TOWARDS THE QUIET MIND
By W. RUSSELL BRAIN
AHUNDRED and fifty years ago, on May II, 1796, a group of members of the Society of Friends opened The Retreat at York as a hospital for those Friends who might be " in a state of Lunacy, or so deranged in mind (not idiots), as to require such a provision." This quiet and domestic event proved to have an in- fluence which extended all over the world, and has lasted till the present day. For in their " retired Habitation " the Quakers applied their religious principles to the treatment of the insane, and, in so doing, together with one or two contemporary Continental physicians, they began a revolution in psychological medicine. As L. A. G. Strong says in a small volume " Light Through the Cloud," (Friends' Book Centre, Euston Road, 5s.), commemorating the 15oth anniversary of the foundation of The Retreat, the Quaker " approach pre-supposed something of infinite value to the sufferer. It said that he was still a person, not a thing : a sick person, yes, but still in- violably a person, and therefore entitled to his likes and dislikes, his feelings and affections, and remaining within reach and worth of the affection of other people. Between a sick person and a mad thing lies all the difference in life. No thing can be welcomed into a family. No thing can be asked what sort of cake it likes for tea (as William Tuke was at pains to ascertain about one of the first women patients)."
To appreciate the revolutionary character of this approach, it is necessary to glance back at the history of the care of the insane in. this country. The first English mental hospital was also a religious foundation—the Priory of St. Mary of Bethlehem, founded in London in 1247, and first used for the mentally sick about 1377. Here through the centuries the unhappy sufferers from disorders of the mind were confined and treated by methods born of fear and ignor- ance. The violent were manacled and chained, and many were tor- tured in the mediaeval belief that they were possessed by devils which could be exorcised only by such methods. From time to time small changes were introduced and did something to improve con- ditions, but on the whole the lot of the insane during the eighteenth century was as bad as it had ever been. Bethlehem was open to the public and was one of the sights of London, visited not only by the irresponsibly curious and insensitive, but also by Swift, Walpole, Hogarth and Johnson. No doubt Johnson's fear of madness was an irrational obsession ; but it was barbed by his knowledge of the terrible fate of the pauper lunatic in his day. The degradation of the mental hospital is reflected in the corruption of its name ; Bethlehem had become Bedlam. In this darkness the Quaker enter- prise seemed indeed to irradiate an inner light ; and a patient re- leased from his chains and taken to The Retreat cried "Eden, Eden, Eden! " Doubtless there were failures, but the general effect astonished those who visited the home, and the publicity given to
the new methods in Samuel Tuke's " Description," which appeared in 1813, spread the reforms throughout the country. Other re- formers came forward ; Bethlehem itself was changed, and is now, of course, one of the most modern mental hospitals in the country.
Some of the most important principles of modern psychological treatment were implicit in the attitude of the Friends to mental illness. The first quarter of the present century saw the rise of analytical psychology, a comprehensive term for psycho-analysis and allied techniques of treatment, which are alike in basing their practice upon the existence of the unconscious mind. This is still the subject of controversy, for, though all psychiatrists agree that some mental disorders are caused by-disease of the brain, they differ about the importance of psychological factors in causation, and about the merits of particular forms of analytical psychology. These differ- ences are due to a number of special circumstances, which render the scientific approach peculiarly difficult. Nevertheless, analytical psychology appears to have established itself as a fruitful method of understanding the mind and treating those of its disorders which are amenable to psychological methods. This involves dealing with every patient as a person, and it demands of the physicians not only a
devotion to his art but, if he is to be a successful therapist, a care for persons, which, whatever its roots, is not very different in quality from that which a century and a half ago animated the founders of The Retreat.
The early patients at The Retreat were also regarded as " a family," and here is the germ of the recognition that mental illness
involves a disturbance of social relationships. In some patients the illness springs from faulty adjustments to the life of the actual family in childhood ; in all, and however caused, it hampers relationships with fellow men. The development of new and better social relationships is therefore an essential part of treat- ment—in the mental hospital for those who have been severely
ill ; outside it for the less disabled—and centres for social readjust-
ment, or group psycho-therapy, have come into existence in the last few years. Here individual psychology meets social psychology, for there is no sharp line between neurotic and normal ; and tht recent establishment of a centre for the study of social psychology at the Tavistock Clinic is a natural step in the evolution of analytical
psychology. In such an institute it will be possible to study the reflection in the group of the tensions of the individual, and con- versely. It is easy to expect more guidance from psychology than it can at present give, but at least it is worth remembering that our political need to reconcile planning and freedom has a psy chological aspect in the relationship between the individual and the group.
In striking contrast to the analytical side of psychiatry, the main development of the second quarter of this century has been the advance in physical methods of investigation and treatment. Analytical psychology has contributed little to the understanding and treatment of ft e more severe forms of mental disorder, probably because the cause of these is in the main physical. But experience has shown that some common mental diseases can be ameliorated or cured by newly-discovered physical methods. A special instru- ment has made it possible to detect and record abnormal electrical rhythms on the surface of the brain, and some progress has been made towards interpreting these and correlating them with abnor- malities of behaviour. All this work is still in its infancy, and it is likely that greater knowledge will bring refinements both of diagnosis and treatment. This may seem a far cry from the Quaker stress upon personal relationships, but the need to employ physical treatment makes it even more important to treat the patient as a person, for if possible he must be made to feel that his treatment is still the expression of care, s3mpathy and understanding. Here, and in the treatment of the incurably insane, psychiatry makes its most exacting demands upon doctors and nurses, Religious devo- tion, and even a sense of vocation, are not universal, nor are they always equally strong in those who possess them. The ideal must often remain an ideal, but it serves as a perpetual reminder that improved material conditions and technical methods are not enough without charity.
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