Women on the Ward: Implications of Confinement and Collective Identity in Selima Hill’s Lou-Lou – Imogen Shaw

Imogen Shaw is an environmental lobbyist and final year Creative Writing MA student at Royal Holloway, University of London. Her work has appeared in several online and print journals, including The Mays and Blueprint magazine. She is passionate about social advocacy and lives in a London flat with her fiancée and a tenacious family of mice. You can follow her on Twitter @ImogenShaw_otr.

Selima Hill’s Lou-Lou is a collection populated by short, sparse poems, which together form a narrative of the eponymous speaker’s period of residency in a women’s psychiatric ward. The most enduringly striking aspect of this is the effect it produces, in combination with Hill’s decision to title every poem with the location in which its musings take place. Within the confines of the ward, this is limited to several rooms, necessitating dates to distinguish the poems, as well as to indicate the passage of time; a number of sequential poems within this collection nevertheless share a title. These decisions are more potent than a simple narrative framing device, however; they shape the identities of Lou-Lou, her much admired Nurse, and her fellow patients, with whom she quickly comes to develop a strong sense of collective identity, complicated by her imminent release and occasional intrusive dreams. The confined setting is mirrored in the restraint Hill shows in affording each poem relatively few lines, and evokes a stifling feeling in readers, who are pulled into the patients’ collective consciousness – their “we”. The patients, removed from the outside world and its seemingly impossible largeness, become magnified, the women often described as ‘large’, (Note 1) with the implication that it is in fact the restrictively compact nature of the ward engendering a trick of perception.

Yet, in combination with this ‘largeness’ is an erosion of individual identity, and absorption into a collective often analogized to an animal herd, or else a series of parts making up an inanimate whole.  Claire Shaw argues that in Lou-Lou there is a marked “parallel between the writing and the madness it describe[s] – in particular, the re-creation of new worlds in both the madness (Note 2) and the poetry” (Note 3). What’s startling is that the ‘new world’ in which we as readers spend so much time comprises almost exclusively three hospital rooms, a corridor, and the solidaristic consciousness of an unspecified number of women suffering mental ill health.

The collective identity, consistently portrayed as a retreat from both individuality and notions of life outside the ward, is never clearer than in the patients’ attitude towards visitors: “We will not have stray people on our beds / asking how we are: we are not better” (Night-room: September 2nd, p.45). These lines, from a relatively late moment in the poetic series, best represent the collection’s major themes in distillation; the visitors are “stray people” – they are at once the other, the ‘strays’ that do not belong, and the normalized – they are “people”, a term Hill never once employs to describe the inpatients. Even more powerfully, the developed sense of collective consciousness is brutally apparent with “we are not better” – simultaneously an assertion of collective solidarity – “we are” – and a resolute shutting off of connection with the outside world as one reaches the end of the line: “not better”. Strangely, a significant part of this moment’s strength lies in its seeming callousness towards the visitors. Even elsewhere, when visitors are described as ‘loved ones’, Hill’s use of italics implies that the phrase is entirely synonymous with “stray people” – as when Sister drives “our troupes of loved ones / meekly home” (Day Room: July 15th, p.22). In both instances, the brevity appears dismissive, because it is just that – but crucially, not of any one woman’s visitors on a personal level. The women of the ward “are not better”; they are not yet ready to leave the reprieve of physical confinement in the ward, or figurative confinement as part of the collective identity that can only exist while they are inside the ward. Thus, thee opening line, “We will not have” is not reflective of petulance or a specific, personal rejection, as it does not simulate a direct, simultaneous verbal rebuff of each woman’s visitors. Instead, it encapsulates a shared reticence, and a simultaneous mental retreat, the individual outward presentations of which, in a sense, do not matter, because to explore them would be to detract from the impression of depersonalization Hill conveys of the ward’s inhabitants.

Perhaps surprisingly, given her representation of psychiatric hospitalization as strongly communal and ‘de-individualizing’, Hill frequently returns to the notion of self-centeredness in mental illness. To clarify from the outset, in consideration of the somewhat loaded nature of the phrase: I do not use the term ‘self-centeredness’ in a critical sense, or to promote the regressive notion of mental ill-health deriving from individual character flaws – quite the reverse. Wonderfully, Hill deftly makes as much clear herself, in her explicit and repeated collectivization of self-centeredness. There are three moments within Lou-Lou that particularly stand out in this regard: “We’re here because we like to keep things simple. / We like to think of nothing but ourselves.” (Night-room: July 2nd 1, p.13); “We refuse to think about anyone but ourselves / and what we want / and how to feel pain” (Night-room: July 4th2, p.15), and, “The fact is we are stubborn. / We admit that. And sister has to come on bended knee / and beg us to respond” (Night-room: July 12th 2). The juxtaposition of extreme self-focus and exclusively plural pronouns serves to symptomize self-centeredness, at the same time as rendering it part of a communal ‘cure’; put simply, the women on the ward are not concerned solely with the welfare of their individual self, but of “themselves” as a unit.  The retreat into shared identity is presented as a necessary escape, a period of stasis in which, ostensibly, the women of the ward will take steps towards individual recovery. Thus, considering only “what we want / and how to feel pain” takes on, if not precisely an altruistic dimension, then at least one of mutual support.

