Manor Hospital
Horton Lane, Epsom, Surrey KT19 8NL
Medical dates:

Medical character:
1899 - 1996

Mental.  Later, mental handicap
The first of the Epsom cluster to open on the Horton Manor estate, bought by the LCC in 1896, was the Manor Asylum.

Building work had commenced on the Horton Asylum but, to relieve pressure on bed accommodation in the other London County asylums, a temporary asylum was built around the Horton Manor House to house 700 harmless chronic female patients.

The Manor Asylum opened in 1899.  The red brick manor house was used for the administration offices, with similarly styled buildings built for staff quarters.  The storerooms, kitchens and laundry were also built from red brick, with curved gables and slate roofs.  Porter's lodges were built at the entrances on Horton Lane and Christchurch Road.

The patients lived in temporary single-storey pavilions made from wood and corrugated iron.   These ward blocks were arranged around side corridors arising from the main corridor.  Further temporary pavilions were built to the north of the manor house; one of these served as a chapel.  An isolation hospital was built in the southwest part of the site and a farm bordering Horton Lane provided work for the patients (and produce for the Asylum).

In 1901 accommodation was added to the site for 100 male patients, who would provide manual labour for the Central Pumping and Power Station across Horton Lane to the west.

Escapes from mental hospitals were rare - of the 14 men who absconded, only seven were successful.  Women rarely absconded.  In 1907 a female patient escaped and was apprehended by Matron, who had chased her down Epsom High Street on a bicycle.  Matron returned triumphantly to the Asylum in a cab with her retrieved runaway, her bicycle stashed on top.

By 1909 ten permanent brick buildings had been added to the Asylum.

During WW1 the Asylum became the Manor (County of London) War Hospital, taken over by the Army Council in 1916. It was emptied of mental patients and the accommodation was used by wounded and sick soldiers. It had 1170 beds, of which 500 were for malaria cases.

Following the war many British servicemen who had served abroad in the Tropics returned home with malaria.  In southeast England the infection was transmitted to local mosquitoes, with over 500 cases of indigenous malaria occuring in several counties, especially Kent and Essex.  A special laboratory was set up at the Manor War Hospital to deal with the problem, under the control of Lt.-Col. Sydney Price James (1870-1946) of the Indian Medical Service.  Sir Ronald Ross (1857-1932), who had received the Nobel Prize for discovering mosquitoes were the vector for malaria, was a frequent visitor to the laboratory. The outbreaks of malaria were successfully dealt with and ceased in 1921.

After West Park Hospital had opened in 1921, the mentally ill patients were transferred there from the Manor War Hospital and it became designated The Manor, a Certified Institution for Mental Defectives.  The new patients continued to provide labour.  Workshops enabled them to learn skills; they made brushes, shoes, baskets and clothing, and learned carpentry and sewing.  They worked in the wards, kitchens, gardens and on the farm, helping to maintain the self-sufficiency of the Institution.  Surplus products were sold to other institutions.  

In 1922 Lt.-Col. James began to treat patients suffering from general paralysis of the insane (GPI), a disease caused by syphilitic invasion of the central nervous system, using malaria therapy.  Initially malaria fever had been induced by injection of infected blood, but the Ministry of Health had decided that, as far as possible, the fever should be transmitted by the bites of mosquitoes.  However, pilot studies at Cane Hill and Claybury Hospitals found that , in 1925 the malaria laboratory found that there was a strong risk that malaria could spread between patients.  Therefore, the laboratory moved to the isolation ward block of the neighbouring Horton Hospital, where a specialist treatment centre and 'mosquito farm' was established.

In the 1930s Horton Lodge, a large mansion on Christchurch Road, was purchased by the LCC as an annexe for the Manor and West Park Hospitals.  It was renamed Hollywood Lodge, to avoid confusion with Horton Hospital.  Part of the Central Pumping and Power Station was converted as detached accommodation and named 'Sherwood'.  In 1938 The Manor had 1292 beds.

During WW2, the Hospital suffered some bomb damage.  It joined the NHS in 1948, caring for moderately mentally handicapped young adults and disturbed adolescents.  It gained an international reputation in the field of industrial and behaviour therapy.  In 1951 it had 1417 beds.

In 1960 it had 1200 beds.  

