The Prevention of Misfits at Home and at Work
- Author:
Ian Skottowe M.D., D.P.M.
Physician-in-Charge, Department of Nervous hncl Mental Diseases, Royal Buckinghamshire Hospital,
Aylesbury The Psychiatric Approach Psychiatry has something?but only something, not everything?to contribute to some instances, not every instance, of problems which involve the management of personal inter-relationships. It is from this moderate viewpoint that I venture to approach the subject of misfits at home and at work. I approach it, as it were, from the frankly abnormal to the more nearly normal, from the ill to the well; to see whether, as has often happened in other aspects of medicine besides psychiatry, the study of the sick reveals events or principles that are relevant to improving still further the lot of those who are well, and so leads to the prevention of more illness.
It is a common experience in clinical psychiatry, especially in the less severe disorders?the neuroses, and the inadequate though not grossly defective personalities, that are seen in out-patient practice?to find that a personal misfit of some kind is a potent cause or a persistent aggravator of the symptoms. It is an essential part of clinical technique to take a careful biography?often an autobiography? of the patient. In most cases, his defences come down sooner or later; he reaches a stage where frankness born of despair is imperative to him for the relief of his emotional distress; cupboards yield up their skeletons; secretly nurtured hostilities, jealousies, resentments, disappointments and frustrations come into the arena of dispassionate discussion. Some are remediable, some are not; but at least we get to know what they are. Many of them result from personal misfits; and we can see how they arise. None are more bitter than those directed primarily, not against others, but against the self; although they usually become projected, secondarily, against others.
Types of Misfit and their Genesis
(i) At Work The examples that I am about to give are anecdotal, necessarily anonymous and disguised in some respects; but none of them are fictitious, they are all based on actual cases, typical of many. They all bear the common feature of a discrepancy between the aptitudes and attributes of the individual on the one hand, and those needed for the job he is in, or to which he aspires, on the other. But they build up into some curious patterns so that the fundamental discrepancy is sometimes hidden and much effort is wasted in following the false scent of the secondary reaction.
The man who, comfortable enough economically, sets his heart on a professional career in say medicine, the law, architecture, or engineering and who just lacks the mental equipment to make the grade has indeed a bitter pill to swallow; but he may just manage to ” take it ” if he gains insight into his limitations early enough; and this is more likely to happen if he has a frank neurotic breakdown and so comes under medical care for the relief of the symptoms that distress him. If he does not do this, he is likely to have a lasting grudge, first against the professional body that rejects him, then against t an ever widening range of concrete society, then against religious conceptions; and so, in an extreme ‘ case he becomes a world-hostile irreligious antisocial psychopath, a frothy reformer, full of specious excuses for his own ineptitude; he does not recognize that he is ill in any way, and indeed it is open to question whether he is, but he is nevertheless a nuisance, if not an actual danger to society, a hanger-on to the fringe of freakish cults, a preacher of seditious nonsense, a quack, an exploiter of weaknesses and frailties in other less aggressive and even less well endowed individuals than he himself.
A similar chain of events can be seen in simpler walks of life. The moderately skilled workman, or woman, not quite skilled enough, yet with aggressive ambition that precludes acceptance of a more humble position better attuned to his aptitudes, is liable to find all kinds of evasions and excuses for his lack of satisfactory work; first in his health?we are all familiar with multiform but vague diagnoses such as anaemia, debility, nervous exhaustion, rheumatism, gastritis, backstrain and so on that so characteristically bespatter his medical card in the space of a few months? then in working conditions, such as excessive hours, 1 unreasonable orders, bullying foremen, bad ventilation, and that never-failing source of contention, bad food in the canteen. Such a one, seldom very particular about the accuracy of his facts, is prone to make noisy sweeping generalizations that, for i indefinite reasons, he can seldom support by chapter ‘ and verse; and he will soon be ranting about victimization, exploitation and?a favourite one, . this?lack of discipline and control, which he himself v would be the first to resent. If such an individual happens to have the gift of the gab, he may collect, about him?or her?a number of under-occupied * Address given at meeting of National Association for Mental Health held in Reading, April 23rd, 1947.
and thoughtless, though otherwise contented individuals who will go with him as much for the sake of a minor thrill or a change from routine, as for any real or critical belief in the Tightness of his rantings. And such a ” cell “, besides being most uncomfortable for other more thoughtful and stable workers to live with, can hinder or stop the entire work of a factory?though not for long? to the despair of the management, the orthodox and properly accredited representatives of the workers and the public. Individuals such as I have described have a characteristic lack of discrimination and fairness and they are really irrational; they neither know nor care, nor try to find out who is for them,” who against them; they are as deaf to entreaties and advice of those whose business it is to.help them (and whom they pay to do so) as they are to the ultimatum of those with whom they are in conflict. It is peculiar that wherever they go, in whatever setting, the story is always similar, and they are never in the wrong; they are entirely different from the prudent, thoughtful, skillful man who knows his job and its faults as well as his own, and who seeks patiently to remedy them by proper and generally accepted methods.
