Mental Health in Post-War Reconstruction
The Editorial Board does not hold itself responsible for the opinions of contributors Vol. II. No. 3 JULY 1941 Price lOd. (1/-Post Free) :Author: D. W. HARDING, M.A. Senior Lecturer in Psychology, University of Liverpool
I Reports from various sources show that up to the present, in spite of air raids, the war has fortunately not produced the wholesale collapse into neurotic break- downs which some people undoubtedly expected. This is one reason for venturing to think ahead, beyond the exigencies of the moment, and to consider the part that the mental health services may be able to play in the work of reconstruction after the war. It may strike some people as a trifle irresponsible?a dissipation of effort? to let our thoughts wander forwards before the immediate task of the war has been completed. But we may take courage from the words of the Minister of Labour and National Service ; speaking a few months ago, Mr. Bevin said: ” Now is the time when thoughtful people ought to be considering the real social implications of the war. … I urge that every citizen should be directing his mind not to tiding over an immediate difficulty but to beginning the building of new foundations now.” Just as we hope for something better than a mere restoration of our bombed cities on precisely the same lines as before, so too we hope that the years of peace will give a social order and a psychological order better than we have had in the past?better, above all, in not containing within itself the seeds of war. Now it would be absurd to claim that the psychological approach to the problem is the only approach. Mr. Bevin, in the speech which I quote, rightly laid emphasis on the vital need for security, by which he meant pre-eminently economic security. No psychologist would underestimate the immense importance of economic security as one contribution to a sense of security in general. And emphasis on the need for security has been a striking feature of recent psychological thinking about peace and war. What, after all, calls out violence and aggressiveness so readily as a sense ?justified or not of being surrounded by dangers and threats ? The politician can find no better soil for sowing the seeds of hatred and aggressiveness than a national sense of insecurity. Hence the stories of ” encirclement “, and the various bogeys which Germans have been encouraged to discover, both in the world outside and in their own midst, during the Nazi regime. Insecurity, real or imaginary, * Based on an Address given at the Annual Meeting of the Liverpool Psychiatric Clinic, March 6th, 1941.
is almost always necessary as a forerunner of national aggression. More positively we can say that a sense of security is a fundamentally important contribution to international peace. Peaceful change demands co-operation. Co-operation involves seeing the other person’s point of view, and being willing to change your own outlook or modify your own demands. It means that you can tolerate the idea of changing a little and of fitting in with a co-operative scheme instead of rigidly insisting that your own scheme must be imposed on everyone. And the people who can tolerate change, whose plans are flexible and open to reasoned criticism, who can welcome the co-operation of others as equals are?paradoxically perhaps?the people who are sure of themselves, who are psychologically secure. They can change because they are big enough. It is the small minds that are rigid, the small minds which are secretly distrustful of their capacities, secretly insecure.
How can we avoid generating insecurity in national life ? One thing we can say at once on psychological grounds. We can never make whole publics secure and mutually trustful in their dealings, so long as their individual members are insecure and distrustful in dealing with each other in civil life. We are apt to think of national policies as impersonal and somehow divorced from the personalities of the people who frame them and carry them out. In politics on a smaller scale we easily recognize the truth of the matter : we know that the member of a parish council can’t lay aside his private personality when he joins in local government; we know that the committee work of the larger units of local government will reflect the personal qualities which have been formed in private life, in family life and business life, and can never be laid aside. And there can’t be much doubt that the same principle holds?even if it cannot be so easily revealed?in national and international relations too. Policies cannot be effective for very long unless they harmonize reasonably well with the private outlook of ordinary citizens. The experiment of prohibition in the States illustrates the point. In the same way no nation can accept distrust and force as its rule for private life and still hope to be all sweetness and light in its foreign policies. This was one of the points implied in Mr. Bevin’s stressing the need for social security.
Some of the ideals that guide social reformers have been expressed by another statesman in these words : “In the model state that all of us are striving after, we would like to see conditions so framed as to enable its subjects to create happiness for themselves. If we are to achieve those conditions the people must be strong and healthy. If they should fall victim to accident or disease they should have available the best of medical science. They should be able to command an income sufficient to keep themselves and their families at any rate in a minimum of comfort. They should have leisure for refreshment and recreation. They should be able to cultivate a taste for beautiful things, whether in nature or art, and to open their minds to the wisdom that is to be found in books. They should be free from fear of violence or injustice. They should be able to express their thoughts and to satisfy their spiritual and moral needs without hindrance and without persecution.” These are not the words of partisan socialism; they were used by Mr. Neville Chamberlain in his first big public speech after he became Prime Minister.
