Course for Supervisors of Occupation Centres & Institution Staff
The C.A.M.W.’s annual three weeks’ Course for Supervisors and Institution Staffs, originally announced for July, has been postponed till the autumn.
It will now be held [in London] from October 23rd to November 11th, and it will be non-residential. The fact that during this period the theoretical and specialised section of the Year’s Course for Occupation Centre workers and Home Teachers will be in process, will make it possible for the students to take advantage of some of its lectures and classes in addition to those arranged for them separately.
Staffordshire Study Week
The Staffordshire Association for Mental Welfare are again arranging a Study Week for those engaged in the teaching of mental defectives in Institutions, Occupation Centres, Special Schools and Classes for backward children.
The Course will be held from Monday, 2nd October, to Friday, 6th October, 1939.
It will include lectures on the medical aspect of mental deficiency, delinquency and treatment of difficult children, and on the functions of the social worker, and there will be demonstrations and practical work in physical education. Practical classes in handwork and needlework will be held, and opportunities will be given for discussion in study groups.
Full information can be obtained from: The Organiser of Centres, Crabbery Chambers, Crabbery Street, Stafford.
The Burden Neurological Institute
On May 12th, Sir Thomas Inskip opened the new Neurological Institute in the grounds of Stoke Park Colony, endowed by Mrs. R. G. Burden. The purpose of the Institute is ” Research into the bodily substratum of mental diseases by the long and intensive study of a small number of cases.” Epilepsy will be one of the first problems to be attacked, and one of the two observation wards will be reserved for epileptics.
The management of the Institute is in the hands of an autonomous committee under the chairmanship of Sir Laurence Brock, and its work will be directed by Professor F. L. Golla.
The equipment includes a theatre for brain surgery and a special radiographic unit devised by Lysholm, of Sweden.
Board of Control
The Board of Control, with the approval of the Minister of Health, have appointed Mr. T. R. Forsythe, M.B., Ch.B., D.P.M., Deputy Medical Superintendent of the Kent County Mental Hospital, Maidstone, to be a Commissioner to fill the vacancy caused by the appointment of Mr. A. E. Evans, M.B., D.P.H., as a Chancery Visitor.
Lay Psychotherapists and the British Medical Association
Last year, it may be remembered, the British Medical Association appointed a special committee to “inquire and report upon the present medical equipment for dealing with mental health in this country, with particular reference to the treatment and prophylaxis of the psychoneurotic and allied disorders.” The Committee’s deliberations still continue, but their recommendations on the subject of the employment of lay psychotherapists have been embodied in the Association’s Annual Report, permission to quote from which has been kindly given us by the Secretary.
Prolonged consideration has been given to this matter, particularly to that part of it which is concerned with the functions of the clergy in regard to psychological treatment. Evidence has been received from individual clergymen, Protestant and Catholic, and it has been submitted that it is desirable that they should be trained in medical psychology so that they may be able ” not only to recognize cases which require psycho-therapeutic treatment rather than moral or spiritual direction, but also to resolve the mental conflicts of the normal individual which otherwise might develop into psychoneurotic disorder.” It has also been suggested that the clergy should co-operate with the medical profession” in undertaking the treatment of mental disorders which have their roots in religious problems,” in so far as no cure can be complete until the patient has achieved a new spiritual adjustment.
The Council ” see no reason why the medical profession should not cooperate in the instruction of the clergy in the principles of medical psychology,” but do not accept the view that ” the clergy should undertake sole responsibility for the treatment of cases which have a psychiatric symptomatology but which raise ethical or spiritual issues,” although they agree that there may be some cases which could usefully be referred by medical practitioners for spiritual direction.
With regard to the practice of psychotherapy by lay practioners, the Council have agreed that, in view of the present shortage of practitioners who have received medical training, such practice should be recognised under certain conditions.
