MILL HILL AND NORTHFIELD EMERGENCY HOSPITALS – for mentally ill servicemen. The originators of techniques for recovery with self-confidence and sociability in people diagnosed as ‘mentally ill’.
In the 1960s two groups of Psychiatrists were deployed to work at Mill Hill and Northfield Emergency Hospitals during WW2. to provide treatment for Mentally Ill servicemen. The staff from the Maudsley Hospital formed the core, but were joined by other psychiatrists.
They had all ‘walked the wards’ of Mental Hospitals during their training and were appalled at the apathy and despair of the patients, and blamed isolation and the ‘containment and control’ regime of the nurses. They recognised how sufferers from mental illnesses were made worse by lack stimulation and any social opportunity, and by universal stigma.
In setting up these hospitals, they refused to employ qualified Mental Nurses, and used other carers to generate friendly purposeful activities for the servicemen, and played down the pathologies.
They generated two main strategies, first by reducing the hierarchical relationship by encouraging friendly relationships, between the doctors, nurses and patients, using Group Forums for decision making and discussion, and then by ensuring the patients were always well cared for and were kept fully occupied with work and leisure activities.
There were differences of opinion as to the causes and treatment of the various Mental Illnesses with which the service men presented. Those who thought they were of psychogenic origin, with individual or group therapy being the cure, and those who thought all Mental Illnesses were caused by some organic malfunction, with physical treatments being the cure. However, they recognised the ‘care strategy’ was effective, whichever the diagnosis and treatment.
When the War ended, they returned to their own, or set up, units and hospitals, and they attempted in various ways to ‘enable sociability’ in support of either physical or psychological treatments as a means of cure.
Below are accounts, that include my experiences of how they attempted to achieve this.
Dr Irwin and Miss Kate Goodyear. Holloway Sanatorium. (They had worked together at Northfield Hospital)
As a student nurse I was taught ‘that when mothers nurture and care for their newborn babies, all the sensations of sight, sound, touch and taste that the baby experiences become motivating pleasures that will become ‘needs’ for approval and acceptance from others for the rest of their lives. When the ‘needs’ are met they ensure contentment and sociability, and if they are not, the result is anxiety, leading to mental illnesses’.
There was no ‘evidence base’ offered, but it made sense with the egalitarian, sociable, varied activities that were lived in the wards, around ECTs and medications. The Matron thought that it was boredom which led to ‘institutional neurosis’. So, the nurses’ part was to engender group cohesion among the patients, and foster kindness in the wards, and share in a full program of work and play activities. These would encourage social interactions which would boost self esteem and self confidence in everyone, and play a large part in their recovery.
William Sargant at The Dept. of Psychological Medicine at St, Thomas’ Hospital. (A special arrangement re the Lunacy Laws)
I was the Ward Sister of the inpatient ward in this unit in the early1960s. Dr Sargant refused to have any RMNs working in the ward and refused to appoint me until he heard where I had trained (with ex colleagues at Northfield) and he had negotiated that the ward be staffed by General Nursing Students as part of their training. He insisted the ward had the ambiance of a friendly Country Hotel, with a variety of occupations and activities that encouraged participation. There was to be no disclosure of diagnoses and no sharing of symptoms between patients, and this was enabled very well by the ‘general’ student nurses. The physical treatments in the morning, and the companionable social ambiance for the rest of the time, worked magic, and Dr Sargant always maintained that his successes were entirely dependent on the nursing care, because he could not carry out any of the treatments without their support.
Aubrey Lewis, with Annie Altschul and Eileen Skellern as ‘carers’ at the The Maudsley Hospital, London.
They had initiated the communal living for the mentally ill men casualties at Mill Hill, during World War 2. This involved work and play, with some early Psychotherapy ‘treatment’, and they called the interplay of the two ‘Group Talking Therapy’.
They put this into practice by treating the patients with individual Psychotherapy and in the wards there were Group Therapy sessions and social activities which encouraged self-knowledge and interpersonal skills, in patients and nurses.
Maxwell Jones at Belmont Hospital (later Henderson)
While a student nurse, groups of us were invited to participate in afternoon group sessions with the 30 ‘psychopath residents’, in the very early days of it being set up.
