Morale and Mental Health in Modern Society
- Author:
TREDGOLD, M.A., M.D., D.P.M.
Paper read at the Annual General Meeting of the National Association for Mental Health, January 6th, 1950. I feel that the title chosen by your Council for this Annual Address is one which is particularly important to us all at the moment, and Particularly appropriate for this Association to discuss. We had hoped to have Sir George Schuster to speak ; but most unfortunately he “ad to refuse, and as I had gone a little way to Put before my fellow members of the Council the importance of the subject, I was in a very awkward position when they suggested I should fake his place as victim for to-day’s Roman holiday. I could, of course?and did?plead my own inadequacies, and need not repeat that again as they will be only too obvious in a foment ; but the answer to my plea, as far as I remember, was that such inadequacy would only Provoke a really intelligent audience like this to jUore constructive thought ; and indeed it is true that there are few greater stimuli to one’s own activity than to see another’s clumsy Iumblings (witness our impatience when we watch a friend trying a key in a lock) so that Perhaps it is fair to hope that my few remarks o-day will provoke you into tackling the matter yourselves. My final defence that it was Appropriate to invite me ever to speak here ^?ce all could read my views in the editorials of Cental Health, was countered, as far as I remember, by a delicate hint that no one ever read the editorial anyhow ! besides being important, the subject is, of course, most extensive, and naturally Sir George ?uld have given you a wider and rather different levv ; but as we are deprived of that, I shall to limit to-day’s discussion to the way in mch members of this Association, and others of eir profession, can deal with the subject. I Propose, therefore, to ask several questions in ach field, and hope that my attempts to answer em, will, as I say, provoke you to a more oniplete exposition. These questions are :
1. What is meant by morale and mental health ? 2. What is our responsibility ? 3. What methods are we to use ? 4. What tools and skills have we ? 5. What parts of the field are most profitable to work in ? Firstly, what are ” Morale ” and ” Mental Health ” ? Both are phrases we hear a lot of, and both are often very loosely used. Mental health in indeed, in some circles?I fear sometimes including the ministerial?used as a synonym for mental illness ; we hear of mental health statistics which are nothing but questionnaires on the facts of illness ; and though I am naturally in favour of thinking in terms of health, instead of in terms of illness, this will not happen by the mere substitution of one word for the other. The production of mental health is more than the avoidance of frank mental illness ; it is a positive effort for the complete well being of every mental function of the individual, and must, therefore, include the full expression of the individual’s personality and the full development of his powers? intellectual and emotional.
Morale is interlinked with mental health and contributes to it ; is it the same thing ? Group morale, however, is another matter, and it is in the sense of the group that ” morale ” is generally used ; high morale implies a group bound closely together by common aims, experience and stresses?supporting each other. It is noteworthy that in groups of high morale the members suffer less from individual symptoms than those where morale is low ; and this perhaps is a commonplace. Disintegrating behaviour is unlikely.
Our Responsibility
The next question is, what part is to be played by ourselves, who are students of mental health with various kinds of training ? We all know that on this point we often become involved in a most bitter controversy in which (in polite circles) we are sooner or later accused of trying to usurp the functions of the Almighty or (in less polite ones) of being emissaries of the Evil One?and carefully chosen and trained emissaries at that ! I feel though, that this needs clarification. It is first essential to keep a discussion on ethics separate from a discussion of the mechanics of behaviour. Of course, as citizens we are all entitled to express our views on right and wrong?and life would be dull if we did not do so?but I do not claim that a psychiatrist has any special title to speak on ethics, but only on the psychological mechanisms of behaviour.
The same, I take it, applies to you as members of the National Association of Mental Health. We are exactly the same case as the surgeon whose job it is to heal his patient’s broken arm, and whose interest lies in its return to full use, and not in whether that use is for good or evil purposes.. This at least seems to me to be the logical conclusion, for I can see nothing in the training of the surgeon or psychiatrist which gives either the right to be regarded (by others or himself) as an authority on ethics. If we agree here, we must still admit that the difficulty in practice is that dividing lines are not so easy to draw in psychiatry as in surgery and that the psychiatrist seems always on the verge of ethical problems ; for the reason that ill use of the mind seems to him to be itself a symptom of ill health ; that is, it is difficult to distinguish bad behaviour in the sense of evil behaviour, from bad behaviour in the sense of sick behaviour. There are perhaps several causes for this ; in the first place, ideally healthy mental behaviour comes in most of our minds to be equated with ideally good mental behaviour ; it is indeed hard to define either and thus difficult to distinguish their opposites. Secondly, even those who find it possible to make a clear distinction in the abstract between these two, still sometimes find it difficult to decide in which category they should place a given example.
