Exclusive – Call the Midwife star Fenella Woolgar on mental health stigma and Sister Hilda's devastating storyline with Louise Wrigley
"Troubles with the mind were frowned upon almost as if they might be contagious"
Louise Wrigley (played by Jenny Walser) is a puzzling patient for Sister Hilda (Fenella Woolgar) and Dr Turner (Stephen McGann) when she turns up at the clinic in Call the Midwife season 10, episode four. First she insists she must be pregnant, though tests show she is not; then she complains of crippling stomach pains, blood in her urine, and blood in her vomit. It is only when Sister Hilda spots a bloody razor blade and examines the blood flecks in the vomit bowl that she realises the truth: Louise Wrigley is unwell – but she is creating her own physical symptoms because of a mental illness.
Though it is not named in the episode, this is likely "factitious disorder imposed on self" – also known as Munchausen Syndrome. The NHS describes this as a "psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves," and "their main intention is to assume the 'sick role' so that people care for them and they are the centre of attention."
Dr Turner tries to refer Louise to a psychiatrist, but she is upset and offended by the mention of mental illness. As her condition escalates, Sister Hilda is able to get her to open up about the trauma of her childhood, and why being a medical patient is so appealing to her; but she is very unwell, and Dr Turner has no option but to certify her and transfer to the Linchmere Mental Hospital.
"I was very pleased to dip into this area of mental health," Fenella Woolgar tells RadioTimes.com, as she reflects on Louise Wrigley's story. "Necessarily in just one episode we don’t get to fully explore its complexity, but we do get to dip our toes into it.
"I think the conditions that aren’t readily solvable can be the most interesting – certainly to Sister Hilda. Having been through the war, she will have had experience of the effect on people’s mental health, some suffering quietly in an era when resilience was paramount and troubles with the mind frowned upon almost as if they might be contagious."
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As we have seen in Call the Midwife with previous storylines around mental illness, that attitude could be immensely damaging. And things haven't entirely changed, Woolgar says.
"I think there absolutely was a stigma, particularly in Britain," the actress tells us. "You were supposed to be resilient, keep troubles private, keep calm and carry on. Stoicism was the order of the day – from public schools to working men’s pubs.
"Obviously recently there has been a greater awareness, and a drive to drag mental health into the open and normalise the difficulties that so many of us experience, but I think there is still stigma around it. There is tremendous pressure on young people to look, feel and act a certain way - there’s a huge disconnect between the airbrushed lives of people publishing on social media and the real daily struggles everyone faces. This can lead to huge problems, I think. There is a worrying trend in young male suicide which we are simply not tackling.
"But there are hopeful things too – I think people feel more emboldened to call out unhealthy attitudes or practices in the working environment which could be damaging and practices like yoga and mindfulness becoming mainstream show a shift towards a wish for more balance in people’s lives."
In the episode, Dr Turner is clear that “a mental illness is no less serious than a physical one”. But was this a common attitude in medicine at the time?
"Absolutely not!" Woolgar says. "We didn’t have much of a history of psychoanalysis in this country (bar the fact that Freud emigrated here escaping the Nazis – which did lead to a tradition being established). There were all sorts of experimental treatments in the 1930s, which were alarming and harmful; lobotomies, ECT [electroconvulsive therapy], etcetera. An approach involving a mix of the biological, social and psychological, was not yet common.
"Dr Turner would have been a very rare GP to tread so thoughtfully and carefully, I suspect."
Both Sister Hilda and Dr Turner try their best to help Louise. "I think they are both kind and thoughtful people, and maybe because of their age they’ve seen a lot of suffering so they have more experience and empathy," Woolgar says.
Dr Turner has particular experience that makes him more empathetic; we know that he suffered a mental breakdown in 1945 after the war, and stayed for five months in a psychiatric hospital. And although he has to certify Louise, he tells Shelagh Turner (Laura Main) that he has grave reservations about the care she will receive in hospital in 1966.
“I know only too well what places like the Linchmere are like,” he says, adding: “It may be the only possible outcome, but that doesn’t make it a good one.”
Woolgar herself agrees. "Obviously asylums were still in operation at this time. It’s easy to tar the whole asylum system with the same brush but of course some good care would have gone on – and sadly most mental health institutions today don’t have the gardens and grounds that asylums typically had pre the 1980s," she explains.
"But as there was no care in the community, it was easy for people with mild mental health problems quickly to become institutionalised and end up there for years. Experimental treatments were still going on – particularly ECT and I think the the approach was very biological at the time – think One Flew Over the Cuckoo's Nest.
"I’m not sure the dignity of the individual patient was paramount, and I don’t think the approach was particularly psychological. I’m not sure that one could get truly better in such an environment."
Call the Midwife season 10 continues on Sundays at 8pm on BBC One. Check out the rest of our Drama coverage, or take a look at our TV guide to find out what else is on.