A certain proportion of men, or women, who are examples of misfits in either kind of setting that I have described do come into psychiatric hands sooner or later. Those who do, are often of cyclothymic temperament in addition to lacking some aptitude or skill, or other quality that is essential for the occupation to which they aspire. Thus they have phases of mild depression and mild exaltation with aggressiveness. And that the evolution of a misfit in the way that I have just described is not a mere theoretical psychological fiction, is abundantly demonstrated by what one actually sees in the consulting room, every now and then. Aggressive, bombastic, world-hostile men break down, sooner or later, and describe themselves?usually correctly, not as a delusion?in self-condemnatory terms, express a surprisingly clear realization of their limitations and a knowledge at last that what they need is help to find their feet in a world that seems to offer them very little, not so much because there is something wrong with the world as because there is something Wrong with them and there is very little they can offer in return. They come at last to recognize that there are two sides to a bargain. Again, in further support of the factual nature of this account of misfits, it is not an exceptional experience to see, or hear from, a patient, perhaps several years after the initial consultation and to learn thkt after accepting advice to eschew a professional career and accept something much humbler, he has found a way of living that leads to contentment and freedom from symptoms, even if it does mean running a small retail business, or a kennel, or being a comparatively humble technician instead of aspiring fruitlessly to high places in one of the professions, or in commerce.
Something must be said of another, though much rarer, kind of occupational misfit, namely the man whose aptitudes and skills are far beyond the demands of his actual occupation, or who, without being exceptionally able, has no outlet for his interests or aptitudes, as instanced by the case of a young man who entered railway service because he wanted to do poster publicity work and who found himself instead doling out excursion tickets and handbills to exasperated queuers. Such a man is likely to find his job boring and monotonous, to suffer therefore from disproportionate fatigue, to feel uncertain, frustrated and insecure, and he is thus liable to develop morbid anxiety or other psychiatric symptoms and to come into psychiatric hands on that account. He too, though for quite different and much more valid reasons may have a grudge against’ society; and clearly it is much more easily remedied than that of the man whose grudge is founded on his own inadequacy, for unless advancing years or imprudent family commitments are a millstone about his neck, he can still be given his chance; and since he is often, by definition, of superior intelligence he is more likely to benefit by explanatory psychotherapy and be more ready to adjust his attitude to the world than is his less well endowed counterpart. But if this adjustment is not effected, and if his social circumstances cannot be modified to remedy his position, he is capable of becoming, and sometimes does become, a most disruptive social force, the more so because of his superior intelligence. I think there has been a tendency to over-estimate the frequency of this kind of misfit, and to take over-elaborate, though not always effectual measures to prevent its occurrence. The trend of scholastic and post-scholastic education, sponsored alike by public authorities, private benefactors and industrial concerns that offer substantial opportunities to promising pupils, is to give a chance to everybody. Desirable and right though this principle is, it can be pushed too far in the direction of giving too many chances to too many people without regard to their inherent limitations, thus tending in some cases to emphasize the very misfits of one kind or the other that it seeks to avert. This fault is liable to arise from excessive preoccupation with the value of technical skills without consideration of the social aptitudes?the capacity to deal with and get on with people that is such an essential quality in the higher ranks of most professions and occupations. One sees this in medicine, in engineering and in science certainly, and I have no doubt, in other professions too. Over and over again one is faced with the problems of the individual who gains promotion because of his technical skill but who, organization and administration being what they are, finds that, as the ladder is ascended?as the nurse passes from the ward to the assistant matron’s office, as the doctor passes from the bedside to the medical administrator’s chair, as the teacher passes from the classroom to the office of the educational director, the scientist from the laboratory to the board room?the limiting factor to efficiency, achievement and personal contentment lies not in the development of technical skill itself, but in the capacity to exercise that skill in a human setting of inter-related but diversely opinionated people. And so, there is sometimes a peculiarly difficult type of misfit to be found at or near the top; and he is a kind of misfit that is liable to have rumbling repercussions throughout the structure and functions of the organization that he is trying to direct. In a word, what he lacks, however good he may be technically, is a capacity for leadership; and since leadership is an essential factor in maintaining good morale, the whole organization suffers. Unfortunately, whereas it is relatively easy by tests and examination to predict the development of intelligence and special skills in an individual, it is exceedingly difficult to predict how he will react to and inter-act with other people once he attains a position of practically undisputed authority and responsibility. For power always tends to be, in the end, a corrupting influence unless it be balanced and controlled from without by some organized arrangement of committees? (always liable to develop into restrictive red-tapism) ?or from within by a proper spirit of humility which is a comparatively rare and certainly imponderable virtue that needs, like friendship, to be kept in constant repair, by the exercise of personal disciplines fundamentally of a religious or spiritual nature, by whatever names one may call them.