This is further emphasized with the arrival of the lines “The fact is we are stubborn. / We admit that. And sister has to come on bended knee / and beg us to respond”; reminiscent of the sparsely brutal “we are not better”, the phrase “We admit that” is not reflective of one actual statement given by any or all of the inpatients. The informal register and deceptive simplicity of the first two short sentences is a misdirection – in context, followed by the image of Sister, “begging” for a response on “bended knee”, it is reflective of the patients’ near escape from individual consciousness. Hill’s Lou-Lou inpatients take on a strange, near omniscience within the confines of the ward, and it’s no accident that “Sister”, an address already connotative of Christian religiosity, ‘begs’ for individual response as though at prayer.

Hill’s poems are not ‘religious’ in any traditional sense of the term, and nor do they use their form to explore religion in the context of recovery from severe mental illness. Rather, Hill uses religious allusions to subtly expand on the nature of the inpatients’ sisterhood. She does not seek, in Elaine Showalter’s words, “to bestow upon madness the romanticized glamour of political protest and of social and cultural contestation” (Note 4) a particularly unfortunate by-product of the anti-psychiatry movement, and one that has had undue impact on critical consideration of female creatives known to have experienced mental ill health. (Note 5) Instead, Hill alludes to the renunciation of ‘normal life’ chosen by the disciples: “We have long forgotten our houses and our homes” (Night-room: July 4th, p.15). She does not mean to imply that there is an element of ‘choice’ in suffering mental ill health, nor that the women of the ward are making purposeful decisions to support one another and aid their individual recoveries. What it does imply is that the women are on a journey with only one another for company, and their shared experiences in combination with their protracted, close proximity act as the chief force binding them together as a group identity. Hill writes, “We’re not that kind of woman anymore”, and “We smell not of ourselves but of each other”; these women are continuously shifting and changing, but in a manner which brings them closer together as their old lives become further distant, and though there is no explicit allusion to religious vows, the tendency of the group inner voice to assert itself in imperatives – “We will not have…”; “We refuse to think…” – renders the women akin to a sect with their own doctrine, here as they are to be “sanctified” (Night-room: July 2nd  2, p.13) by Sister. As such, Hill provides a comprehensive artistic response to Showalter’s urgent question, “…what does ‘speaking for women’ imply? What is ‘to speak in the name of the woman’? What, in a general manner, does ‘speech in the name of’ mean”(p.137)? In Lou-Lou, it means a kind of coherent, unanimous collective response that is near impossible to achieve even within identity-based groups outside the conditions of prolonged, restrictive physical proximity enforced by residence in the ward.

Importantly, more physical aspect of the ‘togetherness’ of the inpatients is given dedicated attention in two specific senses – the first of these appears less frequently throughout the progression of the collection, but is arguably more impactful due to its unflinchingly direct engagement with self-mutilation. The simplicity, and continued use of plural pronouns is designed as though to leave one with the impression that the same network of veins runs between all of these women: “We chew our hands / we open up our veins” (Night-room: July 12th 4, p.19); “We lie in bed and let her swab our veins” (Night-room: July 14th2, p.21); “We slice our little violet coloured wrists, / we spray the walls with blood” (Night-room: August 4th, p.54). The latter lines emphasize this sense most particularly; “we spray the walls with blood” is a wrenchingly potent image, especially following the minimizing effect of describing the sites of the wounds as “little violet coloured wrists”. Moreover, the image is of a significant amount of blood, as though coming from all the women’s wounds simultaneously. This is a highly improbable situation, and that Hill describes it non-naturalistically enough that it mirrors common tropes of horror film and television should be an indication that she does not intend it to be a representation of a plausible situation. Instead, it is a device to elaborate on the patients’ shared pain; it no longer matters to the speaker whose self-injury she describes, as the implication is that all of the women have self-harmed and borne witness, in come way, to their fellow inpatients doing so. In their confinement, self-injury has become normalized to the point where it is entirely depersonal – something that “we” do, that “we” think about. This is pivotal to understanding collective identity in Lou-Lou – self-injury is a physical manifestation of intense mental anguish, in such a way that it mirrors the inpatients’ confinement in a psychiatric ward, itself a physical presence produced in response to mental suffering. The women’s retreat into shared identity, from which Sister eventually ‘drives’ them to emerge, ideally at least partially ‘healed’, is ultimately a psychological sticking plaster.

