Adolescent Instability and Mental Subnormality
At a Boarding-Out Conference held by the C.A.M.W. on Saturday, 13th March, 1937, Dr Lucy G. Fildes gave a stimulating address on the subject of Adolescent Instability particularly in its relation to delinquency and to problems arising in connection with the high-grade defective and those on the borderline of defect.
The main factors leading to maladjustment in behaviour, Dr Fildes enumerated as (a) poor intelligence (b) temperamental instability (c) bad home relationships in relation to the emotional upbringing of the child. Instability she defined as being most clearly shown by an exaggerated response to external stimuli. It was frequently inherited, and if not actually inherited there was often a congenital factor present. If low* intelligence was also present, this placed an additional strain on the unstable individual, particularly as a child, when?unless he was in a Special School?he was continually being put in competitive situations where failure was inevitable. Sooner or later, such a child would turn to ways in which he could achieve success, and frequently these ways might be those of delinquency. Further, his inability to exercise foresight or discrimination often led him into trouble. Between 30 and 40 per cent, of children in Remand Homes were of low intelligence, and between 50 and 60 per cent, were failures at school.
Healy, in his recent book ” New Light on Delinquency had shown that external environmental conditions did not play nearly so important a part in the production of serious and long-continued delinquency as was often supposed. The factor of supreme importance was that of emotional relationships. In the vast majority of cases of delinquency, there was a personal family problem involved in relation to the particular child. The great disaster in the life of a child was the lack of a secure basis for emotional growth. If he felt himself, rightly or wrongly, to be ” rejected “?to be an outcast?he would try to get by some other means the security of which he had been deprived.
At adolescence, the unstable dull child naturally found the greatest difficulty of adjustment. He was unable to understand and deal with the changes that it brings, and his need for help at this stage was very urgent. It was important that such a child should have a real home and?if rejected by his own family? that he should be placed under the care of someone who would take a kindly interest in him and give him the affection of which he felt himself to be deprived. Where this could be arranged, many cases of adolescent instability would be found to be amenable to treatment.
Miss Evelyn Fox, in introducing Dr Fildes, urged the great need for more intensive study of the problem of instability as it affected the treatment of the high grade defective. It raised the whole question of the right criterion of ” Mental Defect ” and demanded the attention of all who were engaged in Mental Health work.
“New Light on Delinquency and Its Treatment.” By William Healy and Augusta Bronner.
Published for the Institute of Human Relations by Yale University Press. After-Care and the Mental Treatment Act
In the Mental Hospitals and Mental Deficiency section of its Annual Report for 1935, the London County Council refers to powers which have been newly exercised under Section 6 (3) (b) of the Mental Treatment Act. As a form of ” After-Care ” maintenance allowances not exceeding the current weekly charge for maintenance in a Mental Hospital have been given to certain patients on discharge, for a period of normally not more than four weeks.
Further, an experiment has been tried whereby two or three patients on recovery, have been provided with technical training in trades for which they had shown special aptitude, the expenses being borne by the Council, under the Act. The results of this experiment, regarded as a form of preventive medicine, are to be recorded in the next Annual Report.
Tt has, in addition, been decided to provide, where necessary, for the placing of child patients attending the Maudsley Hospital in the care of foster-parents, to whom allowances, ranging from 12/6 to 20/- a week are to be paid. Suitable foster-parents will be found through the Child Guidance Council, and cases will be supervised by the social workers attached to the Maudsley.
Mental Treatment in the Isle of Wight
In his Annual Report for 1935-36, Dr C. Davies-Jones, Medical Superintendent of the Isle of Wight Mental Hospital, records that out oft a total of 158! new patients admitted during 1935, only 43 were certified, the rest being either Voluntary or Temporary Patients under the Mental Treatment Act, and he points out that this resource to early treatment is resulting in a reduction in the average lenght of time spent in the Hospital.
A useful summary is given in the Report of the main provisions of the Act, and Dr Davies-Jones emphasises that when the subject of admission to the Hospital is under discussion the two questions that should be considered are : (a) Is the patient willing to enter the Hospital? (b) Is the patient incapable of expressing willingness or unwillingness to enter the Hospital and will he benefit as a Temporary patient? Only the recalcitrant patient who definitely refuses treatment need now, he explains, be certified.
Out-Patient Clinics?of which there are three in the Island-?he regards as essential and not merely subsidiary to the proper application of the Act.