At Home
Misfits at home which we in clinical psychiatry see far more frequently than we see misfits at work? (that is to say they are more often causes of illness, not necessarily more frequently absolutely) are of three main kinds?ill-matched spouses, badly brought-up children and intrusive interlopers, whether ‘’ in-laws’’ or not. All of these may interact to some extent. The last?the interloper?is in principle the easiest kind of misfit to remedy. It is not so much that they are inherent misfits, but rather that they create a set of interpersonal conditions that brings to the surface any latent tendencies to quarrelling that there may be; and at best their continued presence makes exacting demands upon even the most saintly, wellnourished and well housed families. They are therefore more noticeable in times of social stringency such as the present. Clearly their remedy lies in the social and economic spheres; but it should be remembered that even in better times, a proportion of those who are favourably situated in these respects are prone, if they are of lazy disposition, to hang up their hats, blind apparently to the comfort of everyone except themselves. The application of the economic spur, even at the expense of a frank family row is usually a sound investment in such cases, and in the end it benefits the interloper, if he is worth his salt, as much as the family team whose home ground has been invaded.
Few things are more pitiful than the unruly, noisy, boastful ill-mannered child who is a misfit in his own home, the more so because to begin with, it is seldom or never his fault that he is so ; and what is more pitiful still is that, in the fullest sense, it is often not very much the fault of either parent individually. It is simply that the parents I are so ill-matched and are themselves misfits vis-a-vis one another, although not necessarily in the world at large, that they cannot create the harmonious and congenial atmosphere that is essential for the proper development of the plastic personality of the child. One parent is the stronger character, usually?I venture this opinion with the greatest diffidence?the father. We are all familiar with the problem child, brought to the clinic by his mother with the history that he was perfectly all right until his father went to the war; then he began behaving badly; and now he seems to resent the return of his father and in spite of beatings, scenes, tears and entreaties from the mother and , threats from the father, the difficulty continues so ‘ that, as is often said, ” my husband wishes he was back in the army again?and my nerves won’t stand it much longer In short, the child who is a misfit is usually in every sense the product of parents who are themselves misfitted to one another; and in many cases it is the separation of war time, after a brief spell of married life in probably highly artificial conditions, that has brought the misfit to light. In severe cases of this kind, the home becomes an uncongenial place for any of its members; father may well find the ” local ” or the dog-track, a more attractive retreat after the day’s work; the child prowls the streets, the cafes, the fun fairs, when he should be in bed; the dispirited, discouraged mother no longer even tries to provide an appetising supper?difficult enough in these days?nor to plan the occasional family outing with high tea and the pictures, no longer bothers even to try to look, or make the home look, attractive; and so the home is broken in spirit and in morale, if not materially and it is held together in the latter respect only by the arid and biting bonds of sheer economic necessity and perhaps by fear of what the neighbours will think and say.
This sad and common train of events is by no means confined to one particular social stratum; in its essentials it is, I believe, as frequent, relatively, in the setting of the so-called luxury flat, and the suburban villa, as it is in that of the working class tenement. But my impression, from working with a population that is evenly divided between urban and rural elements, is that it is much less likely to progress to its most severe manifestations such as I have outlined, in the village, than in the town, mainly I think, because there is in the village a larger social grouping, beyond that of the family itself, that acts as a kind of outer haven for distressed or misfitting individuals who have been pushed out from their berths in the inner harbour. Even if they cannot find a fit in the immediate family circle, they can still do so in a small rural community, where everybody knows everybody and everything about everybody else. In the town and more so in the suburbs, a family may live cheek by jowl with another for years and be on no more than nodding terms; and if anyone gets, so to speak, pushed out of the inner berth there, he finds himself straightaway tossed purposely hither and thither on an indiscriminating sea of social insecurity. There is no haven in between, such as there is in a village.
Clearly, all these domestic misfits interact with misfittings at work, in either direction. Resentment at an unjust foreman is projected on to the hapless wife, no less than irritation by the nagging wife and noisy child is projected in criticism of the factory management.