This phrase, ‘sticking plaster’, is often employed derisively, to indicate the concealment of an issue with which one is failing to cope effectively. I use it not in this sense, but to expand on its implications as a barrier to contamination and interference. It is in this sense that the collective identity on the ward functions – a protection against “stray people” and whatever they might bring into the ward with them from the inpatients’ lives outside. Much like a sticking plaster, it is a temporarily useful protection, until the moment arrives when one is sufficiently healed that interaction with the external will not cause harm.

The collective identity functions like this insofar as notions of healing and recovery are concerned. However, in the intervening period on the ward, Hill explores it in an additional physical aspect, through continuous and varied use of animal and inanimate similes to describe the female patients in their physical groupings. The women alternately “hide in toilets / like large flightless birds” (Night-room: July 16th, p.17), “sit in rows and grunt / like warm pigs” (Night-room: July 21st, p.24), are herded into the day-room “like horses” (Corridor: July 27th, p.31). The images reflect the lack of freedoms afforded the women in the ward – they are ‘herded’ and ‘driven’ by Sister, they cluster together, penned-in, awaiting nothing but the inevitable driving and herding. In these ways, they are clearly analogous to animals in captivity, and that they are entirely aware of this is evident in the frequency of the speaker’s animal analogies for their group. In itself, this provides another view on the construction of the collective identity: it represses individual rebellion or humiliation, for as an individual, it is very possible to feel humiliation at restriction of freedoms, and act upon desires to rebel. In adopting a ‘herd’ mentality themselves, then, patients are subconsciously protecting their individual selves from feelings of resentment, or humiliation, that they might continue to receive treatment.

The same impulse is at work when the women analogize themselves to inanimate objects, “like lumps” (Night-room: June 3rd p. 8) or “froth”. Paradoxically, it appears to be in these moments where the women are portrayed as akin to inanimate objects, that Lou-Lou begins to re-embrace her individual identity. Just days after the group identity asserts itself thus: “We are no longer human” (Day-room: July 30th, p.31), Lou-Lou speaks in the singular – “I know we look like sacks / but we’re not” (Night-room: August 4th, p.54). She acknowledges, finally, that she is not merely one part in amongst a mass of indistinguishable parts, but an individual within a group, making individual observations upon that group. Moreover, she begins to retreat from denial of the rest of the group’s humanity and personhood, as well as her own. This culminates, a few pages prior to the end of the collection, in Lou-Lou acknowledging a fellow inpatient has a name with which she is addressed: “The little sobbing creature known as Sunshine” (In the Lift: September 21stp.61.) It is a recurring theme within this collection that Hill’s brevity and simplicity of register elide the frequency with which she explores complex inter-personal psychology. Within this line alone, we have Lou-Lou recognizing Sunshine’s individuality and right to a name, yet still unable to refer to her as a person. Nonetheless, “creature” is distinctly different enough to her previous, exclusive employment of specific animals and inanimate objects that it aptly represents Lou-Lou’s as-yet incomplete return to a world populated by individuals, as opposed to a single mass identity. In addition, Lou-Lou notes that Sunshine is “little” in stature, whereas previously, she has considered her fellow patients to be “enormous”. This is another deft hint that Lou-Lou is re-adjusting her mental parameters ahead of her discharge from hospital, and return to the vastness of the outside world; she now sees Sunshine’s size for what it is, rather than perceiving it as magnified because her only point of comparison is the small confines of the ward.

However, re-assertion of individual identity is complicated throughout this collection, by the intrusion of dreams and a momentary escape from the ward. As the title suggests, the poem depicting this incident takes place in a hedge “where I can take my overdose in peace” (In a Hedge: July 25th, p.29). In this moment of attempted suicide, Lou-Lou recognizes her individuality, and isolates herself as ‘other’ and opposed to all the other people who exist in the external place it is clear she only conceives of as ‘outside the ward’. She is not one of those people, “who walk about the streets as if it’s easy / as if they were born/ to wear big shoes and clothes”. As such, there is no contradiction between her perceptions of herself as an individual here while she exists outside the confines of the ward, and as one part of a group identity when she returns. Outside the ward, she and her fellow inpatients are a minority – they are therefore distinguished from the majority, and when alone, can easily find a point of difference by which to identify themselves. In Lou-Lou’s case, she knows she is part of the minority who struggle to  “walk about the streets as if it’s easy”.

