In February 1978 I went to live for two weeks at Prestwich Psychiatric Hospital in north Manchester, on a ward with twenty long-term schizophrenics who had been selected for an innovative rehabilitation programme. Forgotten souls, many of them had been admitted to the hospital long before I was born; I was twenty-six years old.
The objective was to find a way of moving patients out of these asylums, as old Victorian establishments like Prestwich were known, and to support them instead 'in the community'. First, though, 'inmates' had to be persuaded that the many idiosyncratic behaviours they had acquired over decades of institutionalisation, would very likely be alarming to people 'on the outside' and they must learn to conduct themselves differently. The programme they would follow was a 'token economy' scheme and it was delivered on Clayton Ward.
Inspired by the radical thinking of Scottish psychiatrist R D Laing — who explained insanity as "a perfectly rational adjustment to an insane world" — psychologists applied the behaviour modification theories of the American B F Skinner, who asserted that "the results of a person's behaviour can be modified by rewards". The whole was, of course, enabled by advances in post-war psychopharmacology; for patients medicated with tranquillisers like Modecate, and anti-psychotics like Largactil, tended to remain calm and be more receptive to changes in their routine.
Those on the scheme, all of whom were heavy smokers, had their 'good' behaviour — 'engaging in verbal interaction', making their bed, caring about their appearance and so on — rewarded with tokens, and it was these tokens they needed in order to buy their tobacco. However, in an application of Skinner's theory that to outsiders like myself and Observer journalist Alan Road seemed somewhat over-zealous, they also needed tokens to buy their food and drink.
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