I make only passing reference to the misfits that are constituted by the so called ” problem family “. These are really special instances of persons so inherently handicapped, although seldom recognized legally as frankly defective, so irresponsible, improvident and lacking in foresight as to be incapable of accepting successfully the liberties, rights,% duties and responsibilities of the ordinary citizen, and of managing their lives in a proper and selfsupporting way, however favourable their external circumstances may be at the start. Provided that they are not grossly unstable emotionally in addition to being intellectually defective, they are not as difficult a problem as they seem, for their occupational capacity is extremely limited, and it is evident ) to most people who come in contact with them that they are weak-minded. As a consequence, they are unlikely to be much of a socially disruptive force, or to interfere much with the quiet enjoyment of other citizens. They tend to gravitate together in slums, or to create them; and we have been told from several authoritative sources in recent months how fertile they are. Most of them just go on being quietly and contentedly parasitic, and will I suppose, continue to do so until the sheer social and economic burden of them compels the people as a whole to lend a more sympathetic ear to the shy voice of the psychiatrists and others who, from the days of the Wood Report (1929), through those of that masterly survey, ” Our Towns ” (1942) to the current startling conclusion that the national average intelligence level is slowly falling on account of the fecundity of the less well endowed, have-timidly suggested that it might be in the better interests of these poor folk as well as of the people as a whole, to recognize them for what they are and to deal with them appropriately before they entangle themselves in commitments that they have, from the start, no chance whatever of fulfilling.
Principles of Prevention
Although all the examples of misfits that I have cited are those that have, in fact, had a direct bearing upon the onset or aggravation of psychiatric illness, I have no doubt there are many other similar misfits, similarly built up, that a psychiatrist never sees, because their occurrence does not result in actual illness either in themselves or in their associates. They just drag on, unhappy, sullen, sulky, difficult to live with, unreliable, relatively nothing like as efficient as they might be, and carrying with them a rather contagious aura of restlessness and discontent especially bad for young people at home, at school or at work. I am not going to suggest that it is the psychiatrist’s business to put them right, but at least he may properly offer some suggestions about the principles for preventing their occurrence. This I now venture to do; and I lay special accent on prevention rather than remedy, because it is so much easier. As to remedy, I think this is possible in only a proportion of instances. You can remove the intruder from the family circle, sometimes; or you can re-select the occupation of a faultily placed artist or artisan, if his economic circumstances permit it?there is an “if” or a “but” in the attempt to remedy most established cases of misfit. You cannot however effect a real and complete remedy for the wrong man being married to the wrong woman, especially if there are children; the best you can hope for is to patch things up at a workable, day-today, matter-of-fact level; you can never hope to give them the fullness of the family and marital relationship at its best if their inherent qualities are ill-matched. Nor can you do much to remedy the managerial type of misfit?the able technician who lacks the capacity for leadership?without incurring legal risks, or severe personal hardship for him, for something that is, when all is said and done, not altogether his fault?after all he didn’t make his own appointment.
On what lines then, and by whom may preventive measures be taken ?
I would place first in importance the marriage relationship,?the selection of a spouse,?and I would emphasize that it is quite impracticable to suppose that anyone else is going to make the choice except the two people themselves who are concerned. They are more likely to make the right choice if they are taught to think for themselves about these matters before they become involved in them. They may receive guidance, either through a body. organized for that purpose such as we have to-day, or through their general education and experience of the world, or through their parents, or all of these; but in the end the decision must be theirs and theirs alone. It is desirable that guidance, should be given while each is heartwhole. Those who are already bethrothed are. nearly beyond guidance, specially about each other, and if unalterable but ill-matched traits are present, nothing can be done about it, except to point out that care will be needed in this or that respect; in any case, two people in love are seldom in a condition to exercise clear judgement about themselves, at any rate to begin with. I have no wish to intrude into fields that others have made their own, but I would venture the opinion that the essential principles of successful mating are to be found in the recognition and satisfactory matching of certain traits, attributes and circumstances, rather than in any conception of matching personality types.