In 1971  it had 1067 beds, 25 of which were secure beds in locked wards.  By this time the state of the temporary pavilions was causing concern.  Built with a life expectancy of 15 years, they were still in use 70 years later.  During the 1970s the Hospital was redeveloped and large single-storey red brick bungalow units with flat roofs were built on the eastern part of the site.  The temporary 'huts' were demolished.  In 1973 the Queen Elizabeth Hospital in Banstead Woods became a satellite of the Hospital.  In 1975 the isolation hospital was demolished and new staff housing built on the site.  The Hospital by this time had 1042 beds, including those in Hollywood Lodge, Sherwood, Aldingbourne House (a 60-bed unit near Chichester where patients would be sent for seaside holidays), Queen Elizabeth Hospital and Elizabeth House (a former Nurses' Home converted into a hostel for 55 patients working in the community).  In 1979, now under the control of the Mid-Surrey Health District, it had 800 beds for mentally handicapped adults and children.

Following government policy of integrating patients into the community, the Hospital gradually emptied as patients were found alternative accommodation. In 1985 it had 621 beds, but by 1990 only 454. The thriving market garden run by the patients became more difficult to maintain, but continued to sell plants to the public from specially converted barns.

The Hospital finally closed in 1996.

Present status (December 2007)

The bungalow villas that replaced the iron huts have been demolished and replaced by new housing.  The site now contains 'Manor Park', a housing estate of some 340 dwellings.  

Horton Manor House has been converted into apartments, but only two storeys of the western facade and adjoining sections survive, as the building had suffered great deterioration.

The Medical Superintendent's house, three of the service blocks and both porter's lodges are in residential use.  Three original buildings near the porter's lodge on Horton Lane survived until 2004, when they were demolished to provide a car park for the learning disability unit.

The stables for Horton Manor are now used by the Old Moat Garden Centre (a medieval moat to the southeast of the manor house can just be discerned, although it is now covered by trees and shrubs).

Hollywood Lodge became an Old Peoples' home until it closed.  In 2005 it was destroyed by arsonists.

  old building  old building
Horton Manor House, as seen from the east (left) and northeast (right).

  old building  old buildings
The Manor House with its neighbouring buildings.

old building
The former Medical Superintendent's house in Cavell Drive.

old building
The former laundry building has a gabled end and bull-s eye window.

crossroads  old building
The entrance to 'Manor Park' (left) and Manor Drive (right).

Central Pumping Station
The Power Station and Water Tower on the west side of Horton Lane.

Pine Lodge  Pine Lodge
Horton Lane, on the western part of the site, is Pine Lodge, a day centre for people with learning disabilities , and the Old Moat Garden Centre which offers training and work experience for people with learning difficult and mental health problems.  Both are run the Surrey & Borders Partnership NHS Trust.
Malaria therapy

In 1917 Prof. Julius Wagner-Jauregg (1857-1940) in Vienna reported success in treating patients suffering from general paralysis of the insane (neurosyphilis).  Previously incurable, this group of patients accounted for 8% of all admissions to mental hospitals.

Wagner-Jauregg's new treatment was based on the observation that patients with this disease underwent remission of symptoms, or even cure, following contraction of another illness which produced a high fever, e.g. typhoid.  To induce such a fever, and thereby raising the body temperature to kill off the bacteria, he inoculated nine patients with blood from a patient with malaria (the temperature could rise to 40°C or higher during a malarial attack).  Four of the patients made a complete recovery and two others showed considerable improvement.

He then devised a treatment protocol of injection with malarial blood, followed by quinine to quench the malaria, which was a potentially lethal disease, alternating with injections of neosalvarsan to clear the blood of the syphilitic bacteria.  His treatment was remarkably successful:  83% of his patients were freed from progression of the disease, but long-term damage could not be repaired.  However, if the disease was caught in its early stages, patients could make a good recovery and even return home and to work.

WW1 delayed the introduction of malaria treatment in the UK until 1922.

Memories of working at the Manor Hospital

I was employed in the Social Services Department from February 1978 until May 1979, aged 28 years.

Memories may be sometimes clouded, but I have endeavoured to write as accurately as I am able.  I was not sad to see the Hospital razed.  In truth, there were many caring and dedicated members of staff, for whom the well-being of the residents was paramount but, by implication, others were unfeeling and insensitive.