Crichton Royal Institution, Dumfries
Dr Charles Easterbrook, who has been for twenty-nine years Physician Superintendent of Crichton Royal, gives in his last Annual Report for 1936 an interesting survey based on his long experience, of the Causes of Psychosis pointing out the importance of the recognition of the special weakness of the individual whose ” nervous resistance” is sub-normal which may, under exceptional stress, lead to mental breakdown unless recognised and guarded against. He distinguishes four types of ” stresses ” which, acting on the common predisposing factor of a nervous constitution may precipitate mental illness, viz., pathologic, biologic, psychic, toxic, energic and hygienic.
Dealing with the treatment and care of mental invalids at Crichton Royal, London County Council Annual Report for 1935. Vol. VI. Mental Hospitals and Mental Deficiency. Price 1./-. P. S. King and Son Ltd.
The emphasises the part played by intelligent and sympathetic nursing, and pays a tribute of gratitude and admiration to the men and women who have worked under him in this capacity. The Institution has always extensively employed women nurses for male patients as well as female, and he records his experience that ” the great majority of male mental invalids on admission to hospital are most suitably nursed by women towards whom they retain and observe the courtesies and proprieties of man towards woman even in the depths of mental illness “?until the stage of convalescence is reached when the male nurse can best give the companionship then needed.
Accompanying this final Report of Dr Easterbrook’s is a pamphlet forming an introduction to the ” Chronicles of Crichton Royal ” which are to be published by the doctor, going back to the foundation of the Institution in 1833.
Poverty and Neurosis
In dealing with the effect of economic stress in producing nervous and mental breakdown, Dr Mapother, in a Report of the Maudsley Hospital covering the period, 1st January, 1932, to 31st December, 1935, writes :?
“Unemployment, distress, neurosis and loss of skill form a group of conditions each increasing the other until emergence is impossible without intervention that is not merely palliative but reconstructive, and directed to ends that are precisely seen and sought by methods adapted to each case. Given such intervention there is good reason to believe that in many cases it would effect more than any kind of psychotherapy. In many cases, subject to proper safeguards, such help would prove not only the salvation of the individual, but, taking the long view, an economy to the community.”
These conclusions are in agreement with the experience of a colleague, Dr Aubrey Lewis, in connection with work done for men referred to him for treatment by the Public Assistance Committee who have been unemployed for long periods.
“Two constructive methods” he continues “seem worth consideration. The first is re-education … when after treatment the inherent disability which remains is slight, but skill in the patient’s previous trade has been lost. Training for other employment may be needed when the former calling is overcrowded or obsolete. In connection with the Maudsley, adequate maintenance might be a difficulty, but the power to make a grant equivalent to the mental hospital maintenance rate might prove at least a partial solution.”
Employment for a long period under sheltered conditions may be necessary for more severe cases, and he urges the need for a scheme such as that initiated bv the Ex-Services Welfare Society for cases of protracted war neurosis, under which patients though unable to cope with competition in the open market can, protected from the necessity for it, be made practically self-supporting.
Child Guidance Council
The Annual Report of the Council for 1936 records interesting developments connected with educational work in Children’s Homes and Residential Schools. A special three-months course was arranged at the request of the National Children’s Homes, for the workers appointed to take charge of two new houses for nervous and difficult children. The Course comprised lectures, discussions and visits to places of interest and at the end of it, examination papers were set. Complying with another request, arising out of this course, the Council sent an experienced worker to a Home for Girls to observe and advise in cases of difficult children. The visit?which lasted a week?proved to be strikingly helpful, and by special request, it was followed up by a visit from a psychologist who tested the children with interesting and?to the staff?surprising results. The Council feels that this type of service might well be extended, and enquiries with regard to it are invited.
The Report contains a useful list of thirty-five Child Guidance Clinics represented 011 the Council. The eleven Clinics represented on the Scottish Child Guidance Council are also given.
Plans are in hand for a Course for members of the staffs of Children’s Homes and Residential Schools to be held in the Royal Pavilion, Brighton, from June 8th to 12th, 1937. The Fee for the Course is ?1 10s. Od. and it is estimated that hotel charges will be between 9/6 and 10/6 a day. Applications for admittance for the Course should be sent, before May 21st, to the Secretary, Child Guidance Council, Woburn House, Upper Woburn Place, W.C.I.
