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IN THE MENTAL HOSPITAL
LETTERS TO THE EDITOR
IN THE MENTAL HOSPITAL
SiR,-It is regrettable that the first two paragraphs of Dr. Houston’s contribution last week to your " In the Mental Hospital " series should be so full of gross historical Such inaccuracies and fantastic misrepresentations. failings have not been absent from the other articles in this series, as your correspondence columns have indicated; and, in consequence, the whole series is losing much of its value in the minds of thoughtful and
experienced
readers.
The " lunacv reformer " with his very characteristic agitator’s mentality has been a constantly recurring feature of British psychiatry for many years past. Your contributors cannot, for example, be ignorant of the excitements of the early 1920s when the " Montagu Lomaxagitation was at its height. Dr. Houston would, I am sure, be sorry and surprised to know that his opening paragraph is similar in provocative tone to that author’s, though I am well aware that his motives and ideals are utterly different. It is true that the paragraph can be read as though the malpractices he describes belonged to the past. He continues, however, to say " at last a new era is dawning and the doors of despair are being unlocked." He- then proceeds to name certain excellent hospitals as leading the way in activities, most of which were flourishing vigorously in at least a majority of mental hospitals long .
before he was born. I shall not burden your columns by giving detailed facts in’support of that statement, which I could easily do ; but I think it is a pity that such able and enthusiastic workers as Dr. Houston and his fellow contributors have not familiarised themselves better with the history of their specialty and with the work of the real reformers in it, to whom both patients and, hospitals remain infinitely indebted. London, W.1.
HENRY YELLOWLEES.
THE FORGOTTEN PATIENT
SiR,—On Nov. 12 and 26 you published comments on my articles on the Forgotten Patient (Oct. 29 and Nov. 5). These articles were based on a wide knowledge of mental hospitals in England and Scotland, and I am certain that the faults of which I wrote are not confined to a hospital here and a hospital there but are widespread. Of course, it would be a bad region which had to admit that everything I said applied to all its mental hospitals, but probably there are few psychiatrists who would not agree that some of my statements are true for one or other of the hospitals in which they have worked. I will state the main reasons for which I wrote : 1. If things are wrong they should be corrected. 2. If bad things happen and are hidden, their occurrence should be made widely known. 3. A quiet acceptance of evils does little to ensure their termination. 4. The relations of a patient have the right to be told how he is treated and how he lives..
particular criticisms, I have no doubt that people with gross organic brain disease are improperly admitted to mental hospitals : in the usual good geriatric hospital they would overcome their restlessness within a few weeks. It is equally clear that many old people, whose psychotic illness or whose inadequacy in dealing with things has precipitated a breakdown in their confidence, are properly admitted to a mental hospital and are there restored to their normal health. I nfortunately they may not be equal to living alone in lodgings or flats and it is difficult to get anyone to accept a person from a mental hospital. If the word " drove " is thought too picturesque, I will willingly substitute another ; but this will not disguise the fact that large numbers of patients are Turning
many old
to
1193
improperly employed on hospital farms. On a farm the patient is not only out of sight but too often forgotten. He leaves the ward long before the doctor reaches it and only returns after the doctor has long since left it. By of his chronic illness and lack of initiative he is most unlikely to seek an interview with his doctor, and the latter may not seek one either. In theory he will be examined twice a year, but theory does not always agree
reason
with
practice.’