With these difficulties at the onset, it is obvious that practical difficulties follow. The study of disease leads naturally to a desire to study methods of prevention ; and mental illness is no exception. So the psychiatrist is inclined to feel that he must prevent sick behaviour, and study the factors which affect mental health. This is reasonable enough. But it is very easy for him to be led into feeling that he should also prevent bad behaviour and study the factors which affect good. This claim inevitably leads to conflict with politicians, judges, policemen, soldiers, managing directors and all concerned in maintaining discipline or accustomed to protecting society and is responsible for some of the criticisms already quoted. On the other hand one can sympathize only too readily with the psychiatrist’s enthusiasm and public spirit.
Can we make this claim by comparing it again with surgery ? We agreed that the surgeon’s aim was to cure the arm ; but what if that arm were known to him to be going to be used for an illegal purpose?to wield a gangster’s gun ? Should he still cure it ? It seems to me that as a surgeon his duty is still to do so ; though, of course, when the arm is well, as a citizen he may have the duty of trying to prevent it getting a gun. To take another example, a prisoner-of-war camp?should a surgeon prisoner take an opportunity of maltreating his captor, to serve the interests of his own country ? It is possible that this has occurred, and been praised ; but it is, of course, on the assumption that it will not occur, and that the surgeon will always put his professional standards above his national interest, that an international agreement, the Geneva convention, is based. It is on such international agreements that the world, as well as to the nations concerned, depends for increasing co-operation, and any loss is thus deplorable.
If this is true of the surgeon, it must apply too to the psychiatrist or to any other social worker, who must stick to his own field and resist the desire to take his authority outside ; he has no more right to pontificate on ethics than any other citizen?(perhaps I should also add, no less right either ; but, if and when he acts as a citizen he must make it clear that he is doing so, and that he has shed his mantle of psychiatric authority?not an easy task).
If I have unduly laboured this point, I hope you will forgive me ; but I believe it to be fundamental and even if it is accepted by you to-day as obvious, it is not so obvious to many who are less educated. Indeed we constantly meet two misconceptions, the opposite of each other. One is the belief that psychiatrists and their allies are anxious to take over the responsibilities of the control of human behaviour, national and international ; this belief fills them with horror ; the other?perhaps even more embarrassing to us?is the desire for us to do so. One might indeed compare the attitude of the average man to the psychiatrist with that of the owner of a djinn rising unexpectedly out of a brass bottle : first, he exhibits very considerable awe : second, the awe decreases but much suspicion persists ; and third, as the djinn proves his usefulness, his amiability, and as his resemblance to a human being, increases, he is met with familiarity and sometimes a pet name. Finally the owner’s increasing demands for miracles or magic drive the djinn to desperation, or perhaps to seek refuge in his bottle. I fully realize that the need for better national and international relations is 1 MENTAL HEALTH 61 urgent, perhaps as never before, and I believe this is a reason for us all to exert the greatest influence we can. But surely the way to do this ls by using our talents and training in the field for which they are best fitted, and not by fritterlng them away in other projects for which we have no skill. This counsel (to dig only in our own fields) is perhaps disappointing?but if any find it so, he can console himself with the fact that we have in our own territory enough work to keep us occupied for a generation. . Next, we must discuss which part of this work ls likely to be the most profitable, what methods We should pursue, and what tools we have at our disposal. This meeting, composed as it is of representatives of various branches of the social sciences, is, I feel, a particularly appropriate ?ne for such questions to be asked.
Methods
If then we are claiming to play a part as scientists, we must do so in the ways laid down t?r other sciences ; we must follow a threefold Path.
This is described emphatically in a series of rn?st telling adjectives by L. J. Henderson, whose words (quoted by Elton Mayo)* were an intimate, habitual, intuitive familiarity ” Wlth the subject ; a ” systematic knowledge ” ; and ” an effective way of thinking “. To obtain these he had recommended ” hard, persistent responsible, unremitting labour “?” accurate observation of things and events ; selection, guided by judgment, born of familiarity and experience, of the salient and recurrent phenomena, and their classification ” ; finally, ” the judicious construction of a theory, a modest Pedestrian affair “.
This is the path which all the natural sciences nave trodden ; it is the path which we must tread too. There are no short cuts, and the keynote is patience and persistence and Pedestrianism.
T?oIs and Skills If we consider next our tools, we must admit that they are often inadequate or even impercep.le, and our skill primitive. The natural sciences have long passed the days when they Were developing their earliest tools and skills, out if We can think how much they owe to the jnicroscope or the telescope, we can realize now early we are in the development of our tools. Our lack 6f skill has been roundly c?ndemned by Mayo, who has compared us unfavourably with all the natural sciences. I think this is a little hard. Mayo’s suggestion was that we should acquire the skill of communication. His words are worth quoting. ” I believe that social study should begin with what may be described as communication ; that is, the capacity of an individual to communicate his feelings and ideas to another, the capacity of groups to communicate effectively and intimately with each other. This problem is beyond all reasonable doubt, the outstanding defect that civilization is facing to-day.” He could not be more emphatic.