As a parent of a child with learning disabilities myself, I cannot imagine her living in such conditions - but those were different times. The mid 20th century was the era of the 'educationally subnormal', but the medical records of older residents (of which there were very many) showed even more antiquated diagnoses - 'feeble-minded', 'cretin', 'mongoloid idiot'.  Human beings with limited mental capacity were placed in institutions, often far from her homes and then, seemingly, forgotten.  Problems that society found troublesome, or delinquency, or the conception of an illegitimate child, were 'out of sight and out of mind'.  Well is it written: The way a society treats its children is an acid test of its civilisation (Kumar, 1993).

My interview for the position of Social Work Assistant required that the interviewees had lunch together with the Hospital's Social Services staff.  
I looked younger than my 28 years and had decided to tie up my long hair in an attempt to create a more mature demeanour, but in the event I had no time to do so as I was running late. 

Far from observing one's social skills in the Dining Room (a large and typically NHS establishment, which warrants no further description), it was simply an opportunity for all to get to know one another.  No doubt the Senior Social Worker, Kevin Beirne, quietly assessed each candidate, but it was all most informal.  (As I grew to know Kevin better, I realised that social skills in any dining room mattered not at all to this kindly Irishman.)

Lunch was followed by a formal interview in the Social Services hut, situated on the edge of the car park for Epsom District Hospital.

Following my appointment, in conversation with Kevin I was informed that I had secured the job because of the residents' reaction to me and, indeed, mine to them while I was being shown round the Hospital.  Asked at interview what I had thought of the Hospital, I had replied, "Shocked" - not with the residents, but I thought I had anticipated the range and severity of the disabilities; clearly I had not.

My salary would be £3,000 a year (and I had taken a reduction of £300 a year in accepting the position).

The three small, interconnected Social Services offices, which comprised the Department, were reached by turning left, then right, past the three consultants' rooms towards the Hall.  The exceedingly large door key to the Department looked as though it had come straight from the world of Dickens!  It would not be easily mislaid.

The other Social Work Assistants were June and Connie.  Jill was the secretary (and a most efficient young woman).  Kevin and June occupied the far room.  The second room, which accommodated Connie and me, had an opening in the wall to the secretary's office.  In practice, we all often gathered in this second room, where we could discuss matters together without Jill having to leave her desk.

Within a few minutes on my first day, Graham, a gentleman with Down's syndrome, had appeared in the office, leant across my desk and greeted me with a kiss on the cheek.  I was taken a little aback, but would not have minded but for the fact he had a rather green snotty nose - which had been wiped across my cheek.  I quickly developed the ability to handle inappropriate behaviour matter-of-factly.  Connie told me of an incident when she was travelling on the tube with a resident who had suddenly become aware that her period had started, and began to investigate it with no thought of the public setting in which she found herself.  "Pull your skirt down, Mary!" said Connie.  Mary complied.

Kevin had been a monk for 17 years prior to becoming a Social Worker.  He supervised us three unqualified Social Work Assistants, each of whom was attached to a particular consultant.  I initially worked for Dr Witcombe and then (briefly) for Dr McLean after Connie retired.  The two children's wards were part of her caseload.  If we had been free at lunchtime, Connie and I would occasionally go to the children's wards to help feed the children.  The nurses were very kind, but there was always so much to do and it could not have been easy to give time to individual children.  The third consultant was Dr Worters, for whom June worked.

Ward staff were hospitable and would usually brew tea when we visited a ward.  Tea for the residents, however, was brewed on some wards in a communal teapot into which was added the tea, milk and sugar.  Marvellous idea - unless one did not take milk and/or sugar.  It appalled me but, to my shame, I never spoke up.

During my association with the Department, a small group home opened in East Street.  I believe it was the first such home attached to the Hospital, and I believe Kevin was greatly involved in championing it.  He truly had passion for the rights of everyone for self-determination, albeit recognising that some needed greater support than others.

My duties included liaising between families and the Hospital, attending Case Conferences, and supporting residents generally.  For example, I took a mother and her son to a small home run by a religious order on Hayling Island in Hampshire, where the mother hoped her son would be admitted.    I travelled to a Case Conference in Harlow, Essex - it was the first time, I understood, that anyone from the Hospital had been able to attend since the individual had been admitted.  I did a poor job on that occasion as I had not done enough background work and did not know the person involved very well.  I have also greatly underestimated the length of time the journey would take and arrived just as the meeting was closing!