But supposing the necessary economic and political and administrative reforms could be carried through and something approaching this ideal state were attained? would that by itself be enough to enable its subjects to create their own happiness ? Isn’t it true to say that the social reformer is almost always disappointed in his efforts to make people happy through changes in their external surroundings ?? that we most of us have an immense capacity for achieving unhappiness and dis- satisfaction in spite of the most favourable circumstances ? We can be sure at all events that economic security and favourable material circumstances are in them- selves no guarantee of happiness or of mental health. The fact is that when the social reformer speaks of economic and social security and when the psychologist speaks of the sense of security on which mental health depends they don’t both mean the same thing.
We know from common observation that the materially secure people cannot be relied on to act as if they were also psychologically secure. For example, they may exhibit the typical sign of insecurity in jealous anxiety about their social or professional status. We all know of the sort of foreman who finds excuses for not passing on a worker’s suggestion for improving an operation, or the director who invents plausible objections to a subordinate’s good idea, or the suburban woman who frets over the presumptuous show she thinks her neighbours are making. Their insecurity shows itself in aggressiveness if they are criticized or their opinions challenged. Their self-esteem is so precarious that they dare not admit that they might be wrong. They are intolerant of new ideas. They are constantly ready to find fault, and delighted with the opportunity of keeping, or putting, somebody else ” in his place These are some of the commoner symptoms of psychological insecurity. Can we possibly say that those who exhibit them possess full mental health ? And yet these signs of insecurity are found in every social and economic grade. They are so common as to be taken for granted even among people whose material circumstances are far more favourable than the most optimistic reformer hopes to provide for the masses of people in any near future. In other words, we cannot hope that psychological security and mental health will automatically follow when economic security is attained.
Mental health?or what would be better described as psychological health? cannot be taken for granted, any more than we can take it for granted that our teeth will automatically remain in a healthy state without any attention. Mental health means something more than merely avoiding a nervous breakdown or keeping out of a mental hospital; as a community, we need to advance to a higher con- ception of what psychological health might be. At present we are like the people who go to the dentist only when a tooth aches intolerably.
The ordinary man cannot help observing the more striking cases of psycho- logical ill-health, for example in the puzzling and disturbing cases of suicide that he reads of or has known of among his own acquaintances, in the alcoholism that afflicts some brilliant or delightful person, in the inexplicable moral lapses that bring a previously blameless man into the police court, in the pathological miserliness of a wealthy recluse. We can most of us by now agree that in these cases there is some disturbance of psychological health or balance. Too often, though, the lay public tends to associate these disturbances of balance with insanity, where it would be psychologically more apt to associate them with normality. There may be a fairly definite line between actual insanity and normality, but there is certainly not between normality and the psycho-neurotic conditions which produce the bulk of unnecessary suffering in everyday life.
We need, therefore, to lead the public beyond the idea that those who show lack of mental balance or are psychologically in a muddle are to be thought of in connection with the insane and put in a category of people sharply differentiated from ourselves. Not only is it psychologically unsound but it also increases prejudice against being treated. Nervous breakdown, suicide, alcoholism, compulsively criminal behaviour, these are the highlights of psychological ill-health; but they emerge from a closely related background?from depression, shrinking timidity, irrational resentments and grievances, domineering aggressiveness, together with such common troubles as sleeplessness, nervous headaches, nervous indigestion.
These are familiar things, easily observed, even if many people prefer to ignore them as far as they can. In claiming due attention for them it is often useful to refer to the more specialized study of psycho-neurosis in everyday life which was reported some years ago by investigators of the Industrial Health Research Board. They interviewed a well-assorted group of about 1,000 people, mostly factory and office workers, and including all grades, from directors downwards. They gave them a psychiatric interview with the aim of discovering how many of them were suffering from psycho-neurotic symptoms, and corroborated the findings of the interview by an experimental technique. They found these symptoms of psycho- logical ill-health occurring with considerable frequency among all types of worker and within all grades (though there were slightly fewer nervous troubles among people in authority). Exact figures are often misleading, but it is worth while mentioning that they found about thirty per cent, of the commercial and industrial workers suffering from definite nervous symptoms. That figure excludes very slight nervous symptoms, and the passing difficulties of adolescence, and it also excludes the emotional effects of ” real ” troubles and reasonable anxieties. It is a disturbingly high figure for actual psychological disorder ; even though the majority of the sufferers were far from psychological collapse, and would probably remain so, there is little doubt that their lives were going to be far less satisfactory all round than they could have been. Remember too that these were the findings of a psychiatrist of wide experience working with a capable experimental psychologist and publishing the results for an official government body.