With this I think we should all agree, but I think too that we can claim to be beginning at least two methods to this end?though I should be the first to admit they both need a great deal of development.
Firstly, there is the art of obtaining information, in which, no doubt, the technique of listening plays a large part. This is of benefit in at least one side of communication ; and most of us have perforce developed this to some extent in our profession. By contrast we do not seem to have been so successful in developing our skill in the other side of communication? that is imparting new ideas.
Secondly, there is the skill of interpretation? that is the unravelling of the underlying influence of behaviour. This must be practised by the psychiatrist and to an extent by his allies. Although no doubt various analytic techniques provide an understanding of deeper matters, I do not think it is right to say that understanding can only come by analytic methods, and I feel sure that many of you (who have not had the privilege of analytic training) will agree that you do in fact obtain some understanding of many pieces of individual and group behaviour without it. Again in parenthesis, it is interesting and rather sad to find that those whose skill is great in interpretation?in the sense of understanding?are not necessarily as expert in interpretation in the sense of explaining what they understand to others.
Subjects
The next question is, on what subjects can our methods and skill rightly be used ? We must readily admit that there is no lack of these, even within our prescribed scope, so that we need, after all, waste no sympathy on those who are anxious to work.
The fields in which we can work are many and varied ; each no doubt attracts different people ; Mayo, E. {1946). The Social Problems of an Industrial Civilization. Harvard University Press. industry, the structure of Society and of the family, education, vocational guidance and selection ; in all these relations between individuals and groups are at the root. May we consider a few examples ?
In industry the urge is for more and yet more productivity ; we are assured that on this depends our national survival. Many factors influencing productivity are, no doubt, material ; many others are psychological. In the midst of this struggle we find the most glaringly illogical behaviour?strikes which gain nothing but disrepute for their leaders, managers whose ” efficiency ” produces go-slow, men with excellent technical skill promoted to positions where social not technical skill is required. Illogical behaviour of this kind in an individual would indicate study of emotional roots of his actions. Can we doubt that this needs a similar approach ? Besides these examples, there are also in industry, many tensions between the different levels of the hierarchy, and of course between management and the workers, which would surprise the- simple-minded doctor used to working as one of a team.
The relationships which exist in Society, national and international, are as much deserving of study ; illogical behaviour is equally common, and tensions so obvious as to need no emphasis. Again there would seem a strong case for the work of scientists trained in interpreting unconscious motivation. Another point was made by Mayo ; co-operation between individuals and groups is woefully inadequate and inefficient. We simply do not know enough about the reasons that lead two individuals or groups to collaboration, or to combat. Here again, study and patient observation is wanted.
In other fields, such as education and vocational guidance, we may find frequent examples of behaviour directed by unconscious complexes, and of group tension ; and it is perhaps an interesting reflection of the latter that those engaged in teaching are almost the only people left who are recognized to need one-third of their year as holiday?that is away from the site of tension. But here perhaps this is not the major problem of psychology ; more important is the application of tests for aptitudes and for intelligence, to the training for the professions and trades. Again, what are the factors which influence the transfer of ideas from one person to another ? Is the result of research on this applied to teaching generally ?
It seems to me that each of these fields would benefit from the appreciation of these points. Trained scientists would gradually acquire familiarity with the observed facts of each, and then a systematic knowledge ; later, an effective way of thinking, if developed, would provide a new approach to the problems I have already mentioned as examples of illogical behaviour and tension. There is no suggestion, that the work and experience of those already in the field would be lost or superseded?only that it might be amplified. After all, the illustrations I have taken, have not, so far, been satisfactorily dealt with by existing methods. This is perhaps enough to indicate the width of the field of mental health, seen from various angles from which study may occur. I do not of course in any way deny the value of the established medical method?learning about health from illness ; and there is no doubt that much of value can come from this. But by far the greater part of our resources of money and workers are already directed on to the study of the sick, and my purpose to-day has, therefore been to stress the other side. The estimates for expenditure on treatment and on research are sometimes in the neighbourhood of 20 : 1, so that we have a long way to go to adjust this balance.
May I finish by summarizing very briefly the points I have tried to make : 1. The study of the mental health of Society is one which is urgent to-day. 2. The social scientists whose branches are represented here to-day can play a great part in this study. 3. Their approach must follow the path of any other science, and consist of three steps, the unremitting labour of ascertaining facts and so gaining familiarity with the subject, the classification of the subject, and the judicious construction of theories. May I repeat again? these must be ” modest pedestrian affairs, that is they must not go too fast and they must expect to be frequently knocked down “. Unless this path is followed, we must lay aside all claims to authority as scientists, and have no more (but no less) than any other citizen. 4. We have certain skills to work with? the techniques of eliciting facts and of interpretation, which we must and can develop. 5. There are many parts of one field, which could bear the application of these methods. These are all of fundamental importance to our everyday life, and to the future of our civilization.
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