Following a request by a mother for home-leave for her daughter, I decided to make a home visit as a result of a tip-off about the most inadequate of home circumstances.  My initial reaction had been that one did not have the right to deny a resident the chance to spend time with their family, but I changed my mind after I had visited.  I was shown into the house through the back door, where a modern enamel bath had been placed in a corner of the scullery/kitchen.  It had presumably been purchased some years previously, but never plumbed in and, over time, had become a handy receptacle for all manner of things.  In the room off the kitchen stood a metal bed frame (no mattress), upon which was strewn an assortment of grubby blankets - this was to have been the daughter's bed.  I was permitted to view upstairs.  The father's bedroom was reasonably furnished and comfortable, but elsewhere one was able to view the sky - as parts of the ceilings were missing, as were several roof tiles.  Everywhere was accumulated filth.

Our Social Services Department came under that for Epsom District Hospital (under Miss Pritchard) and that, in turn, came under the umbrella of Social Services situated in Ashley Road.  Together with a newly appointed Community Nursing Officer, I spent a week in the Ashley Road Department, observing generally how things worked.

At some time during my employment at the Hospital, there was a time of industrial unrest.  I felt I could not strike because of the nature of my work, dealing with vulnerable people.  I resigned from NALGO because I was concerned at the possibility of being called out on strike.  There were some picket lines at the Hospital, but no abuse was meted out to those who did not join in.

Of the patients, Reginald became a particular friend.  He was an elderly gentleman who would often pop into the office to pass the time of day.  He resided on Hunter Ward, where he had a bed in a vast dormitory.  For some weeks he addressed me as 'madam', a courtesy he had obviously been required to extend to the female staff per se during his early years of incarceration in the place.  He eventually accepted that I was happy to be called by my given name.  He told me about the very early days of his time at The Manor, when the huge hall was the locked physical barrier between the male and female sides of the establishment.

One day, in my free time, I took Reggie and another elderly chap for an outing - actually a drive and thence to my home for tea.  It was with some surprise that they both squashed into the downstairs toilet to relieve themselves.  It was an early indication to me of the reality of life in the institution.

Alfred, a gentleman of advancing years, had been admitted after the sudden demise of his mother.  He was thoughtfully given a side room, but he was totally unfamiliar with institutional life.  Sadly, his cherished possessions, which included a carriage clock, were locked away in case they should be stolen.  Three months later he died.

Next on the left after Hunter Ward was a ward for elderly ladies (the name of which escapes me - Haven, perhaps?).  On this ward lived Lizzie, who was completely blind.  A sweet old lady, she had spent most of her life at the Hospital, having been sent there for some misdemeanour in her youth and deemed in need of care - and forgotten, or so it appeared.  She did the most intricate crochet work and was always delighted to pass the time of day with any of us who found the time to sit and chat.

On the Hospital site was the Adult Training Centre (ATC) run by the caring and kindly manager, Mr Brooksbank, and his staff.  Many residents occupied their day hours there.  The work was repetitive and, I imagine, grew boring.  Inventive ways were devised to enable the residents to complete simple tasks.  For example, if a specific numbers of washers were needed to be packaged, single washers could be placed onto a pegboard and then gathered into a bag.  I never saw the residents forced into completing tasks they disliked.  On one occasion I witnessed Mr Brooksbank in a fury.  He picked up the telephone and complained vehemently to the Charge Nurse who had found it humorous to send a resident to the ATC wearing a dunce's hat.

Some residents would undertake odd jobs for a little money.  Kevin told me of the occasion he allowed a resident to clean his car.  The chap was determined to make a first class job of it.  The black design line around the car proved stubborn to remove, but the task was eventually completed with a pad of wire wool!  Kevin was not in the least put out, but simply accepted that these things happen.

Hollywood still stands on the corner of Horton Lane and Christchurch Road.  Residents were accommodated there too.  At morning coffee they would gather in the dining room and learn a little Makaton.  Whenever I was able, I would join the session. One tiny, rather frail lady, Joan, would always be asked to sign 'pig', for this was the one sign she could recall effortlessly.  She always appeared proud of her ability and her face would crease into a broad smile at her achievement.

