A Review of the Psychoneuroses at Stockbridge
MENTAL HEALTH 29 :Type: Reviews :Author: G. P. Coon and A. F. Raymond. ? Austen Riggs Foundation Inc., Stockbridge, Mass.
This work attempts a critical evaluation of the cases which have been under treatment at Rockbridge between the years 1910 and 1934. jt is divided into three main parts. In the first he setting is described in which treatment is carried out, and a brief description follows of the type of case and the methods of treatment used to8ether with a case study of ninety-two patients. In the second part a statistical study is under- taken of 1,060 cases of anxiety state or neuras- thenia selected from 5,300 admissions during period .under review with two detailed tv!?W~Up studies- Frequency and association jables are given for a wide range of factors, throughout this section there is a careful attempt at comparison with the follow-up work of other linits, the most important being those of the avistock Clinic and the Cassel Hospital.
In the third part there is a general summary ar>d a series of appendices giving not only uable information as to how the follow-up ^ork was done but also a vivid insight into the Methods of treatment in use at Stockbridge.
hese evidently rely to an important extent upon |he education of the patient in sound psycho- logical knowledge of the workings of his mind through talks and pamphlets here reproduced. .. is outside the scope of the present review to 1Scuss the principles upon which the Riggs oundation has evolved except in so far as they affect the significance of this book. Admission ls limited to patients suffering from psycho- neuroses who are able to live in the quite open environment of the two hostels run by the oundation which are situated in the small town o Stockbridge. Thus many severe neurotic, Psychopathic or delinquent personalities must e inadmissible. The treatment appears to consist^ of an intellectual re-alignment of the Patient’s attitude towards his problems and symptoms by re-education and moral suasion carried out during a first admission, which is, y comparison with most other clinics, remark- a ‘y short. The authors frankly admit the ?mitations of these methods with certain Patients, and the limitations become apparent n the somewhat superficial dynamic accounts of , e Problems of etiology. Nevertheless, within ese limits there can be no question that the methods employed have the utmost value, and at the Stockbridge workers have much to teach us concerning the rapid and effective readjustment of psychoneurotic patients. For example, the mean duration of first admission is 37 ? 24 days which may be compared with 4 ? 1 months for the Cassel Hospital (probably the most closely comparable English institution). This latter figure is, itself, generally considered to be low, but it is necessary to bear in mind that treatment at Stockbridge is not usually concluded at the end of the first admission, re-admission and subsequent treatment interviews being the common practice.
The immediate results obtained appear to be very good, .57-8 per cent, of the cases being graded ” much improved ” on discharge. In the follow-up work which was carried out in two separate studies, one between 1929 and 1930 and one between 1936 and 1939, some astounding discrepancies are revealed. For example, approx- imately 48 per cent, are graded as ” well ” or ” very much improved ” at the first follow-up compared with 8 per cent, at the second. The authors bravely set out to explain this divergence. The factors which they adduce are of interest to all who are concerned with follow-up studies. They mention in particular the difference in the use of terms by the two separate groups of investigators who carried out the earlier and later studies, the factor of selection of cases and the different methods employed. In the earlier work, for example, the follow-up was by letter only; in the later work many other methods of contact were used in addition. This may involve a double error in that the most grateful patients may be most likely to reply and that their own interpretation of their condition may be wide of the mark. Experience at the Tavistock Clinic where a group of patients who did not reply to a follow-up letter were compared with a group who did has tended to discount these errors, but the question must remain an open one. In general, the statistical handling of the material in the book appears to be excellent though the titles of some of the tables are a trifle confusing and necessitate careful reference to the text. One is, however, left with a feeling of the inadequacy of most psychiatric case histories for subsequent statistical research, a feeling which is strengthened by the authors’ observa- tion that only 3*6 per cent, of the histories studied could be termed ” excellent ” in the sense of their completeness, whilst only a further 9-9 per cent, were classed as ” good “. There can be no doubt that few psychiatric clinics would emerge with a better record than this, which is probably due to the copiousness of the data which have to be recorded and the tendency to omit negative findings.
This is a book which should be in the hands of all those who are planning similar studies in the future and.of those who have to plan the keeping of records in the present. C.H.R.
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