Progress in Huntingdonshire
The Huntingdonshire Education Authority, as the result of a Survey recently undertaken, has approved a scheme for the establishment of two classes for the forty-three retarded children who have been ascertained in the Ramsey District of the County, and for the appointment of a Visiting Teacher, with special experience, to give advice and help to teachers in the other areas in dealing m the ordinary elementary schools with the fifty-one retarded children found therein.
These children are to be given special training under the supervision of the Head Teacher, to consist largely of manual work, in accordance with a syllabus arranged and carried out with the advice of the visiting teacher. Any children whom it is found impossible to retain in the schools, even with special teaching, will be sent to Special Residential Schools outside the County.
For the twenty-five children in the County between the ages of five and sixteen who are under the Statutory supervision of the Mental Deficiency Acts Committee, a Home Teacher has been appointed who will visit and teach them in their own homes. This Scheme is being instituted not only for the obvious benefit it will bring to the defectives concerned, but also to gauge their character and capabilities by means of the close contact which will be kept with them.
It is anticipated that in this way useful information will be obtained as to the number of cases needing institutional care.
Scottish Association for Mental Welfare
The Scottish Association has recently published its Fourteenth Annual Report giving an account of the chief activities carried 011 by its Local Care Committees, of which there are now twenty-six. In addition to the After-Care visiting of children who have left Special Schools, a number of these Committees have instituted Occupation Centres and Clubs where much useful work is being carried ?n. The Mental Hygiene Committee of the Association has continued its propaganda campaign during the year, and public lectures have been arranged which have been widely advertised. Special efforts have been made to stimulate the formation of Child Guidance and Mental Treatment Clinics, and the Report contains a useful list of these, with particulars as to days and hours and the names of the physicians in charge.
Appended to the Report is an address on Mental Hygiene in Everyday Life given by Dr W. Harrowes at the Association’s Conference held in Dundee 011 October 9th, 1936.
The Secretary of the Association is Dr Constance P. H. Hunter, and its address, 25 Palmerston Place, Edinburgh.
Paisley’s Occupation Centre
Kersland House, a beautiful mansion with a conservatory and garden, has been left, under the will of the late Mr. Edward Cochran, to the Renfrewshire County Council for Mental Welfare and handed over by them to the Paisley and district Voluntary Committee for Mental Welfare for use as an Occupation and Employment Centre.
The children of the Occupation Centre numbering twenty-six were formerly taught for half a day in the premises of the Y.W.C.A. in the centre of the town. Now they attend Kersland daily from 9 a.m. till 3 p.m. and have a hot two-course dinner at mid-day. These children are taught personal hygiene, housewifery, baking and other useful home duties and are given exercises to increase their muscular control. Both boys and girls are trained to do handwork, ranging from bead stringing to embroidery, knitting and rug-making. Simple songs, dances and games are taught and great enthusiasm and interest is displayed in a percussion band. Gardening is also taught.
At present there are twenty-three names on the Employment Centre roll. This Centre is run for ex-pupils of the Special School who are unemployed or unemployable. A^arious handcrafts are undertaken by these boys and girls who are paid on the completion of their work. The older ” children ” attending this class will also do the work in the garden and will cultivate tomatoes and, plants in the conservatory.
The Education of M.D. Children in Fife
In the Annual Report of the Medical Officer of Health for the County Council of Fife, published recently, there is an interesting Appendix devoted to the subject of Special School Children?contributed by Dr R. A. Krause, Deputy County Medical Officer?which illustrates some of the difficulties met with by administrators in tackling this problem.
A popular agitation has been set on foot against the practice of sending children to Special Class Centres outside their own areas, a criticism largely engendered as a result of the transfer of a large number of children to centralised Special Classes in a comparatively short space of time, following on a Survey undertaken in 1934.
Dr Krause contends that to keep defectives in special classes in the ordinary schools is not a practicable policy; only in a large centre can proper grading be carried out, ” more efficient teaching is possible, satisfactory arrangements can be made for practical instruction and the teachers can discuss their difficulties and co-operate with each other.”
In recording a suggested compromise put forward?that the younger children should be retained in one or more special classes in their own area, and that the older ones (11 plus) should be centralised in a larger centre? Dr Krause doubts whether this would do much to allay the present discontent on the part of the parents as one of their main objections to special class instruction is the retention of the children after 14.
He emphasises the value of Special Class instruction beginning not later than the age of 8, and points out the desirability of borderline children with I.Q.’s between 70 and 80 being included in this special education. This measure would, he thinks, very considerably cut down adolescent delinquency, which so frequently results in children whose education has not been suited to their needs.