Situated further along Horton Lane was Sherwood.  It seems odd that young people could be accommodated in a boiler house, but t
he facility was self-contained with its own workshop.   (I wonder if today's members of the David Lloyd Centre, which now occupies the site, have any idea of the dramas, tears and laughter that were enacted therein?)  On Thursdays, after supper, I would make myself available to chat to any of the residents there who wanted to, privately if they so wished.  When I began to do this, I felt apprehensive as some of the young people had violent histories.  However, no-one offered violence to me and they were seemingly content to pass the time of day with someone who demonstrated interest.  We would talk of their dreams and aspirations, and sometimes I would be asked to write a letter home.    Mr Springer, one of the Charge Nurses, seemed to be greatly respected by everyone (he passed away a couple of years ago).  One felt he had particular empathy with the young people for whom he cared and would always work in their best interests.  

A weekly meeting was convened at Sherwood every Friday afternoon, where each resident was interviewed to consider his or her work and behaviour.  Requests for permission to go into Epsom or for other 'treats' would be considered.  This meeting was attended by the workshop manager, the Charge Nurse, a doctor (usually Dr Piers) and the Social Work Assistant.  Very disruptive behaviour would result in the offender being transferred to the lock-up ward, Pegasus.

Pegasus Ward was situated on the far side of the Hospital site and was, I imagine, how criminals were kept in former times.  There were dormitories for male and female residents, and a series of lock-up rooms with nothing in them but the bare concrete floor.  I heard of Mogadon for the first time here, used presumably for calming those who were excessively agitated.  To be released from Pegasus required three consecutive positive reports from the ward staff.  It was frustrating to see the disappointment on the faces of those who had achieved two positive reports, but who had then succumbed to a sudden outburst during the third week - and were back to square one.  I suppose the staff would have said that they dealt with difficult behaviour in the best way they knew as accepted good practice at the time.  They cared for the residents on a daily basis; I did not.

Vivienne decided to leave Pegasus with little thought of the consequences; she launched herself out of a first floor window, breaking both legs.  Later, 
one bitterly cold morning, I passed her in a long, windswept corridor.  She was sitting in a wheelchair with no coat on, no covering for her bare legs, and just slippers on her feet, while her nurse chatted to a friend.  I complained to the nurse in charge when I arrived on the ward.

Chase Ward was home to young men who, one day, decided to have a party.  There was to have been McDonalds brought in, but we ladies in the Social Services Department soon became involved; among the four of us we cooked most of the food.  One day, I saw Peter, a resident on Chase, lying on the floor of Woolworth's, behaving oddly.  The public walked around him in some embarrassment, attempting in no way to intervene.  If I hadn't known him, I probably would have done the same.  I said, "Get up please, Peter, and go home!".  And he did.  Brian also lived on Chase.  He was just a month older than me.  I caught up with Brian in the 1990s, when I began working in a local group home as a night carer.  Although he has now moved away, I still see him around Epsom from time to time.

Friendships and closer relationships existed, as well as more casual sexual encounters (as one might find in any setting), and perhaps in spite of attempts by staff to discourage them.  Maureen, no oil painting in the eyes of the world, with her haggard face and toothless grin, could occasionally be seen emerging from the thick bushes with her reward of a couple of cigarettes.

Linda lived at Sherwood and her pregnancy caused some consternation.  But she was excited at the prospect  of motherhood and spoke about her baby with enthusiasm, if somewhat unrealistically.  We were under the impression that she would be admitted to a mother and baby unit for the first days following the birth.  She had spent very little time with her baby before it was removed from her and was distraught.

The other side of the coin, however, was the longstanding love between John and Margaret.  John was employed as a road sweeper by a local authority and was proud of his ability to hold down a job, but Margaret was in need of daily support.  They both wanted to marry and  Kevin gave considerable thought as to how this might be achieved. One suggestion he put forward was to utilise existing unused accommodation at the rear of Sherwood.  But all he proposed fell on deaf ears and John and Margaret never married.  However, they did manage an annual holiday at Butlin's, with John caring for them both during their time away. Given the right support, they probably could have succeeded in formalising their relationship.

Some residents dreamed of the time when they would 'go home' or just have a visit from their family.  A few carried around with them a birthday card, or perhaps a postcard, they had received in the past, some in a very distant past.  Many of these mementos had become dog-eared over the years, such was their importance.

