- Email: [email protected]
THE MIND IN UNEMPLOYMENT
311
invalidism may be understandable responses to environment and not merely the expression of a habitual antisocial attitude or of a psychopathic personality. The situation is not dissimilar from that which obtained during the late war, with its prolonged and almost intolerable stresses to which many proved unable to adapt themselves. The present troubles may be less terrifying and less violent than those of war, but they are, for the continuously unemployed, insistent and without abatement or lull; they occur in the setting of daily life and are associated with subtle but wounding conflicts within the family. A morose irritability or a gloomy resentment is often visited upon the immediate relatives though it is primarily directed against the social conditions which have created their insecurity and misery. The psychological play in such a situation is not far to seek ;a it is described very simply in Dr. PRATT’S brochure. The manner in which the social worker or administrator of material relief can take a part in diminishing these evil effects of unemployment is, as Dr. PRATT points out, more a question of his or her habit of mind and freedom from emotional entanglement than of any active interference. Where interference is required it will generally be in the presence of deviations from health so severe as to require psychiatric attention. But the great mass of depression, suspicion, and resentment which is the fruit of unemployment will yield in some measure or a
z
THE LANCET
LONDON:SATURDAY, FEBRUARY 11, 1933
THE MIND IN UNEMPLOYMENT AMONG the evils which unemployment brings
in
its train none is more alarming than impairment of mental health in the workless population. Something has been done of late in this country to counteract such influences by the provision of training centres, opportunities of recreation and physical exercise, organisation of unremunerative but satisfying work, and other schemes, such as those initiated by the Society of Friends. But there has been little precise information available about the form of ill-health chiefly found among the unemployed, or about the circumstances in which it is most likely to develop. Some studies that are now being carried out on a London group of unemployed suggest that neuroses are seldom found where there has not previously been evidence of a definite disposition to such disorders in response to any social or individual stress. It is not only in the form of well-defined neuroses, however, that the results of enforced idleness manifest themselves. There are numerous less obtrusive deviations from the normal balance of the personality that are the almost inevitable outcome of insecurity, dependThese ence, and lack of satisfying occupation. deviations may most strikingly be encountered where occupation had previously been constant rather than casual, and there had therefore been greater security ; where, moreover, the work had made sufficient demands on the capacity of the worker to afford him grounds for a feeling of worth and adequacy. In a valuable pamphletjust issued by the National Committee for Mental Hygiene in the United States, Dr. GEORGE PRATT sets out the responses to economic adversity which are most frequently found, and the means by which they may be combated. It is addressed not so much to physicians, who may be called on to deal with definite mental disorder, as to social workers, nurses, and those who administer relief on official or voluntary bodies. They it is who are daily in contact with hitherto normal and on the whole contented people who are now unwillingly obliged to change the habits of their lives, and are deprived of their usual outlets and means of satisfaction. Where there is danger of a gradual deterioration of morale and the development of apathy, despair, self-pity, or resentment among the unemployed, it is necessary that those who attend to their material needs should also take into account those psychological factors which are of the utmost importance for the future. They must recognise that truculence
changed
to
sympathetic (not sentimental) understanding,
and sometimes to advice. The part of the general practitioner in providing such mental hygiene is difficult to over-estimate. But equally important, however, are those measures for which the community, rather than individuals, must be responsible, and which provide means of occupation and recreation, thus keeping alive self-respect and preventing a corroding dissatisfaction. It will, in most cases, be imperative that these activities should be begun by outside agencies, rather than by those who will benefit from them, for in the sufferers initiative has often become weak after months or even years of unemployment, and there will have been little or no preparation for the use of a leisure that may be unwelcome and turn to taedium. The spread of schemes for dealing with the mental problems of the unemployed is a sign in this country.