Briefly, a matching of intellectual status, interests, social class, cultural standards, spiritual values and sex needs should be the aim; and serious disparity in any of these respects should give pause to even the most ardent suitor or the most insecure spinster. Over all, it cannot be too strongly impressed on young people?and some not so young?that marriage is not completed, only begun, with the signing of the register; it is not a static, but a fluid relationship, needing constant adaptability, sympathy and courage to make it and keep it as it should be. Unless the approach to it includes a consideration of its spiritual aspects it is not likely to be a very satisfactory affair. If the marriage relationship is right, it will go a very long way towards preventing misfits in that generation, and in the next; for fundamentally, although, as I have indicated, there are other causes, the most potent and most widespread are those that live in the very structure of the family circle itself. The next set of preventive measures lies mainly in the educational field; and I will go so far as to say I think they are primarily matters for the educational psychologist rather than for the doctor or psychiatrist. Group testing at appropriate ages will reveal those who are poorly endowed or have special disabilities. Some will benefit by special educational measures, some will need psychiatric or other medical attention. But all this group should be retested individually at intervals and those who, despite special tuition, do not come up to a level that will enable them to stand on their feet in competition with their fellows should not be allowed to drift merely because they have reached school-leaving age. Perhaps the most difficult of all tasks for the educational psychologist is to select and guide that small top fifth percentile of brilliant, gifted pupils as they approach school leaving age; and it is a matter for wider educational activities than his to see that too much accent is not laid on intellectual prowess, and that the foundations of proper character-training and the capacity to deal with people are laid no less surely than are fostered and evoked the exam-passing aptitudes. It is here I think that the recommendations of the Fleming Committee are likely to achieve their greatest value. But in any case, some kind of liaison between schools and the Ministry of Labour or employing authorities?an extension of that which exists at present?with a view to occupational guidance, is imperative; and I should like to see properly organized selection procedures throughout industry, commerce and professional life.
As for the child who is already something of a misfit in an incompetently managed or unhappy home, I am sure that although something can be done by psychotherapy and social service for some such children and their parents, its value is pretty limited; and there is in my experience a hard core of such cases for whcm the only real hope is a boarding school. I do not mean a special residential school, for although such places are of considerable value, they are more suited to the backward, the handicapped or the grossly maladjusted child who needs special tuition as well as removal from his customary environment, than to the kind of case I am thinking of, which is the inherently normal child who is being persistently badly brought up. One sees him in the more fortunate classes of society, as well as the more humble, and every-one is familiar with the awkward difficult boy, or the flouncing, sulky girl who is improved out of all recognition after two or three terms at a good school. They even manage eventually, to get on .quite amicably with the most difficult and stupid of parents in the holidays and in the end become ” good types “; but left at home, a good many of them become real and irremediable misfits in later life?they never learn to behave and are always selfish, they never make good parents, and .so it goes on. I should like to see similar facilities afforded to similar children from more humble homes. They should not be sent to special residential schools, which try as one may to avoid it, do carry with them an aura of abnormality faintly comparable with that of a mental hospital, and they have the peculiar distinction of not having any regular holiday periods. I should like to see ordinary boarding schools set up for these children, fundamentally similar in their aims of character training to the public schools but attuning their cultural standards to something that does not differ too sharply from the accepted cultural standards of the homes from which the children come and the way of living to which they will eventually go. An important factor in many misfits is that they r lack proper character training and so are handicapped in dealing with ill-fitting occupational or domestic situations that they may encounter later. If their homes are unsatisfactory, I know of no way they can get sound character training except at a good boarding school; and their removal to such an establishment sometimes has a most salutary effect upon exhausted, apparently irresponsible and inefficient parents.
All these people then, the parent, the teacher, the educational psychologist, the family doctor, the psychiatrist, the industrialist, various ministries and the legislature itself, have something to contribute to the prevention of misfits; none has an exclusive lien upon this work, and all must play their parts. I have ventured to give only an individual psychiatrist’s point of view of their respective roles without in any way implying that all this work is primarily a psychiatrist’s business?only some of it, in some cases.
I have left till last what is I think, one of the most important, yet one of the least discussed aspects of the whole matter. I refer to the effort that the individual himself can and should make to adapt himself to his environment and to people, but seldom does, mainly I think, because he is not taught to do so and because there is little in the peacetime social evolution of the present century that is designed to evoke a sense of personal responsibility, and much that leads to a demand for rights and benefits with little reference to the need for a corresponding in-put of duties and obligations. But most people have an inherent sense of fair play, and in the end if they are properly guided it becomes dominant in their way of living, so there is no need for despair. The material is there if we can only evoke it. In healthy people this is ultimately a matter of self-examination and of conscience; it cannot be considered in its entirety only on a materialistic economic plane; -it is inseparable from fundamental conceptions of right and wrong. And somehow it seems from the evidence, that the churches?whose part in this is surely obvious?and the people, have got pretty far apart in many ways. It is not for me to intrude upon their ground; but that the churches have a part to play, and in my view an indispensable one, in the interpersonal relationships of people and so in the prevention of misfits there can be no possible doubt.
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