Occupational Therapy in Wartime
- Author:
Elizabeth Casson, M.D., D.P.M.
The decision to continue the publication of this Journal is the result of many holding the belief that the only hope for humanity depends on mental health and, therefore, to a large extent on the understanding of what mental health means.
On the first day of this war, I listened to the conversation of a colonel and a member of the Indian Civil Service. Both were retired men whose whole lives had been spent in unselfish service to others, who had brought particularly able minds to each problem that had occurred in their work. The colonel had started as a youngster in the South African War and his life work had been governed by his desire to put to an end all that could lead to war. His outlook was that of a doctor who fights disease. The Indian Civil Servant had spent all his working life in thinking out and guiding the development of good government and of all that was best in the district where he had served. To both, the outbreak of another war meant the break up of most of that to which their lives had been devoted?but both realized that the war had been caused by a failure of mentality. As the judge put it: ” We, none of us, have the necessary mentality to prevent war?none of us knows how.” We all know that humanity is capable of thinking out how to live at peace if we could only learn how to use the intelligence that could solve the problem, but we are either mentally defective or we use our intelligence wrongly. It is surely worth while, therefore, to bring to every problem that confronts us any psychological knowledge we have managed to collect, so that in time we may manage to use well the best there is in us to help the world to better use of what intelligence we have. We all feel equally helpless at first in the face of our problems, but it is just here that a knowledge of how to use our minds should help us.
The war has brought many problems of ill-health and inefficiency that need all our intelligence to combat, but there is no doubt that in trying to overcome its horrors, men and women of goodwill do advance the treatment, not only of those who suffer because of war, but also of those whose sufferings still go on long after the war is over. An instance of this is found in the application of Occupational Therapy* which was developed scientifically during the 1914-18 years.
Beginnings of Occupational Therapy
The regular occupation of mental patients was well organized before then, and doctors and nurses knew from experience that a well-occupied patient recovered more quickly than one who was idle and bored, so that some of the best of the old “asylums ” were real hives of industry. It was in France, during the last war, that one of the Canadian surgeons instituted organized occupations among the surgical patients and this was quickly followed by others, English and American, but the effort was sporadic and there was no time to develop this seriously in the English army. The American casualties, however, returned to their country where there was an opportunity of providing craftswomen ready to work under the surgeons, and Occupational Therapy was applied intensively to those who needed help. So successful was this that rehabilitation centres were soon developed for the treatment of civilian industries, and schools of Occupational Therapy were founded. To these was brought the best tradition of those already engaged in occupying mental patients ?a tradition that had originally come from England.
After the 1914-18 war the new Occupational Therapy Schools propagated this knowledge and expanded it, and soon all the American mental health services realized that no hospital could be considered complete without its Occupational Therapy Departments where qualified graduate workers carried out the doctors’ prescrip- tions. These hospitals became centres for study which were visited by European doctors.
In 1927, when I visited America, I was much impressed. Really beautiful buildings were provided for printing, bookbinding, joinery, pottery and weaving?all work in which the mind could be absorbed, directed by those who were trained to set sick minds to the occupations needed to promote recovery. I visited also the Boston School of Occupational Therapy, where students were trained, and some of the State Mental Hospitals, T.B. Sanatoria, etc.
Occupational Therapy in England
It was my privilege to help to bring back to England some of what I learnt in America. The Philadelphia School of Occupational Therapy offered a scholarship to Mrs. Owens, now Chairman of the Association of Occupational Therapists in England. She became the first principal of the Dorset House School of Occupational Therapy, where a large number of students have completed their course. Other schools were founded in London and Edinburgh, and many doctors who visited America have become equally enthusiastic as to the help which Occupational Therapy can give, so that there has been a constant demand for the students to start new work in Mental Hospitals as they qualify. One of the earliest activities of the National Council for Mental Hygiene was to hold a conference of those interested in Occupa- tional Therapy and the Board of Control has done much to encourage it. Each Annual Report of the Board shows that Commissioners constantly notice what is being done to occupy patients, and they carry on from one institution to another any original ideas or improvements that they have noted.
The Royal Medico-Psychological Association is another body which has done much to spread accurate teaching. On several occasions they have arranged study tours, an outstanding one being a visit to Sandpoort Hospital in Holland where two days were needed to see all the Occupational system that absorbed 90 per cent, of the patients. The Hospital estate was large and gave an opportunity for much out of door work, gardening, excavating sand for new buildings, cement work, joinery and crafts for men and women. From these study tours medical superintendents returned to develop similar schemes in their own hospitals, some of the first to become well known being in Exminster, Chester, and the West Riding of Yorkshire.