Attached to The Manor was the Queen Elizabeth Hospital (QE) in Banstead, which was a step away from incarceration at The Manor.  I went to QE only a couple of times. (This Hospital has undergone the same fate as The Manor and the refurbished properties are currently on the market as I write.)

Many residents were desperate to leave, yet others found life on the outside too difficult to cope with after years 'inside'.  On more than one occasion, former residents presented themselves in the office, asking to be readmitted.  Appeals to senior nursing officers having been turned down, they next sought help from Social Services.  To an able-bodied young man, I gave a little money for his return fare to London from my own pocket.  On one occasion, Kevin made frantic telephone calls late in the evening to St Mungo's , a charity
based in London helping homeless people.  Kevin drove the man there himself.  

One winter evening an elderly lady arrived in the office, begging for admission.  For once, Kevin was at a loss, so I slipped a note to him offering to accommodate her overnight
(only my husband and I were at home, for this was before we had children).  Kevin looked at me and asked if I was sure I wanted to do this.  My guest proved to be not particularly grateful, refusing the roast chicken I had cooked, accepting two fried eggs in its stead (but leaving the yolks).  The following morning Kevin had found somewhere for her to go (I don't remember where) and he disappeared with her.  The bedroom, after she had spent the night in it, smelled most unpleasant.  I do not say this judgmentally, as who would not smell if they lived on the streets?  I washed all the bedding.

I had commenced my employment in February 1978 believing that such institutional care was a medical necessity for people with learning disabilities, many of whom had accompanying physical needs.  I left in May 1979 firmly accepting that society imposes this model of care upon people.  Happily, such a view is less tolerated today and we now consider care primarily as a social need, with the views of the disabled person taken into account.


Once I left Social Services one of the first things I undertook for Reggie, my particular friend from the Hospital, was to take him to his childhood home in the East End, where his brother still lived.  It was the dream that Reggie had often spoken about.  Like many others, he longed for a visit from his family or to visit them.  It was truly to be a grand day out.  We walked to Epsom station and took the mainline train to Waterloo before transferring to the underground. During the journey Reggie decided he urgently needed to use the toilet.  We exited the train at the earliest opportunity and, thankfully, made it!  Reggie's brother welcomed us, made tea, and then we sat in awkward silence.  What had I expected?  I hadn't given much thought to what would happen once I had helped the brothers to come together.  Naively, I assumed they would be at ease with one another, but too much water had flowed under their respective bridges.  We returned the way we had come, stopping briefly to buy some lunch.  At Waterloo we had a long wait for our train so I took Reggie to a cafe on the platform.  He chose a sandwich, a cup of tea and a creme caramel.  The latter he could not eat, so he double-wrapped it in paper napkins and pushed it into his pocket 'for Mr Port' (one of the Charge Nurses).

I maintained my friendship with Reggie over the years, occasionally taking my children to visit him.  One day I arrived home from holiday to find a letter from the Hospital announcing that his funeral was to take place the very next day at Epsom cemetery.  In due course the funeral party arrived - two nurses and two residents from his ward.  Reggie was buried in a pauper's grave and, a quarter of a century later, I still go and stand where I believe his unmarked grave to be, just to tell him he is not yet forgotten.

Many friendships, some of which endured, were made at the Hospital.  Jill, the secretary, moved to Jersey, where we attended her wedding.  Maureen, who had replaced Connie when she retired, lives locally and became a regular visitor as we had children of the same age who played together.  Kevin moved to the North to open his own home and I learnt in due course that he had died.  Connie became a dear friend indeed - and godmother to my disabled daughter.  She died in 1990; my daughter and I weep for her still.

The offices once occupied by the consultants now form part of the elegant refurbished buildings that have become private residences.  When they were first on the market, I had a look around the site.  I could clearly recognise
the three consultants' rooms from the outside of the main building, but it was quite confusing to pinpoint them exactly inside, as internal walls had been demolished and new partitioning erected.

Document written by Jane Taoka for a project undertaken by the Bourne Hall Museum, Ewell.
(Author unstated) 1917 List of the various hospitals treating military cases in the United Kingdom.  London, H.M.S.O.

Abdy C 2001  Epsom Past.  Chichester, Phillimore.

Chaplin R, Peters S 2003 Executives have taken over the asylum: the fate of 71 psychiatric hospitals.  Psychiatric Bulletin 27, 227-229.

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