From our own common experience we can confirm the findings of these investiga- tors that psychological ill-health shows itself most clearly perhaps in social relation- ships. We all know, to mention a few examples, the sons tied to their mother’s apron strings, the over-diffident people, the miserably isolated and solitary, the people who are afraid of showing affection or enthusiasm, those who are upset at any criticism or difference of opinion, those who make a bad impression which we try to explain away by saying that ” it’s just their manner Such people are psychologically in poor or indifferent health. Yet we can hardly call them abnormal?they’re just like the rest of us but a trifle more so. Especially when we are tired we realize how easily we could tend in the same direction. And the social life in which such states are so common forms the matrix of our politics and of all the machinery of public life.
Now we have to get people to realize that such states are not only mild psycho- logical maladies, but also curable maladies. The trouble is that at present we never dream of seeking a remedy until we have reached complete breakdown. For those people who dimly realize that their psychological health is poor, and who want to do something about it, all we have are the popular journals of practical psychology and various forms of faith healing. Thanks to our psychiatrists we do possess better techniques than those. But they are not extended to people who are fairly well, but could be a lot better ; our social customs and ways of thinking limit them almost exclusively to those who have seriously broken down.
It is humbling to realize, and many people are reluctant to admit, that everyday psychological ill-health or imperfect health is not curable by one’s own good resolutions, or by hard work, or exhortation, or fresh air. Like other forms of imperfect health it needs the help of specialists using specialized techniques. It is only in the last generation or two that these techniques have been developed. Naturally enough, the public as a whole cannot yet trust them fully. Nor should anyone claim that they yet deserve complete and unquestioning trust.
Criticism is possible of the training and of the methods of some psycho-therapists, and it is part of the healthy development of the work that there should be such criticism. In regard to applied psychology of all kinds we are in much the same position as our ancestors were to dentistry a hundred years ago. We know that the present techniques must in time come to seem relatively rudimentary. Yet that can be no good reason for failing to make use of those that we do possess. The perfected techniques of the future depend for their development on our willing- ness to use the imperfect techniques of the present.
At the present time?especially in view of the demands of post-war recon- struction?we need to ensure that society shall develop the full potential value of psycho-therapy as rapidly as possible. I want to suggest that the development of the mental health services depends just now upon the ordinary intelligent lay public. We have reached a point where it is, in a certain sense, for us to develop the potentialities of psycho-therapy or fail to. We cannot wait passively until the specialists have perfected their techniques and bring them to us ready-made. Up to now the development of psycho-therapy has come about almost exclusively from the efforts of the specialist workers. But in every applied science there comes a point when further progress must depend on the community as a whole. The community must provide conditions which invite and elicit further progress. The sound development of the applied sciences always demands a certain reciprocal education?the specialist educating the layman and the informed layman in turn educating and asking for further progress from the specialist.
This happened for example over intelligence tests. There were many early attempts by German psychologists, besides Galton in England and J. McKeen Cattell in America, to devise tests of general capacity. No great progress was made, but the possibility of such tests had been hinted at and to some extent explored. Then the alert layman took a hand, this time in the form of the French Ministry of Public Instruction. The Ministry invited Binet to do something far beyond the capacity of psychology at that time: but they knew what they wanted, and by asking the specialist for it and creating favourable conditions for his work, they got it. From that time tests of intelligence made enormous strides, and there still continues a mutually stimulating interchange between the psychologist and the practical men and organizations who can use his work.
The specialists can and often do achieve a great deal in spite of the public, in the face of apathy and misunderstanding. In the long run, though, they can only do what the public asks them to do. By now, the psychiatrists and psycho- pathologists have completed the first step in showing us the possibilities of their science and techniques, possibilities which are not yet fully developed. Their more complete development waits, I believe, on an effective and informed public demand making itself felt. Before that demand can be made we must, as a community, come to accept standards of psychological health as much in advance of our present standards as our ideas of dental health are in advance of the standards of a century ago.
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