Maxwell Jones explained to us that what his unit was trying to achieve was social bonding behaviour, which would instill individual self esteem, and acceptance of authority in their lives. He refused to employ Mental Nurses and used Swedish social workers instead. He removed all authoritarian management and control in the unit, except for compulsory attendance at three daily groups, each with a different focus. In the morning, there was ‘self-help group therapy’ with invited contribution from the ‘staff’. Visitors were invited to join the midday group sessions with the residents, because they always became critical and antagonistic, and this stimulated group cohesion and rewarded cooperative endeavour in the residents. The evening group was concerned with organising aspects of management and control of their daily living. In addition they had responsibility for managing their individual behaviour in maintaining the function and success of the group as a whole. This included the authority to dismiss members, and to authorise new admissions.
The ‘residents’ were not considered to be ill, and an important aspect of the unit was to minimise stigma. The social workers were non-participatory ‘watchers’, rather than carers.
Tom Main at The Cassell Hospital
Tom Main and the Matron, Doreen Weddle pioneered the concept of A Therapeutic Community, and trained nurses specifically. “Their creative and innovative ideas came to fruition, with the development of the concept of the therapeutic community, and the evolutionary ideas on nurse training and practice. As a result of which the traditional nursing role changed and grew into a more dynamic psychosocial role.”
I heard Tom Main give a talk and received a copy of The Ailment, which described a recurring problem with a few non-compliant patients. He explained about the relaxed social atmosphere, with plenty of activity, and group therapy as treatment. Having denounced the traditional authoritarian and ‘omnipotent’ nursing role, he encouraged collaboration and companionship.
Quote from The Skellern Lecture website re her nursing time at The Cassel Hospital.
“During Skellern’s time at the Cassel, ideas of note emerged, in particular a model of practice that was called ‘psychosocial’ nursing’. This defined the idea of the nurse ‘working alongside the patient and engaging in day to day activities, and ‘problem solving’. The key to this approach was the concept of the therapeutic ‘use of self’, and the Matron, Doreen Waddell, was an important theoretician who unfolded this idea.”
Dr. George Bell at Dingleton Hospital
This Hospital became a beacon, in the UK and in America, for the effectiveness of ‘communalism’ as the most important contribution to care.
David Clarke at Fulbourn Hospital.
This Hospital became known for the ‘socially enabling’ changes which were introduced.
Dr. Martin at Claybury Hospital.
Dr. Martin tried to turn the hospital into a ‘socially enabling’ unity. There is a book called ‘A Hospital Looks at Itself ‘ which gives accounts from various people of trying to implement the aims of making the whole hospital into a ‘Therapeutic Community’. This did not come to fruition, but more social freedom for the patients remained.
Bob Hobson is renowned for his antipathy to all physical treatments, including drugs, for mental illnesses. He did not work at the Emergency Hospitals, but he learned from their experiences, always stating that ‘I had a superb grounding in the Therapeutic Community approach’. His therapy in Manchester, developed into the Conversational Model for individual and group therapy. This emphasised interpersonal friendships as essential for restoring self confidence and contentment.
First of all, the psychiatrists were unanimous in deploring the state of mental nursing in the Mental Hospitals where they had done their training, and they all refused to have RMN nurses in the various units and hospitals after the War. They were also aware of the detrimental effects of ‘stigma’ that mental illness incurred, and tried to distance the Units that they set up, from mainstream psychiatric provision.
All these people recognised that ‘regimes’ that encouraged social engagement were ‘in some degree, therapeutic’. However, they did not gain any understanding of how or why it was effective. There was one partial exception, and it was Dr. Irwin and the Matron, Miss Goodyear, at Holloway Sanatorium, who understood that “when mothers nurture their newborn babies, all the sensations of touch (especially in the mouth), sight, sound and hearing, etc., teach the baby to need emotional nourishment from others for the rest of their lives. If this is not forthcoming as they go through life, then ‘mental illnesses’ result.” It is this “evolutionary” advance that defines ‘humans’ as being sociable.
These understandings can be formulated into An Enhanced Model of Socially Enabled Care for people with Disorders of Behaviour.