In February of 1915, a fifty-five year old woman, who we will call Ella, was admitted to London’s Colney Hatch Asylum, exhibiting symptoms that doctors defined as “mental stress.” For the past three weeks, she was, according to her case notes, “noisy and restless … she gets little sleep … it is difficult to persuade her to take nourishment.”1 Ella seemed afraid of everyone in the hospital, refusing to be examined by a doctor, though that may have been because she didn’t speak English, and thus, didn’t understand what was happening to her. In the space on her intake form for “any other information,” it was noted that “she had had a fright owing to bombs being dropped near her home in Antwerp.”2
It is estimated that between 200,000 and 260,000 Belgian refugees spent some time in Britain and Ireland during — or for the duration of — the First World War. The British and Irish public were generally quite eager to help these refugees, especially as newspapers produced increasingly horrific stories of German atrocities against the women and children of neutral Belgium.
Taking in refugees was as much a political move to support anti-German sentiment, as it was an attempt to aid what was popularly referred to as “gallant little Belgium.” In fact, Belgians were portrayed as so heroic in defiance of German aggression that many in Britain were disappointed to discover that the refugees they encountered were just ordinary women and men.
As the war progressed, exceeding nearly every expectation for violence and suffering, most people lost focus on the plight of refugees. At the end of the war, the Belgian government was desperate for manpower to rebuild, which gave the British government a perfect excuse to send refugees home as quickly as possible (many had employment contracts terminated, and the government offered free, limited-time one-way tickets home).3
But the refugee crisis of the First World War was an enormously significant one, not only in terms of propaganda value, but because it led to the development of a legal definition for “refugee” by the League of Nations, one which still shapes the legal basis for refugee law today. (The original definition only applied to Turkish and Serbian people — it was expanded in 1951 to include people of all nationalities.)4 The quarter-million displaced persons who came to Britain were only a small fraction of the approximately 10 million people globally who were displaced because of the war.
There is a good deal that we can, and should, learn about the refugee experiences of the past that can aid us in better dealing with refugee crises today. According to the Office of the United Nations High Commissioner for Refugees, approximately 65.3 million people were displaced from their homes in 2015, the highest number recorded since the United Nations began tracking displaced persons.5 The sheer enormity of the numbers, and the overwhelming images of refugee camps and transports makes it difficult for us to understand some of the individual refugee experiences.
However, in studying the case notes of women who were treated for psychological trauma during the First World War, I found a number of Belgian subjects who were also treated in asylums and public hospitals for conditions directly related to their war experiences. Though they were perceived as “mad” by doctors at the time, their “symptoms” — their behavior, their words, and their fears — were all very much rooted in their refugee experience, and certainly helped me understand more clearly what a truly overwhelming experience that can be.
Today, when refugee issues are discussed, the source of trauma is often described as a specific violent incident, or set of incidents, such as physical attacks, rape, or torture. While these are all critically important facts in a displaced person’s experiences, a fact that is often overlooked is that the experience of being a refugee, of embodying displacement, is in itself often a traumatic one.
Arrival in a new country was not, and is not, the end of the refugee experience by any means. Finding housing for displaced persons is both critical and challenging. While some were fortunate enough to have friends or family waiting for them in Britain, it was not uncommon for Refugee Committees to ask public hospitals and asylums to take in patients for whom no other shelter could be found. One asylum placed cots in converted parlors or dining rooms due to massive overcrowding.6
What other information is available about these displaced persons can be found in the case notes of those who were admitted to the hospital as patients. At the time these records were made, psychologists and asylum doctors relied on theories of heredity and biology to treat madness — essentially, it was believed that madness was an inherited condition, and that women, who were believed to be inherently less mature and more emotional than men, were naturally predisposed to breakdowns. Therefore, patients’ descriptions of their experiences were not considered essential components of case notes, and their input in their treatment was minimal, at best.
It was because of this, that Ella’s testimony about her experiences was not necessary to doctors. They did not consider that the area in which she was staying in London had been subjected to a number of air raids since her arrival in August, and must have been genuinely disturbing for someone who had already escaped “bombs being dropped near her home in Antwerp.” Instead, a note in the case file reads, “She does not speak English, only Yiddish and Flemish and it is so difficult to get her to understand anything that is said to her … She cannot give a coherent account of herself ….”7
It may be clear from the above notes that these doctors, overworked and overextended as they were (some doctors were responsible for hundreds of patients at any one time), didn’t have much time for the cultural and linguistic differences between them and these new patients. In discussing her case later, during her incarceration, doctors noted, “As she only speaks Jewish it’s impossible to elucidate her mental condition (sic).”8 The inability to communicate with those around you, especially to be unable to advocate for oneself, clearly added to patients’ stress, making their stay in the asylum that much longer and more painful.
Without diagnostic criteria or treatment plans, doctors and hospital staff focused on coercing the patient into behaving properly so that they could re-enter society. Thus, their descriptions of the patient tend to be very superficial and pejorative. Ella is described as “noisy, restless … Neglects herself completely and is faulty and dirty.”9
During their stay in the asylum, talking, weeping, or any other kind of outburst, especially in women, was perceived as a behavioral failure. Patients who could not, or would not, follow instructions were often sent on bedrest or in isolation to correct their behavior. For a woman like Ella, who, we learn, had already been separated from her family in Antwerp, and lived in terror of being separated from her husband and children in England, such corrective action must have been devastating.
Ella died in Colney Hatch Asylum in April 1916, having suffered from bronchitis at least since her admission to the hospital. Even in the final entry in her case notes, entered two days before her death, doctors focused on the noise she was making, and the disruptive nature of her speech, noting “Patient much weaker, not so noisy and restless.”10 The case notes she leaves behind offer us the smallest of indications regarding her pre-asylum life, but those insights also provide us a way of thinking about the trauma of the refugee experience, and the difficulties that Ella faced, even after finding physical safety in London.
As in 1914, stories about refugees fill the news, and debates regarding their identity rage in governments around the world. But few of those stories ever shed light onto what it means to embody displacement, or to try and cope with the memories and fears of the refugee experience. Case notes offer one method of accessing those experiences. They also force us to realize that displaced people have always met with hostility and distrust as a result of their experiences, as if their humanity was somehow diminished by their displacement. If these case notes serve any use to us today, let us hope it is to remind us all of the traumatic experiences and memories with which displaced people have to contend, and help us do better for those we encounter in the future.
- London Metropolitan Archives. Though access to the specific records in which I found this case is prohibited under British Data Protection legislation, I obtained special permission from the London Metropolitan Archives to use it in my work. Simply put, British law requires that all personal medical records and case notes be sealed for 100 years after its production, and researchers are bound to protect the identities of the people in those records. This is why I adopted a pseudonym for the patient known as Ella. Return to text.
- Ibid. Return to text.
- Denise Winterman, “World War One: How 250,000 Belgian Refugees Didn’t Leave a Trace,” BBC Magazine, September 15, 2014. Return to text.
- Arrangement of May 12, 1926 relating to the Issue of Identity Certificates to Russian and Armenian Refugees League of Nations [PDF], Treaty Series Vol. LXXXIX, No. 2004, accessed August 1, 2017. Return to text.
- Adrian Edwards, “Global forced displacement hits record high,” UNHHCR, June 20, 2016. Return to text.
- London Metropolitan Archives, H65/A/01/004, Bexley Hospital/Administration: Medical Superintendent’s Report Books, 15. Return to text.
- London Metropolitan Archives. Return to text.
- Ibid. Return to text.
- Ibid. Return to text.
- Ibid. Return to text.