For the Coronation
The Secretary of the Ipswich Mental Welfare Association (Miss C. A. Woolston) sends the following account of hozv defectives in her area are playing their part in Coronation preparations.
Since 1922, a Basketry Occupation Centre has been open for lads and young men who by reason of mental defect have been unable to get employment in the ordinary labour market. Here hundreds of attractive saleable shopping baskets have been made and the workers have benefited by weekly allowances amounting in all to upwards of ?405. Owing’ to competition with cheap foreign-made goods, the Basketry trade at the present time cannot be called a profitable one. But this fact does not worry our workers, who are as pleased with a modest remuneration as with a big wage; they plod contentedly along, week by week, quite oblivious of the state of trade and happy in the thought that whether their output be small or great, they will receive the same allowance each Friday.
The Coronation has, however, opened up another temporary occupation for these young men, and also for the girls and women who, since 1922, have been attending a Sewing Class twice a week. By arrangement with a leading Store in the town, thirteen young men and eight women have been occupied daily in making floral decorations for the streets. Up to date, 62 strings of 27 yards each in length have been made and delivered. Each 27 yard length of rope is subdivided into foot lengths, on which are wired alternately large red, white and blue rosettes, the latter being waterproofed to withstand bad weather. All the girls and eight of the boys are employed in making the rosettes, and it takes them all their time to keep up a supply for the remainder of the boys who are affixing them to the rope, but the occupation goes happily forward. The workers, no less than their parents, are pleased to know they are helping in an activity of national importance, and are delighted with their augmented allowances resulting from it.
Association of Occupational Therapists
This Association has been formed during the last few months, with the following objects :?(a) to provide a central organisation for Occupational Therapists, both men and women, (b) To institute an examining board and issue certificates, (c) To encourage the employment of registered workers, (d) To educate public opinion to appreciate the necessity for Occupational Therapy in all hospitals and institutions, (e) To provide opportunity for members of the Association to meet for the purpose of exchanging views and attending lectures and demonstrations, (f) To establish and maintain, if desirable, a journal or newspaper in the interests of the Association.
Membership is limited to graduates of approved schools who have held a whole-time appointment as Occupational Therapists for not less than one year, and (until March 1st, 1939) to those who have never attended an approved school but who have had a minimum of four years’ practical experience of Occupational Therapy as a whole-time employee. Any persons interested in the subject who do not come within either of these categories may become associate members at the discretion of the Council.
Further information can be obtained from the Hon. Secretary, Association ?f Occupational Therapists, care of G. E. Holt and Son, Victoria House, Southampton Row, W.C.I.
Nottingham’s New Appointment
The Nottingham Education Committee have appointed Miss D. E. Carscallen, a graduate of Alberta University, and a certificated teacher, with a B.A.Honours Psychology degree of the University of London, to be Junior Assistant Psy chologist. Her main duties will be, under the supervision of and in co-operation with the Senior School Medical Officer and the Inspector of Schools, to assist in the ascertainment of feeble-minded children and in the assessment of retardation of other mentally abnormal or subnormal children in the schools. She will also be required to undertake special psychological treatment of children where this is indicated.
South Africa’s Need
In his Annual Report for the year 1935, recently published, the Commissionei for Mental Hygiene in the Union of South Africa (Dr William Russell) draws urgent attention to the increasingly difficult situation with regard to Mental Hospital accommodation.
Particularly in the Transvaal and Western Province is there grave overcrowding, the two Mental Hospitals serving these areas (at Pretoria and Valkenberg) being packed to capacity. Additional beds for Europeans have been ” squeezed into every available space in dormitories, day-rooms, and even passages”. In the non-European sections of these Hospitals, the congestion is so great that ” conditions in the dormitories at night are truly deplorable “. If these conditions continue, he warns the Government, ” the mental hospital service may fail to meet the requirements of the country during the next few months,” and he pleads for ” a more generous attitude to this essential social service”.
The establishment of a new Mental Hospital at Krugersdorp has been decided upon, but it is unlikely to be ready for patients until the end of 1939; extensions at existing institutions during the intervening period are, therefore, imperative.
An interesting comparison of the number of beds available for mental patients in the Union, as compared with those in other parts of the Empire, is given in this Report. Thus while in South Africa after authorised additions have been made there will be only 120 beds per 100,000 of the total population; in England and Wales there were in 1934, 401 beds per 100,000 ; in Scotland, 390; in New South Wales, 353, and in New Zealand, 445.
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