hopeful
THE PATHOLOGY OF APPENDICITIS Accute
appendicitis
is one of the most common
and dangerous of the surgical emergencies, and there
and dangerous of the surgical emergencies, and there is a good deal of evidence that mild attacks of inflammation of the appendix occur much more frequently than is generally supposed. Our knowledge of the exact pathology and setiology of the disease is, however, far from complete, and any serious contribution to their elucidation is to be Prof. L. ASCHOFF has long been welcomed. interested in appendicitis ; he wrote a monograph Morale. The Mental Hygiene of Unemployment. By George on the subject as long ago as 1908, and his views K. Pratt, M.D. The National Committee for Mental Hygiene, on the pathology of the disease are now well known. New York. 1933. Pp. 64. $0.25. 1
invalidism may be understandable responses to environment and not merely the expression of a habitual antisocial attitude or of a psychopathic personality. The situation is not dissimilar from that which obtained during the late war, with its prolonged and almost intolerable stresses to which many proved unable to adapt themselves. The present troubles may be less terrifying and less violent than those of war, but they are, for the continuously unemployed, insistent and without abatement or lull; they occur in the setting of daily life and are associated with subtle but wounding conflicts within the family. A morose irritability or a gloomy resentment is often visited upon the immediate relatives though it is primarily directed against the social conditions which have created their insecurity and misery. The psychological play in such a situation is not far to seek ;a it is described very simply in Dr. PRATT’S brochure. The manner in which the social worker or administrator of material relief can take a part in diminishing these evil effects of unemployment is, as Dr. PRATT points out, more a question of his or her habit of mind and freedom from emotional entanglement than of any active interference. Where interference is required it will generally be in the presence of deviations from health so severe as to require psychiatric attention. But the great mass of depression, suspicion, and resentment which is the fruit of unemployment will yield in some measure or a
z
THE LANCET
LONDON:SATURDAY, FEBRUARY 11, 1933
THE MIND IN UNEMPLOYMENT AMONG the evils which unemployment brings
in
its train none is more alarming than impairment of mental health in the workless population. Something has been done of late in this country to counteract such influences by the provision of training centres, opportunities of recreation and physical exercise, organisation of unremunerative but satisfying work, and other schemes, such as those initiated by the Society of Friends. But there has been little precise information available about the form of ill-health chiefly found among the unemployed, or about the circumstances in which it is most likely to develop. Some studies that are now being carried out on a London group of unemployed suggest that neuroses are seldom found where there has not previously been evidence of a definite disposition to such disorders in response to any social or individual stress. It is not only in the form of well-defined neuroses, however, that the results of enforced idleness manifest themselves. There are numerous less obtrusive deviations from the normal balance of the personality that are the almost inevitable outcome of insecurity, dependThese ence, and lack of satisfying occupation. deviations may most strikingly be encountered where occupation had previously been constant rather than casual, and there had therefore been greater security ; where, moreover, the work had made sufficient demands on the capacity of the worker to afford him grounds for a feeling of worth and adequacy. In a valuable pamphletjust issued by the National Committee for Mental Hygiene in the United States, Dr. GEORGE PRATT sets out the responses to economic adversity which are most frequently found, and the means by which they may be combated. It is addressed not so much to physicians, who may be called on to deal with definite mental disorder, as to social workers, nurses, and those who administer relief on official or voluntary bodies. They it is who are daily in contact with hitherto normal and on the whole contented people who are now unwillingly obliged to change the habits of their lives, and are deprived of their usual outlets and means of satisfaction. Where there is danger of a gradual deterioration of morale and the development of apathy, despair, self-pity, or resentment among the unemployed, it is necessary that those who attend to their material needs should also take into account those psychological factors which are of the utmost importance for the future. They must recognise that truculence
changed
to
sympathetic (not sentimental) understanding,
and sometimes to advice. The part of the general practitioner in providing such mental hygiene is difficult to over-estimate. But equally important, however, are those measures for which the community, rather than individuals, must be responsible, and which provide means of occupation and recreation, thus keeping alive self-respect and preventing a corroding dissatisfaction. It will, in most cases, be imperative that these activities should be begun by outside agencies, rather than by those who will benefit from them, for in the sufferers initiative has often become weak after months or even years of unemployment, and there will have been little or no preparation for the use of a leisure that may be unwelcome and turn to taedium. The spread of schemes for dealing with the mental problems of the unemployed is a sign in this country.
hopeful
THE PATHOLOGY OF APPENDICITIS Accute
appendicitis
is one of the most common
and dangerous of the surgical emergencies, and there
and dangerous of the surgical emergencies, and there is a good deal of evidence that mild attacks of inflammation of the appendix occur much more frequently than is generally supposed. Our knowledge of the exact pathology and setiology of the disease is, however, far from complete, and any serious contribution to their elucidation is to be Prof. L. ASCHOFF has long been welcomed. interested in appendicitis ; he wrote a monograph Morale. The Mental Hygiene of Unemployment. By George on the subject as long ago as 1908, and his views K. Pratt, M.D. The National Committee for Mental Hygiene, on the pathology of the disease are now well known. New York. 1933. Pp. 64. $0.25. 1