: Brief biographical details
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| A physician in Leicester, he inherited his father's practice as a ‘mad-doctor’ and established a reputation for successfully treating the insane, as an early adopter of ‘moral’ treatment in psychiatry. He was physician to the Leicester Infirmary but resigned after allegations of financial mismanagement. He was also known for supporting radical political causes, campaigning against the Test Acts. He wrote an early textbook of psychiatry (1782), which rejected the traditional humoral theories of medicine in favour of a descriptive approach that anticipated 20th century phenomenology. The family tradition of mad-doctoring was continued by his sons. |
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| Famous as a judge and jurist, and author of an early legal textbook, as well as being Chancellor of Exeter Cathedral. Many of his judgements related to insanity and mental disorder as a cause of offending, and he recognised insanity as a defence to criminal charges. |
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| ‘Rab’ Butler was a leading politician on the moderate wing of the Conservative party throughout the mid-20th century, known to forensic psychiatrists primarily as the chairman of the ‘Butler Committee’ on Mentally Abnormal Offenders, which initiated the RSU programme and the development of modern forensic psychiatry. 7 As Home Secretary he introduced the 1957 Homicide Act, introducing the concept of diminished responsibility into English law, and was also chairman of the National Association for Mental Health (later to become MIND). |
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| Following wartime service, which included escaping from a Prisoner of War camp, and several years in captivity where he made observations of the effects of imprisonment, which led to his MD thesis, Trevor Gibbens trained in psychiatry, becoming Senior Lecturer in Forensic Psychiatry at the Institute of Psychiatry, and later Professor, posts which he held for almost 30 years. |
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| Although primarily known as a general psychiatrist, Denis Hill, Professor of Psychiatry at the Middlesex Hospital from 1960 and at the Institute of Psychiatry from 1966, supported the development of specialist forensic services, and was extremely influential as the only psychiatrist on the Butler Committee. He was directly involved in the development of the unit at the Bethlem Royal Hospital, but sadly did not live to see it opened. |
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| Born in Hackney, and later High Sheriff of Bedfordshire. Famous as a penal reformer and inspector of prisons in the UK and throughout Europe, his work contributing to significant reforms in the 1774 Gaol Act. He particularly campaigned against the use of mechanical restraints, and the confinement of the mentally ill within prisons, and campaigned for the establishment of an asylum in Liverpool. He was also famous as a non-conformist and free thinker. After his death he was commemorated by the first statue to be erected in St Paul's Cathedral, and his name is remembered in the Howard League for Penal Reform. |
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| Born at Dolwydellyn, near Conwy, Llywelyn established control over all of North Wales through both political and military skill. In 1218, at the peace of Worcester, Llywelyn asserted his supremacy over all of Wales, but Henry III would not recognise this. Although he held effective military and political control he failed to establish a single principality, and after his death his son, Dafydd, was unable to maintain his territories. |
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| Recognised as one of the founders of forensic psychiatry in Britain, Peter Scott worked with both juvenile delinquents and adult offenders, developing an outpatient and assessment service at the Maudsley Hospital, where he took charge of forensic services in 1948. He was a strong advocate of psychiatric work within prisons and was critical of the proposals to develop RSUs, arguing instead that resources should be used to provide better standards of care within prisons, delivered by the NHS rather than the Prison Medical Service. |
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| Anthony Ashley Cooper, 7th Earl of Shaftesbury was a prominent MP, evangelical, and social reformer, espousing causes including factory reform, the protection of working children, and the abolition of slavery, as well as the welfare of the mentally ill. He was appointed to the Select Committee on Pauper Lunatics in 1826, helping to establish the first independent inspectorate for such establishments and becoming a Commissioner in Lunacy, a post he held until his death. |