The Council’s recommendations are as follows :? A. That the Representative Body approve the following principles: I. No lay psychotherapist should undertake treatment unless : (i) The patient has been recommended to him by a registered medical practitioner, or has had his case investigated by such a practitioner at the request of the lay psychotherapist. (ii) The lay psychotherapist has undergone a prescribed and approved course of training. II. No medical practitioner should recommend a patient to a lay psychotherapist unless: (i) The medical practitioner is himself a specialist in psychological medicine, or has referred the case to such a specialist. (ii) The medical practitioner has satisfied himself that the lay psychotherapist has undergone a prescribed and approved course of training. III. Where treatment is undertaken by a medical practitioner and a lay psychotherapist in co-operation, the responsibility for the case should lie with the medical practitioner and there should be consultation from time to time between the medical practitioner and the lay psychotherapist.
B. That the Representative Body expresses the opinion that lay psychotherapists should undergo a special training of at least 2 years’ duration on the basis of a curriculum to be agreed upon by the responsible bodies: and that the Association take the initiative in putting machinery in motion for the establishment of approved courses of training.
It is not yet known whether these recommendations on so highly controversial a subject will be adopted as the policy of the Association, but they are to be considered by the Representative Body at a meeting to be held during July.
A Physician’s Philosophy
In view of the issues raised by the British Medical Association’s Committee on Mental Health referred to above, the following reflections of the Physician-Superintendent of the Crichton Royal Institution, Dumfries, in his Annual Report for 1938, would seem to be particularly opportune:? ” In the practice of psychiatry, and particularly in dealing with the permanently afflicted, it appears to me that a philosophy of medicine, guiding principles to the understanding and treatment of disease, is not enough; equally important is a philo.sophy of life, an appreciation of the ultimate values of the universe. Our choice is between realism and idealism. In this materialistic age in which applied science has played such a prominent part, it is probably not surprising that alike in philosophy, literature and art, realism holds .sway; … The world as we know it, … finite things in time and space, life and death on this earth, we are told that these are the only realities. They exist in their own right, with nothing behind them, nothing supporting them. Such a philosophy, with its neglect of aesthetic and moral values, religious experiences and intuitions, makes life seem particularly purpo.seless, if one lives amongst those whose world of sight and hearing is extremely individualistic and different from one’s own… . The psychoses become particularly tragic if one must believe that the false beliefs of our patients deal with the ultimate realities of life.”
After suggesting that, once a creed of idealism is accepted, a fundamental change of attitude to the psychotic patient follows, Dr McCowan continues: “… . while it may not be the duty of the physician to discuss religion or philo.sophy with his patients, there are many, particularly of our neurotic patients, in whom discussion, and if need be, guidance on these subjects, is an essential part of treatment, if real integration of their personality is to be achieved. Again, his philosophy may well affect the attitude of the psychiatrist towards the incurable p.sychotic. To the realist, the incurable psychotic in an individual who may well be looked after as a matter of routine or even of interest, but scarcely as a worth-while human being. To the idealist, on the other hand, the psychotic does not differ from the physically ill patient: he is a human being who is doubtless fulfilling the purpose of the divine reality behind the scene as well a>s is the physician himself. Surely such a difference in attitude must tend to a difference in treatment.”
Psycho-Analysis in Norway
We learn from the Lancet, 20th May, 1939, that in Norway a Government order has recently been made restricting the employment of psycho-analytical methods of examination and treatment, to doctors who are specially authorised by the Department for Social Affairs, and prohibiting the use of such methods by foreign medical men without special permission from the Crown.
In this measure, ” psycho-analysis ” is defined as:
” any examination or treatment which is continued regularly for a considerable time, and whose object is to clarify, interpret, or otherwise influence unconscious mental processes.”
Tavistock Clinic (Institute of Medical Psychology)* It is disappointing to read in the Report of the Tavistock Clinic for 1938, that the site acquired for the erection of an In-Patients’ Hospital has had to be sold, owing to lack of funds. A more modest plan for the provision of beds and facilities for treatment, research and teaching, has been substituted, but about the materialisation of even this plan the Report speaks guardedly and there is no indication of its certain fulfilment.
The urgent necessity for expansion is shown by the fact that at the end of the year under review, there was a long waiting list of 480 children and adults accepted for treatment. The total number of new cases treated was 1,071 in comparison with 1,133 in 1937.
