Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1943?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1942 : (from Swaylands, Penshurst, Kent.) Present Address: Ash Hall, Bucknall, Stoke-on-Trent / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    for a physical disease. Such “ iatrogenic ” neuroses are fairly common. Again, since a neurosis which has become chronic presents an exceedingly difficult problem, more adequate provision for early treatment must also be highly relevant. Lastly, there is one aspect of treatment which appears at every stage and which is still in its medical infancy, namely, the provision of the most effective occupational therapy. There is a great field for progress in all these matters. Stage 2. The next stage, which is too often the first to be considered in connection with rehabilitation, covers that delicate period when the patient is fit to leave the hospital, but is not yet capable of leading a normal life. The gap between hospital and working life is the one which requires the most careful bridging, and is the point at which failure occurs most frequently in the treatment of psychoneuroses, as also in the treatment of many other medical and surgical conditions. There are, of course, a number of patients who proceed quite readily from hospital to working life, but many find this a very difficult step. It may be worth while at this point to consider what arrangements can be made at the present time for the patients under our care. Some are fortunate in that they are able to afford a short period of convalescence before returning to work. This they may spend either at a holiday resort or at an ordinary convalescent home or with their families at home. Any of these may be an excellent arrangement in certain cases, and it is our habit to send patients who have recovered from depression away for a holiday as a routine procedure before they return to work, particularly if they have had electrical shock therapy. For others, however, and particularly for the long-standing neuroses, the arrangement is not a good one. They come from a hospital atmosphere in which they have usually been happy in the society of other patients whom they have grown to know well, they have been leading a well regulated and fairly well occupied life. They would find a sudden return to full normahty more than they could stand. Idleness at home, often in the atmosphere in which the neurosis was generated, is a bad alternative. There is at present no convalescent home which will provide for them quite the environment which they need. Stage 3. For the patient who has passed successfully through this second or convalescent stage of his recovery another problem may arise, that of the third stage of rehabilitation, the period of return to work. Occupational difficulties, due to unsuitable or unsatisfactory type of work, or to lack of any work at all, are important contributory factors in the factors were constantly occupying our attention before the war, but at the present time they have become mercifully greatly reduced. It may be worth while to recall that in the Annual Report for 1941 it was demonstrated that, so far as we were able to ascertain, there had been no material increase in the total incidence of neurosis among the population served by this hospital. At the same time it was pointed out that there were a number of patients whose illness had definitely been precipitated by war conditions. The number was comparatively small but it was sufficient to suggest that, as the total incidence did not appear to have changed, there must also have been a number of patients whose condition had improved as a result of the war. Investigation has shown that this assumption is correct. Out of a total of approxi¬ mately 200 patients treated during the last two years we have estimated that 20 have benefited to a material extent by finding work which satisfied them, some¬ times for the first time in their lives. Government training schemes have aided some, others have been happier in the Forces than ever before (a reminder that the indiscriminate rejection of patients with a history of neurosis may not always be wise). Still others with the bogey of unemployment no longer in front of them have dared to change their jobs. The following is a typical example :— Case 1.—Mr. H., aged 42, was admitted to the hospital in a state of considerable depression and agitation. He had been drinking excessively for some years and had gradually become more despondent about himself. At the same time his physical health had deteriorated and he had developed peripheral neuritis. He was the only son of wealthy parents and possessed abilities beyond the average. He had never had to earn his own living and so had frittered away his time earning practically nothing, and not having the impetus to stick to anything consistently. He had gradually taken to whisky as a solace from boredom and dissatisfaction. His condition improved quite rapidly in the hospital, he was a thoroughly co-operative patient and he took a keen interest in occupational therapy. It was obviously necessary to find for him some worth¬ while occupation, and this would have been a difficult problem in peacetime. However, he had some mechanical skill and he agreed to take a Government course of training as a fitter in order to do useful war work. He was able to attend the official training centre, whilst still a patient in the hospital, and he was delighted to find that he had discovered his true bent. He proved to have very great mechanical aptitude and, after completing the course, he was sent to do important repair work at a factory. He 3