Medical and general reports and accounts for the year ended 31st December, 1943 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1944?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1943 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    Such was the position in the early 1930’s. There was obviously considerable scope for improvement in the skill and ability of the average psychiatrist, in the availability of psychological treatment, and in the organisation of nursing care, occupational therapy and after care. There seemed, however, definite limits to what could be achieved in the treatment of the neui'oses and functional psychoses along psychotherapeutic lines. Moreover, those functional nervous disorders which would not respond to psychotherapy and skilful nursing care remained essentially beyond the reach of treatment. Modern Physical Treatments The fourth decade of this century has, however, seen the introduction and widespread use of many new methods of treatment involving the use of physical agents. These include cardiazol and electric shock therapy, pre-frontal leucotomy, insulin therapy, continuous narcosis and narco-analysis. These new methods have called forth many protests and much disagreement particularly from the more orthodox adherents of the analytical schools of psychotherapy. Tlieir use has also stimulated a return of interest in the physical and constitutional factors in mental disorder. In the main this has undoubtedly been a healthy trend since a too exclusive preoccupation in one direction may lead to a one-sided approach to the treatment of psychological illness. There is, however, a danger that in the welter of new ideas some of the older methods of proved value may be overlooked and thus more be lost than is gained. If the practical value of the work of such therapists as T. A. Ross be accepted as of a very high order, the new treatments may be seen in correct perspective as an addition to, rather than as a substitute for, the older methods. At the Cassel Hospital one is qualified only to speak of the treatment of the neuroses and of certain milder psychoses, such as the milder forms of depression which are generally, quite erroneously classed as neuroses. The approach to the treatment of these disorders at the hospital has always been thoroughly eclectic with the maximum freedom given to each physician to pursue his own methods. It may, therefore be of value to describe the therapeutic methods at present in use in the hospital, so as to show how by common consent the new has so far been blended with the old. It must be realised that every patient presents a new problem which is differently handled by each physician, but in the main the following presents a general picture. THERAPEUTIC METHODS AT THE CASSEL HOSPITAL Preliminary Steps The first step in treatment is the investigation of the complaint which is recorded as far as possible in the patient’s own words and those of his relatives. The setting in which that complaint has arisen is then investigated and the patient’s own background, his development, habit formations, his relationship with others and his family history are all studied. A thorough physical examination is made with any special investigations which may be necessary. After this has been completed a preliminary formula¬ tion is given to the patient of the nature of his disorder, its origins and the steps which have to be taken to overcome it. In many cases in which no physical findings are revealed and no special physical treatments appear to be necessary, the emphasis is still upon a purely psjn-hological approach. Many terms have been employed to indicate the different methods of psychological therapy. Sugges¬ tion, explanation, persuasion, analysis, all have their exponents who are apt to speak as if the method chiefly employed by them was the only worth while one. Actually, each of these processes enter in varying degree into all systems of psychotherapy. Indeed it may be said that there are really but two processes which have to be followed and which invariably proceed hand in hand—the processes of ‘ elucidation ’ or ‘ analysis ’ and of ‘ re-education ’ or ‘ synthesis ’. The emphasis in one type of patient or with one type of physician may be on the one process or the other, but neither remains for long absent from treatment. It is often found that those who claim to practise the most rigid analytical therapy, spend in fact much time educating their patients in the tenets of their particular doctrine. Elucidation or Analysis The process of elucidation involves the use of a number of techniques, not all of them psychological. Special physical investigations have • already been mentioned. They may play an important part in the disentangling of certain complex psychiatric syndromes. Special psychological investigations may also be necessary. These may include tests of intelligence for which the revised Stanford-Binet Scale and Raven’s Progressive Matrices are in use at this hospital. They may also include special tests of temperament, such as the Rorschach Test. The main method of psychological elucidation remains however, that of further discussion of significant matters in the patient’s life history, often proceeding along the lines of the distributive analysis of Diethelm. A Jung association test may be used to elicit complex-determined ideas of special impor¬ tance, and in a number of cases Freudian free association and dream analysis are employed for varying periods. In connection with the process of elucidation one special technique of new develop¬ ment must be mentioned, namely, the method of narco-analysis.