The Director of Studies reports that in addition to the training of doctors for specialisation in psychotherapy, provision is made for the instruction of general practitioners and the number of medical officers from mental hospitals who take courses of training has increased. Amongst the lectures given to lay students was a series on problems of delinquency specially for magistrates, 34 of whom attended.
The work of the Research Department during the year included a ” FollowUp ” of 104 cases of adults treated for delinquency or potential delinquency, and the completion of the investigation of the present position with regard to 500 cases of children treated between 1921 and 1924. Of the first group (adult delinquents) 55.8% were recorded as ” Relieved” after a period of 3 years or longer; of the second group (children) improvement in the condition for which treatment was originally given was, after a similar period, still present in 77% of cases.
The endowed research of the Clinic has continued to be concentrated on ” disorders in which it has long been suspected that a source of the pathological structural changes concerned, might be found in the prolonged disturbances of bodily function which accompany the chronic emotional states of certain psychological types.”
In the spring of 1938, Sir Henry Brackenbury retired from the Chairmanship of the Council, after 8 years’ service, and his place was taken by Lord Alness.
Malet Place, London, W.C.I,
Colchester, one of the many interesting sections is that devoted to the subject of ” Licence.”
Dr Turner reminds us that, so far as he knows, his Institution was the first to use this method of dealing with defectives and it is mentioned in a Report as long ago as 1866. Then it fell into abeyance and was not revived until 1919. On January 1st, 1939, the number on licence amounted to 17% of the total number of patients on the books, and it increases every year. In reviewing the situation from the standpoint of his long experience, Dr Turner writes that he isconvinced of two things ” :?
” One is that Institution care is neither required, nor de.sirable, for all defectives even if it could be provided, but I would lay even greater stress on the importance of sending many more defectives than come now to institutions for training and stabilisation, so that they may successfully return to the world again.”
” The second is, that of all forms of extra institutional care, licence, because of its elasticity, is far and away the most advantageous both to the patient and the community. The institution is and should be, for a far larger number of patients, a treatment centre for arresting and ultimately overcoming the difficulties reflected in the failure of the subnormal person to get along satisfactorily in the environment to which he belongs. The Institution will therefore always be lo.sing its best patients and having to keep the most dependent and least adjusted. All the older Institutions were founded with the ideal that they could educate and train the defective, so that he should return to the world. They were intended to be run as schools and not as custodial institutions.” “… . later, chiefly from the United States, came a wave of fear that the defective would so increase in numbers that the burden would be insupportable. Thi.s brought in its train the idea of permanent care to prevent breeding. Fortunately now, that wave of fear has been banished amongst thinking people. We all now accept licence as a normal proceeding.”
Dr Turner recommends that girls sent on licence to domestic service should be placed near the Institution, as he thinks that it is essential to maintain close contact and that the friendly visits paid to the Matron and the opportunity of help and advice given by them, make all the difference between success and failure. Of the 31 girls in ” living-in ” service at the time of writing the Report, all but 4 were within bus rides of one or other of the Institution Hostel Branches.
It is interesting to read that out of all the girls sent out on licence since 1919 (the exact number is not given, but it is stated that it amounts to ” some hundred”), only 4 have returned to the institution on account of pregnancy. During the year under review, 96 out of the 191 cases on licence had to return to the Institution, but most of these returns were temporary and part of the normal working of the system, and were not due to failure.
A Danish Tribute to an English M.D. Colony Readers of ” Mental Welfare ” may remember that some time ago an article was published on the methods of training low-grade defectives used at Bridge Home, Witham?a branch of the Royal Eastern Counties Institution. In a Danish paper, Dr Gunnar Wad, Medical Superintendent of the Ostifternes Aandsvageanstalt Institution, Ebberodgaard, draws attention to this article from which he quotes at length, and in describing a personal visit to Bridge Home he pays the following tribute to the work and to the man (Dr FitzGerald) to whom its initiation and success is largely due:? “The impression of this institution on me,” Dr Gunnar Wad writes, “was overwhelming and unforgettable. I had seen a number of other institutions in England where medium and high-grade defectives were treated by methods which only differed very slightly from what we do here at home. This wa.s, on the other hand, something quite new for me, something which I would not have thought possible if I had not seen it.”