The only equivalent moments that take place inside the ward, prior to Lou-Lou’s gradual psychological re-adjustment as she anticipates her release, occur at night, within dreams. Even then, Hill draws a line of separation between these experiences and the conscious, collective experiences while awake on the ward. While this collection has, as the 2004 Bloodaxe edition blurb proclaims, been “shorn of her crazy metaphors”, Hill nonetheless makes use of unconventional metaphor to delineate Lou-Lou’s dream landscape from that of the ward. She does this through references to Lou-Lou’s hair; early in the collection, Lou-Lou articulates, “I find myself alone inside my hair” (Night-room: June 28thp.11), “I rock inside the forest of my hair” (Night-room: June 29thp.11). She is in the Night-room when this action occurs, and it only becomes apparent in the lines that follow each of these declamations, that she is in fact dreaming. However, the use of hair here is still crucial to Hill’s construction of the dreams – it acts as a physical border to the confines of Lou-Lou’s individual mind. It grows outward from within her head, much like her illness, and there are a number of quietly poignant references to Sister attempting to guide Lou-Lou towards improved health and conception of her own identity through styling her hair:  “She’s looking at my hair / as if to say / Where do we begin / but I don’t know” (Day-room: July 25th, p.28.) Her hair is thus presented as a locus for the issue of negotiating the boundary between her mind and the outside world. The “tiny men” (Night-room: June 28thp.11), in her dreams, and  “the tiny woman / who drags a little suitcase round my head” (Night-room: June 29thp.11) exist beneath her hair, concealed inside her head and disrupting it from within, acting as dream-representations of her conception of her illness and its effects upon her.

Lou-Lou is, ultimately, always an individual within the confines of her own mind – this does not mean she feels as though she exists in there in isolation, especially as Hill demonstrates that the character personifies her mental ill health. What it does is reinforce the notion that although the collective identity of the women on the ward is an incredibly important element of this collection, and is portrayed as a crucial aid to recovery provided that one eventually re-asserts their individual identity, it is never all encompassing. The women’s individual identities are deeply repressed, but they are always there beneath the surface.

Read in isolation, the final lines of the collection can seem flippant: “…they lead us away to be normal, / hair-dos swaying” (Reception: September 25th, p.64). However, this is not a collection where any one poem is intended to be read in isolation. The collection’s self-references, subtle alterations and short, direct echoes achieve their full effect precisely because they occur in chronological sequence. Leaving readers with the “hair-dos swaying”, in context, is understated brilliance: the inpatients’ hair denotes the boundary between their inner and outer lives, their mental states and physical existences. Hairstyles are also, ultimately, superficial even as they are to varying degrees revelatory of identity and self-perception. The women leave the ward to be “normal”; they leave as people who will be considered to look “normal” by others, partially because of the way their hair has been done. They leave the collective identity and deep, shared psychological understanding of the other patients, and re-emerge into a vast world of far too may jostling individual identities for such a close collective identity to be developed, so they must signal their identity with outward markers. Yet, they still take with them their experiences on the ward; their hair was done for them, there, to prepare them to leave. Hill’s implication is that they’ve now to see if they can replicate the same effect at home.


1) Selima Hill, Lou-Lou (Northumberland: Bloodaxe Books, 2004), p.7, p.17, p.48.

2) Shaw’s introduction to this essay explains her choice to use the term ‘madness’, citing her personal experiences as “a poet who has been certified as ‘mad’ and who has accordingly spent time in psychiatric institutions.”

3) Claire Shaw, ‘Welcome to the Wonderland of Dreams: Selima Hill’s Portrayal of Madness in Lou-Lou and Bunny’, Sheer Poetry, 2004 http://www.sheerpoetry.co.uk/advanced/dissertations/welcome-to-the-wonderland-of-dreams [Accessed 24/12/2017]

4) Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830-1980 (New York: Virago, 1989), p.134.

5) See Tillie Olsen, Silences (New York: Virago, 1980), pp. 224-226.


Hill, Selima Lou-Lou (Northumberland: Bloodaxe Books, 2004)

Olsen, TillieSilences (New York: Virago, 1980)

Shaw, ClaireWelcome to the Wonderland of Dreams: Selima Hill’s Portrayal of Madness in Lou-Lou and Bunny’, Sheer Poetry, 2004

Showalter, ElaineThe Female Malady: Women, Madness and English Culture, 1830-1980 (New York: Virago, 1989).

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