Priorities the Way Ahead
- Author:
Derek Russell Davis
Some of the fervour with which Adolf Meyer championed the mental-hygiene movement in the United States in the 1920s came from his feeling that he had failed to anticipate, and take steps to prevent, his widowed mother’s second illness. She had become deeply depressed when he left Switzerland to make a career in America. She broke down again two days after her younger son’s marriage to a foreign girl. Many such illnesses could be prevented, Meyer argued, if families knew more about the conditions in which mental illness is liable to occur.
What ought people who are aware of the issues be doing now to help prevent mental illness? Young people especially want answers to this question. Tell us, they say, what we can do to counter the tragedies arising from drugs, drink, delinquency, depression, dropping out. Mind has been giving answers piecemeal. In this the last edition a more general statement is called for, a broad look at preventive measures.
Educating in the humanities
We must try to ensure that the main purpose of education (in schools and colleges and through the mass media) is to help people to discover what it means to be ‘incorrigibly human’ and recognise their common humanity - ie, identify - with others. The danger is, as it always has been, that the emphasis is placed on the acquisition of the knowledge and skills which equip successful students for an elitist position ? in society. The humanities rightly taught - history, literature, drama and the arts traditionally - bring people together in an understanding of one another. Technology as well as the natural and social sciences can be taught as humanities if the stress is laid on the part they play in meeting human needs and aspirations.
Teaching on mental hygiene
Much has been learnt since Meyer’s day about the f conditions affecting the development of behaviour in childhood and adolescence - especially social behaviour and the formation of identity. We also know more about the dynamics of families, the ‘support systems’ of families, the crises (or ‘psycho-social transitions’) which individuals and families go through, and about what goes wrong, and when and in what circumstances. Teaching on these subjects goes down very well in schools, and should be part of the ordinary curriculum. Yet professional mental-health workers often seem reluctant to share their knowledge and experience with young people or with the man in the street. When they are prepared to do so, they tend to confuse by speaking in the terms of an esoteric RoyalCollege psychiatry.
,? I s I o H umanit ies I r l L-A’’) Mif The humanities bring people together’ Supporting support systems Members of families look after each other. Nuclear families are supported by extended families Grannies in particular serve as arbiters and as marriage- and child-guidance counsellors. Individuals are supported by friends and neighbours, as well as relatives, and have relationships in other contexts as well: school, work-place, trade or profession, church, leisure-time society, club or pub. Also in supporting roles are the various caring organisations: church, Samaritans, voluntary groups, etc.
The mental illness of an individual usually reflects a disorder affecting the whole family which is relieved, more or less satisfactorily, when dynamic changes have taken place within the family. Resorting to professional advice or other help outside the family happens when the family becomes unable to cope. Admission to hospital, which may become necessary when support systems are beginning to break down, may lead to further weakening of them. Professional treatment lies, at least in part, in the support of existing support systems, to which lay counsellors also add strength.
Spreading counselling skills
The techniques of counselling are easily learnt and can be exercised by any sensible, sensitive person capable of ‘non-possessive warmth, genuineness and accurate empathic understanding’. They need not be restricted to graduates with special training. The objectives of counselling are to restore a person’s confidence in himself and others, to help him define for himself the problems facing him and to decide how to deal with them. Counsellors are needed in every sphere: schools, colleges, factories, offices, clubs, etc. Teachers, clergy, personnel officers, Samaritans, social workers in voluntary agencies, wardens of hostels, youth leaders and other providers of care can make an important contribution to support systems. They are more effective as preventers of illness when they have ready access to advice from professionals. A greater proportion of the time of professionals in the future should be devoted to consultation with counsellors and other care-givers. Preserving communities
Housing policies, transport policies, policies affecting the mobility of workers and all other social changes must be measured in terms of their effects on families and communities. There is plenty of evidence to suggest that the disruption of communities by rehousing or urban planning may have serious effects on the functioning of extended families and support systems, with consequent increases in mental illness. We must do more research into these effects in order to be able to do more to avoid or counteract them. ‘Grannies in support’
Intervening at times of crisis
Mental illness is liable to arise out of a crisis for an individual or a family. An example of such a crisis is the actual or impending loss (through death or in some other way) of a key person. Meyer’s mother feared that she would be losing her son. Meyer realised too late that her letters had become less frequent and had hidden her feelings. In cases like this, and in crises of other kinds, help can be given relatively easily if the need is recognised. Much more difficult are the crises of adolescence associated with leaving school, starting a job or embarking on a career, emancipating from parents, creating a new pattern of relationships and the first affair - the ‘crisis of intimacy’. Young people are highly vulnerable during these years. This is the age at which they are liable to become alienated from parents and other adults, to champion anarchy or revolution and to start to misuse alcohol and drugs. Intervention is far from easy.
Helping adolescents
We should look more closely at what schools are doing to prepare young people for the crises of the middle teens. Perhaps this deserves a higher priority, in which case more would have to be left for the further education system to do in training for jobs to meet the changing demands of industry and commerce. Career guidance could be more realistic. More could be done to help young people at special risk because of their identity problems. However, it may be that we should develop new methods outside the schools to provide help and prevent illness during the adolescent years. This is an area for more experiments.
Bringing the alienated back into the community The people most at risk are those who, having broken their ties with relatives and old friends, do not form new, stable relationships with others. They are liable to become alienated altogether or to adopt a life-style which keeps them out of close relationships. Some go to sea. Some become vagrants at home or abroad.
Some make superficial relationships through membership of a commune, a drug sub-culture or a squatters group. Some find solace in bars and clubs on the fringes of society. Some take to crime. We should not be too concerned if young people spend a year or two in the wilderness ? getting them back is the problem. Many of the more severely alienated of the last generation arrived, by various routes, into mental hospitals where they tended to be labelled as schizophrenic. This way of providing care is no longer possible - even if it were satisfactory, which it is not for it tends to perpetuate alienation. We have yet to find new ways of bringing the alienated back into the community. This is likely to be the most important challenge to be faced by mental-health workers during the next decade. The new ways will not be ‘medical’ in the narrow sense in which this word has been used in the past, but the job to be done is one of healing, ie, restoring the capacity to function as a whole person. Something of what this involves will be understood by . a public which is educated in the humanities. ‘More realistic career guidance’ ‘uopuoi ??u?#iaa OC.j SUSirtSIO 3111 U008 rrrgr ‘A drug sub-culture’
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