” For the first time in my life I gained an understanding of the just claims of low-grade defectives, not alone to nursing, but also to occupation and education, and in a manner which made them a part of human society. In this institution, thanks to all the work carried out, a greater fund of human happiness is found than I have seen in a corresponding place elsewhere… .” “A few things are still for me inexplicable. I cannot understand how one can keep all patients employed, even the most excited, nor can I understand how one can in every case avoid using muffs, etc. I can only answer my own and the questions of others, by saying ‘ I have seen it with my own eyes.’ ” In attempting to ” explain the inexplicable,” Dr Wad suggests that there is only one way of doing it, viz., by attributing what has been achieved to a medical superintendent who is ” in possession of a special gift to inspire his staff, combined with enterprise, inventiveness and a feeling for and understanding of the defectives far above the ordinary.”
Mental Health Emergency Committee
The work of the Mental Health Emergency Committee continues along the lines indicated in our April number.
Its latest activity has been to approach all the Directors of Education and School Medical Officers, County and County Borough Medical Officers of Health, the Visiting Committees of Mental Hospitals, as well as Mental Deficiency Committees throughout England and Wales, with offers of assistance towards securing the help of educational psychologists and social workers skilled in dealing with cases of emotional disturbance both in adults and children if and when an emergency arises. A number of Local Authorities are already giving sympathetic consideration to the problems involved, and it is felt that the Committee’s rapidly growing Register of Salaried Full-Time Social Workers in the Mental Health field should prove of great practical help towards their solution.
Leicester Mental Hospital
A copy of The Patients’ Magazine, which is edited, printed, bound, published and contributed to, entirely by patients of this Hospital, has reached us, and we are glad to draw attention to a venture which should be more widely known.
The magazine is issued quarterly, and is now in its 16th volume. It is attractively produced and its spirited accounts of Hospital activities give the impression of the existence of a real ” esprit de corps.” Illustrations of various Hospital ” Functions” add to the interest of this gallant little periodical.
Child Guidance Council
In its Report for 1938, the Child Guidance Council draws attention to the widening conception of the province of ” Child Guidance ” which is beginning to be extended to the maternity and child welfare centre and to be accepted as a department of public health administration. In the Islington and Marylebone Centres, e.g., the work done by Dr Mildred Creak and Dr Grace Calver has resulted in the recognition and treatment of personality problems at a very early age, and has opened out avenues of enquiry offering great promise.
There are now 54 Child Guidance Clinics in Great Britain recognised by the Council (a list of these is given in the Report) of which 16 are wholly maintained by Local Authorities. 10 Clinics are partially so maintained, and the remaining 28 are independent voluntary clinics, or clinics functioning as out-patient departments of voluntary hospitals or education departments of Universities.
The Council announce the following forthcoming activities :? Year’s Course of Training for Staffs of Children’s Homes and Residential Schools: This Course, arranged at the Battersea Polytechnic, in co-operation with the Child Guidance Council, begins on September 18th, 1939. The Course is a full-time non-residential one, open to men and women.
It will be adapted to the special needs of the individual student and will include instructions and practical demonstrations in some or all of the following: Physiology, hygiene, normal psychology, and care of difficult and nervous children, home nursing and/or first aid handicrafts and household repairs, household management including cookery and dietetics, physical training, mothercraft and/or catering and simple book-keeping. It will include observation visits to Maternity and Child Welfare Centres, Nursery Schools, Play Centres, Child Guidance Clinics, and a wide variety of Homes and of Day and Residential Schools. In addition, a certain number of sessions will be devoted to actual work with children of different ages.
Further particulars can be obtained from the Principal, Battersea Polytechnic, London, S.W.ll. Course of Lectures at Newcastle A Course of Lectures on the ” Understanding and Management of Children ” for staffs of Children’s Homes and Residential Schools, will be held at Newcastle-on-Tyne, from October 9th to 15th. Fee, ?1 Is. 0dv payable in advance.