Effect of War on Occupational Therapy
The war, bringing a very great opportunity for expanding the work has also, unfortunately, interrupted much that was doing well. This was made almost inevitable by the taking over of many Mental Hospitals for Emergency Casualty Hospitals, and the consequent overcrowding of others. Thus in one hospital, the really spacious and excellently equipped occupation departments, which served as models for others, have been taken over as extra wards and nurses’ quarters, and the mental patients have to suffer not only the overcrowding in their wards but also the curtailment of the work and recreation that aided so definitely their recovery.
In other hospitals, however, the result of the war has been to increase the scope of Occupational Therapy. In some, which have been taken over as complete war units, the Occupational Therapist and her department, have been made available for Service and for casualty patients, while in other instances, the mental patients have remained in part of the hospital, and the Emergency Medical Service has appointed an additional Occupational Therapist to treat their patients.
In some instances Institutions for Mental Defectives have been taken over as general hospitals, making well-equipped workshops and trained craft teachers available for the use of the war patients sent there. Many people have realized, for the first time, how excellent is the organization of a colony where all the work is done by people quite incapable of managing themselves who can, under guidance and control, produce food for thousands of people, and make themselves far more useful than many of those of high intelligence who do nothing for their neighbours and have never learnt that they might.
All of this has meant not only an increased appreciation of the good results obtained in cases of war injury or illness, but has introduced the advantages of this form of treatment to doctors until then unfamiliar with the good results obtained by it.
The Army, Navy and Air Force, and Emergency Medical Service, have all appointed Occupational Therapists since the war began, partly through the demand of the psychiatrists who had learnt at such hospitals as the Maudsley and in America to value their help, but the orthopasdic surgeons are equally insistent in being supplied with those trained to provide not only the occupation that will exercise a special injured joint or muscle, but which will shorten the cure by the improved morale of those intent on carrying through their daily job in the carpenter’s shop or the games provided as occupational treatment.
Training for Occupational Therapy
The supply of trained workers is now far below the demand. In normal times all have been absorbed, so that special methods of training must be made available to supply the present need. The Association of Occupational Therapists has instituted examinations for masseuses, experienced mental and orthopaedic nurses and craftswomen after they have received intensive training, but the bombing of Bristol has for the present much limited the Dorset House School, and the London schools have closed. Every effort is being made to get intensive training going. There are well qualified people available for this who can then direct the work of those less experienced. There will then also be an opportunity for making use of partly trained auxiliaries and of a number of voluntary workers whose work in the fields of music, lectures, recreational crafts and games will be invaluable. Work is already being done by the University of London to organize educational activity in hospitals, which comes under the heading of Occupational Therapy, and the London County Council classes in air raid shelters must be doing much for the mental health of those in attendance.
Those who would like to study the subject further are referred to the Association of Occupational Therapists, c/o Messrs. G. E. Holt & Sons, 201 Victoria House, Southampton Row, London, W.C.I, or to Miss E. M. Macdonald, the present Principal, Dorset House School of Occupational Therapy, Clifton, Bristol, 8. Several valuable articles have been published lately in the Lancet on Occupational Therapy as applied to war conditions, and many are finding TheTheoryof Occupational Therapy, by Haworth and Macdonald (published by Bailliere, Tindal & Cox at 6s.), a useful handbook.
As in all other conditions found in wartime, problems must be met as they occur. We are faced by many problems in the field of Occupational Therapy. Some of these are: the large number of patients in need of it, the psychological casualties among the Services, patients depressed by air raid and black-out conditions, and the wounded whose interest in recovery is not being stimulated. To meet these we have a few well-trained workers, and many willing to help, both among the authorities who want to get the best, and those who have not yet quite grasped the nature of the need. We have a splendid number of untrained people wanting to alleviate the sufferings of others. Surely our intelligence should be enough to guide all these into the right channels where the best work can be done.
An interesting story was told the other day in the Manchester Guardian of how a gang of big boys who had been a ” problem ” in the public air raid shelters became thoroughly helpful when the heavy raids on the city last December brought them in contact with danger and suffering. They looked after elderly people, carried messages, fetched water, brought first-aid equipment, and made themselves generally useful. All of which goes to emphasize the point, so long ignored, but now becoming more and more recognized, that the older adolescent needs the stimulus of reality to bring out the best in him. Activities devised for his entertainment often fail to evoke a response because, however interesting, they are still artificial, in the sense that they are specifically provided and not compelled by circumstance. The innermost secret of the success of the East Suffolk and other youth squads is that the jobs the members do are real jobs. … Times Educational Supplement (22.2.41). *
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