It is all very well for Mr. Sargood to speak so cheerfully about the work in his region. I too will say how good the good work is. But senior psychiatrists have willingly shown me bad things in their hospitals in the South West Metropolitan Region as they have done elsewhere. I am glad to hear that the majority of committee members perform their duties properly ; but negligence does occur, though again I would prefer not to particularise. Bracebridge Heath is fortunate to have so many Polish nurses and some Polish doctors :the opportunist will feel that this excellent staff for Poles might well solve the problem for all the mental hospitals in the Midlands ! But how often does this obtain throughout the country’? What of the hospital with three Poles, a Ukrainian, and a Yugoslav ? How will they muster a doctor and a nurse for each rationality’? Dr. Falla has argued from the particular to the general. No-one will deny that neurotics are often severely disabled by their illness ; but the ultimate test of disability is the necessity- for inpatient care, which must surely never, or almost never, be essential for a neurotic. I should be pleased to know what valuable work for psychotics is being done by mental-health organisations Is’their work predominantly for the neurotic or the psychotic’? There can be no doubt that a great deal of effort is made in every mental hospital to treat the patients. What varies is the point at which this effort ceases. In a few it never ceases. In some it may be years before the psychiatrist decides he must devote his limited time (I dealt with this last year) to more promising material. But in many it stops the moment the patient leaves the admission ward ; and in a few hospitals he never experiences any care because he -is admitted straight to- a chronic ward where no patient ever gets more than the most cursory attention. It is my contention that care ceases early rather than late. Mr. Sargood implies that I employ half-truths and that my pictures are painted in lurid colours ; Dr. Falla calls my descriptions exaggerated and distorted ; Dr. Duncan says that what I say is grossly misleading. I do not think that there is any need to defend myself. No-one has to do more than travel a little to see for himself. The only difference between these critics and myself is in our interpretation of facts, and this interpretation ultimately depends upon the difference in our sense of values. In. thejustified enthusiasm for the energetic treatment of recent admissions, one often hears the psychiatrist say what good work could be done for these patients if only he was not hampered by having to spend so much of his time looking after the chronic patients whom his predecessor had neglected. He will ask why these cannot be moved elsewhere and given the material necessities of life, so that he can, by his hard work on the present generation, prevent new admissions from ever becoming chronic. But, assuming that chronicity can be prevented by his energetic treatment-and I like to think that it can-this does nothing to solve our present problem, which is the restoration to health of the tens of thousands of chronic patients at present in our hospitals for whom the likelihood of a normal life seems remote indeed. I think that most relations of chronic psychotics will share my beliefs ; many psychiatrists evidently condemn them. The truth is most likely to come from the young nurse and the young psychiatrist. Miss Restell’s letter ’
IN THE MENTAL HOSPITAL
SiR,-It is regrettable that the first two paragraphs of Dr. Houston’s contribution last week to your " In the Mental Hospital " series should be so full of gross historical Such inaccuracies and fantastic misrepresentations. failings have not been absent from the other articles in this series, as your correspondence columns have indicated; and, in consequence, the whole series is losing much of its value in the minds of thoughtful and
experienced
readers.
The " lunacv reformer " with his very characteristic agitator’s mentality has been a constantly recurring feature of British psychiatry for many years past. Your contributors cannot, for example, be ignorant of the excitements of the early 1920s when the " Montagu Lomaxagitation was at its height. Dr. Houston would, I am sure, be sorry and surprised to know that his opening paragraph is similar in provocative tone to that author’s, though I am well aware that his motives and ideals are utterly different. It is true that the paragraph can be read as though the malpractices he describes belonged to the past. He continues, however, to say " at last a new era is dawning and the doors of despair are being unlocked." He- then proceeds to name certain excellent hospitals as leading the way in activities, most of which were flourishing vigorously in at least a majority of mental hospitals long .
before he was born. I shall not burden your columns by giving detailed facts in’support of that statement, which I could easily do ; but I think it is a pity that such able and enthusiastic workers as Dr. Houston and his fellow contributors have not familiarised themselves better with the history of their specialty and with the work of the real reformers in it, to whom both patients and, hospitals remain infinitely indebted. London, W.1.
HENRY YELLOWLEES.
