Occupational Treatment of Mental Illness
- Author:
Iveson Russell, M.B., Ch.B.,
F.R.P.S., D.P.M., Med Supt. North Riding Mental Hospital. Bailliere, Tindal and Cox. pp. xvi, 231. 6/-.
For several years now, the occupation of patients in Mental Hospitals in this country (notably the North Riding at Clifton, the Cheshire County at Upton, the Cardiff City at Whitchurch and the Devon County at Exminster), has been organised on intensive lines and referred to as ” occupational therapy
Up to the present, however, no book has been published dealing exclusively with this subject, and therefore those who have introduced this line of treatment and others who are anxious to do so, will be glad to learn that this gap has been filled with the publication of the book ” Occupational Treatment of Mental Illness”.
The author, Dr J. 1. Russell, is Medical Superintendent of the North Riding Mental Hospital, Clifton, York, so well known as one of the pioneers in introducing ” Occupational Therapy ” in its true form into Mental Hospital routine in this country. This in itself should hallmark the book as one well worth perusal by the general public as well as by those more intimately associated with the care of the insane.
Dr Rees Thomas (one of the Commissioners of the Board of Control) who writes the Foreword, points out that the occupation of patients in mental hospitals in this country has been practised for one hundred years or so, but fails to draw the reader’s attention to the fact that this has been limited to willing patients, representing on an average about 30 per cent, of the total. This is a very different thing to what is meant to-day by ” occupational therapy ” in its true sense, as those who read this book will learn.
Indeed it will be seen that rather than simply allotting to congenial tasks those who want something to do, ” occupational therapy” means the creating of suitable occupations for those who have no inclination to do anything.
Dr Russell’s book, therefore, should do much to convince those who have taken no active steps to introduce Occupational Therapy, that it has great possibilities and is really worth while.
The book is divided into two Parts. Part I is Theoretical and comprises twelve chapters. Part II, consisting of eleven chapters, is Practical and?one might add? highly technical in some instances. Witli regard to Part I?the first three chapters deal with the objects and benefits of Occupational Therapy and the psychological and clinical types to be occupied. Herein it is pointed out that the Schizophrenic, in which introspection has become a habit, constitute the major part of the problem and that the Paranoic is the most difficult. As a rule the latter can only be occupied in activities which do not benefit the hospital in any way.
To those who make up their minds to introduce Occupational Therapy into their particular hospital, Dr Russell gives appropriate words of caution “not to be too ambitions to start with, and ever to remember the limitations of the patients as ivell as the equipment.”
To meet the various interests of patients, occupations are classified by Dr Russell into nine groups. Chapters 4 and 5 are devoted to the prescription and questions such as whether the patient shall be occupied in bed, in a ward class or at an occupation centre. The fact that ” Occupation can be started in new admissions much earlier than has formerly been done” and that ” suicidal patients need not be excluded provided there is proper supervision”, are pertinent remarks which it is hoped will be followed literally by those who read this book.
Chapter 6 describes details of the “habit training ” of stuperosed and faulty patients, and ” outdoor parties” are dealt with in Chapter 7.
The next three chapters are devoted to the formation of ” ward classes” amongst patients not fit to leave the ward (e.g., senile and cardiac cases, cripples and low grade mental defectives), and the organisation of classes of Swedish and Physical Drill. In this connection, Dr Russell advocates a properly equipped gymnasium and swimming bath for all Mental Hospitals in future. The last two chapters in Part I deal with accommodation, equipment, and the purchase of supplies. This is naturally one of the most important and responsible duties of anyone aspiring to the rank of “Occupational Officer” and should, of course, include a record of how the material has been used, and the disposal of all articles made. Part II is the Practical part of the book and includes chapters on Design, Woodwork,
Basketry, Brush Making, Mat Making, Printing and Bookbinding. Concrete and Plastic Modelling, Weaving, etc. As has already been stated, much of this is highly technical (specific to each section) and only of interest to those who make that particular subject their speciality. Indeed one cannot help feeling that matters such as the selection and storage of timber and much other detail mentioned in Chapter 14, are definitely outside the province of ” Occupation Therapy” as applicable to a nurse in a Mental Hospital and pertain rather to the Clerk of the Works. Occupation Therapy in no sense means the teaching of a trade to patients in the way that is done in a Colony for Mental Defectives. We repeat that it cannot be too strongly emphasised that its object is to give the patient something to do, and the consideration of whether the article made is of any value should not enter into the question. In fact, it is quite likely that the more strictly the occupation fulfils its main object, the worse the results will be in the value of the finished product!
In the chapter dealing with Brush Making, one finds the remark that the object should be “not to produce the greatest number in the least possible time, as any business firm ivould do, but on the other hand to avoid the use of machinery and make them in a zt’ay which, if adopted in the trade, would soon bring the firm to bankruptcy” e.g. ” quite an hour can be spent by one patient making a scrubbing brush which can be bought in the market for 2d.” With this we are thoroughly in agreement.
The writer of this book is tilling virgin soil and therefore one naturally hesitates to criticise it at all. It is hoped, however, that the one or two criticisms which have been made here will be received in the friendly spirit in which they are given. Indeed one can only admire and recommend a work which strikes a new avenue of approach to the treatment of cases of mental disorder. The book is well produced with a reference index and several helpful photographs and diagrams as well as a useful plan and elevation of an ” occupational centre It also contains a valuable list of the names of firms from which suitable supplies can be obtained. It should prove invaluable?not only to those working for special examinations in the subject, but to every member of the staff of a Mental Hospital who wishes to keep abreast of the times. R. E.
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