For preliminary notice and syllabus apply to the Secretary, Child Guidance Council, Woburn House, Upper Woburn Place, London, W.C.I. Institute for the Scientific Treatment of Delinquency The Institute’s Annual Report for 1938 records a year of great expansion and development made possible by generous financial assistance received and by the facilities provided, as a result of the move to new premises, at 8 Portman Street, W.l.
During the year, 166 new patients were seen, of whom 42 were treated. The total number of patients treated (old and new cases) was 106, and at the end of the year 26 were on the waiting list for treatment. In 48 other cases, advice was given without the patient being seen. An increase in the number of cases referred by Courts is noted, viz., 106 as against 92 the previous year.
In 1938 (to give some examples of ” Discharges and Disposals ” as analysed in the Report) 7 cases were discharged as ” cured,” i.e., as those in which ” some fundamental cause of the delinquency has been discovered and treated satisfactorily “; 26 were discharged as ” improved ” ; 23 were referred to other institutions; 24 were not suitable for psychological treatment, and 33 refused it. The largest diagnostic groups amongst the 166 new cases referred, were the “character cases” (56) and those classified as “psychoneurotic” (53). A table giving the types of offences for which patients were referred, gives the largest group as “Theft” (76), with “Sex Cases” (46) coming next in the list.
The Institute’s educational activities are increasing and a Week-end Lecture Course for Doctors was an innovation during the year. Another development in this branch of its work was the recognition of the Institute by the University of London as a centre for Extension Lectures, and in the autumn 57 students enrolled for a course of 24 lectures on ” Social Psychology,” forming part of the four-vear course for the University Diploma in Social Studies designed primarily for social workers and probation officers. Special M.D. Schools in 1938
In the Board of Education’s Report for 1938, the following statistics are given in regard to Special M.D. Schools :? Residential Day Schools Schools Maintained by Local Education Authorities … 134 _ … 11 Maintained by Non-Local Education Authorities ? … 10 Total 134 … 21 The total accommodation in these Schools, on March 31st, 1938, was 16,375 (of which 4,246 was in schools maintained by the London County Council). This shows an actual decrease of 32 on the figures of the preceding year. Report on the Voluntary Mental Health Services The final meeting of the Committee presided over by the Earl of Feversham, which for the past three years has been considering the position of the Voluntary Mental Health Services, was held on June 9th. It is hoped that the Committee’s Report will be available within the next few weeks, and in our October issue, first place will be given to it. The price of the Report will, we are informed, be 2/6. Copies will be obtainable from the office of the Feversham Committee, 47 Whitehall, and from the C.A.M.W., 24 Buckingham Palace Road, S.W.I, or they can be ordered through any bookseller.
Scottish Training Week
Under the Mental Deficiency Section of the Scottish Association for Mental Hygiene, a training week will be held in Glasgow from 9th to 13th October, 1939, for those engaged in nursing-care, teaching or visiting of ineducable children and adults, other than helpless ones. Lectures and practical work will cover most kinds of activity suitable for Occupation Centres, and visits will be paid to Centres in session, day and resident. The number of students will be limited, but anyone interested can receive particulars from Dr Constance Hunter, Secretary, S.A.M.H., 23 Eglinton Crescent, Edinburgh.
South African Council for Mental Hygiene
In our last issue, we reported the opening of two Occupation Centres in Johannesburg, under the auspices of the South African Council for Mental Hygiene.
As we go to press, further news reaches us from the Secretary, Mrs. Netta Levine, who reports that the Government have now recognised the Centre, and a grant not exceeding ?250 per annum is to be made towards its maintenance by the Social Welfare Department. A second class is therefore to be started shortly, and plans are being considered for beginning the work also in Cape Town.
The Council is hoping shortly to open a Hostel for stabilised feeble-minded male patients from institutions in whose case home conditions make discharge on leave impossible. In this venture also, the Department of Mental Hygiene is giving its support by a subsidy of a per capita grant of ?3 10s. per annum. It is proposed to limit the number of patients received to 16, in order that conditions may approximate as far as possible to a normal home. The underlying idea of the scheme is to re-establish these patients in community life, and when they are fully re-orientated and have proved themselves capable of earning their own living, to obtain their discharge from the provisions of the Act.
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