THE FORGOTTEN PATIENT
SiR,—On Nov. 12 and 26 you published comments on my articles on the Forgotten Patient (Oct. 29 and Nov. 5). These articles were based on a wide knowledge of mental hospitals in England and Scotland, and I am certain that the faults of which I wrote are not confined to a hospital here and a hospital there but are widespread. Of course, it would be a bad region which had to admit that everything I said applied to all its mental hospitals, but probably there are few psychiatrists who would not agree that some of my statements are true for one or other of the hospitals in which they have worked. I will state the main reasons for which I wrote : 1. If things are wrong they should be corrected. 2. If bad things happen and are hidden, their occurrence should be made widely known. 3. A quiet acceptance of evils does little to ensure their termination. 4. The relations of a patient have the right to be told how he is treated and how he lives..
particular criticisms, I have no doubt that people with gross organic brain disease are improperly admitted to mental hospitals : in the usual good geriatric hospital they would overcome their restlessness within a few weeks. It is equally clear that many old people, whose psychotic illness or whose inadequacy in dealing with things has precipitated a breakdown in their confidence, are properly admitted to a mental hospital and are there restored to their normal health. I nfortunately they may not be equal to living alone in lodgings or flats and it is difficult to get anyone to accept a person from a mental hospital. If the word " drove " is thought too picturesque, I will willingly substitute another ; but this will not disguise the fact that large numbers of patients are Turning
many old
to
1193
improperly employed on hospital farms. On a farm the patient is not only out of sight but too often forgotten. He leaves the ward long before the doctor reaches it and only returns after the doctor has long since left it. By of his chronic illness and lack of initiative he is most unlikely to seek an interview with his doctor, and the latter may not seek one either. In theory he will be examined twice a year, but theory does not always agree
reason
with
practice.’
It is all very well for Mr. Sargood to speak so cheerfully about the work in his region. I too will say how good the good work is. But senior psychiatrists have willingly shown me bad things in their hospitals in the South West Metropolitan Region as they have done elsewhere. I am glad to hear that the majority of committee members perform their duties properly ; but negligence does occur, though again I would prefer not to particularise. Bracebridge Heath is fortunate to have so many Polish nurses and some Polish doctors :the opportunist will feel that this excellent staff for Poles might well solve the problem for all the mental hospitals in the Midlands ! But how often does this obtain throughout the country’? What of the hospital with three Poles, a Ukrainian, and a Yugoslav ? How will they muster a doctor and a nurse for each rationality’? Dr. Falla has argued from the particular to the general. No-one will deny that neurotics are often severely disabled by their illness ; but the ultimate test of disability is the necessity- for inpatient care, which must surely never, or almost never, be essential for a neurotic. I should be pleased to know what valuable work for psychotics is being done by mental-health organisations Is’their work predominantly for the neurotic or the psychotic’? There can be no doubt that a great deal of effort is made in every mental hospital to treat the patients. What varies is the point at which this effort ceases. In a few it never ceases. In some it may be years before the psychiatrist decides he must devote his limited time (I dealt with this last year) to more promising material. But in many it stops the moment the patient leaves the admission ward ; and in a few hospitals he never experiences any care because he -is admitted straight to- a chronic ward where no patient ever gets more than the most cursory attention. It is my contention that care ceases early rather than late. Mr. Sargood implies that I employ half-truths and that my pictures are painted in lurid colours ; Dr. Falla calls my descriptions exaggerated and distorted ; Dr. Duncan says that what I say is grossly misleading. I do not think that there is any need to defend myself. No-one has to do more than travel a little to see for himself. The only difference between these critics and myself is in our interpretation of facts, and this interpretation ultimately depends upon the difference in our sense of values. In. thejustified enthusiasm for the energetic treatment of recent admissions, one often hears the psychiatrist say what good work could be done for these patients if only he was not hampered by having to spend so much of his time looking after the chronic patients whom his predecessor had neglected. He will ask why these cannot be moved elsewhere and given the material necessities of life, so that he can, by his hard work on the present generation, prevent new admissions from ever becoming chronic. But, assuming that chronicity can be prevented by his energetic treatment-and I like to think that it can-this does nothing to solve our present problem, which is the restoration to health of the tens of thousands of chronic patients at present in our hospitals for whom the likelihood of a normal life seems remote indeed. I think that most relations of chronic psychotics will share my beliefs ; many psychiatrists evidently condemn them. The truth is most likely to come from the young nurse and the young psychiatrist. Miss Restell’s letter ’