14 MARCH 1958, Page 30

A Doctor's Journal


KITING in a recent issue of the New York

State Journal of Medicine, Dr. J. N. Muller remarked that if present-day estimates are cor- rect, a quarter of a million people in New York City need psychiatric care. Of course, it may be that it is the tense, restless, driving kind of people who gravitate to cities; but, even if this estimate is on the high side, there is a problem here which properly belongs to the field of public health. Dr. Muller comments on the use of tranquillisers —'We do not know how many people at work on machines, or driving cars, are having these drugs. We do not know how the drugs affect reaction time, learning ability, accident risks. Do they cause depression? What is their effect on the expectation of life? . . . These are among the many unanswered questions which must be dealt with if we are to take full advantage of new ad- vances in drug control of mental illness.'

Used in small doses, and under proper medical control, the tranquillising drugs have an im- portant place in the treatment of tension states and all the manifold bodily disorders which may accompany tension. The function of these drugs is to help the patient through a spell of stormy weather, so to say : they ought not to become a crutch without which he cannot get about. They are an aid to the physician in his exploration of the causes of tension, but not a substitute for rational management of the illness. Much has been said about the risk of addiction—but that risk is in the individual and not in the drug. Most people are unlikely to become addicts to a sedative; the occasional one who is vulnerable has to be protected. The determined addict will register with several doctors and get barbiturates from all of them.

Another risk is that the regular sedative- eater will, during of attack of depression, save up his supplies and take them all at once, and no one can really prevent that if he is bent on self-destruction. I imagine that the majority of those who take an overdose sleep for a day or two and wake up, or are brought round; there are available now a number of powerful stimu- lants which counteract the sedative effect on the brain. Anyway, it is an open question how many of these seekers after oblivion seriously intend to kill themselves. My guess is one in seven. The rest have some other motive—such as the punish- ment of an unloving wife. No one knows how much self-medication goes on around us. Some of the milder sedatives can be bought across the counter at a chemist's. I look at the citizens sitting in rows in the Tube, abstracted, brooding, and wonder what propor- tion of them are more or less narcotised. What did they do in the days before tranquillisers? Just endure it? Or were they comforted in a system of beliefs that their descendants have lost?

'Tunes,' Mr. Frank Loesser is quoted as saying, 'just pop into my head. Of course, your head has to be arranged to receive them. Some people's heads are arranged so they keep getting colds. I keep getting songs.' Mr. Loesser is just now

working on an adaptation of the novel Green- willow, a story 'set in any place at any time' which resolves the conflict in a boy who is troubled by wanderlust. Novels of the present day can't just tell a story in the old-fashioned way—they have to resolve conflicts. Why resolve a conflict about wanderlust? Think of all that has been achieved by the compulsive wanderer. How much less ex- citing life would be ' without our James Bonds!

I liked Tom Hopkinson's comment on The Hidden Persuaders in the London Magazine. He says that this • much-discussed book makes two very important points, but misses one of equal importance. First is that there has been a shift in the pattern of American life (and therefore, perhaps, after the customary British delay, of our own) from 'inner-directedness' to 'other directedness.' The old-style, inner-directed people were governed by goals implanted early in life by their elders. Other-directed people are largely guided in their behaviour by the expectancy of the crowd with which they associate an by the increasing desire of Americans to make a good impression on their 'peer' group. In the first case parents set the tone; in the second it is the herd, the team, the gang.

The consequences of this shift, if it it taken seriously, are quite alarming. The 'herd mentality' is producing an American state of mind which is at war with its own supposed philosophy and ideals. Sturdy independence and free enterprise are the battlecries of the West against the slave State abroad and 'creeping Socialism' at home. Yet the aim of the business school and its 'human engineering' is not to produce individuals, still less rugged ones, but a rationalised conformity. Future leaders must above all have a respectful concept of authority. What kind of leaders will these be, I wonder?

The second point is that the business mind is not afraid to attack a cherished institution—the family. Management has a 'challenge and an obligation' to create a favourable, constructive attitude on the part of the wife that will liberate her husband's total energies for the 'job; even his sexual activity must be relegated to a second place. So this is the brave new world that manage- ment is leading us into! A policy of total control of the individual—perhaps the Kremlin could be asked to advise : after all, with forty years' ex- perience . . .

The third point, which isn't made, is man's capacity to pervert a potentially useful discovery.

Through exploration of the mind the Americans might find out why, in the rush to make money, they forget to live. But insight into deeper motives is being applied, through 'motivational research,' to the job of making still more money. In spite of Hopkinson's rather gloomy survey of the situa- tion, however, I am not too alarmed about the prospect. In the States there are many influential people with their feet firmly on the ground and a lot of outspoken debate goes on about every- thing. We could do with more of it here.