Twelfth medical report to the committee from the medical director : presented: 31st December, 1938 / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1939?]
Catalogue details

Licence: In copyright

Credit: Twelfth medical report to the committee from the medical director : presented: 31st December, 1938 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

    18/36 (page 14)
    where she led a very strenuous life, working very hard and playing very hard. She became friendly with a set of people who were better off than herself, and this rather increased her tendency to ex¬ travagance which had always been a source of dissension with her relations. She finally helped herself to some money from a Staff Fund meaning to return it at the end of term, but towards the end of term when she found herself unable to do so she became very worried. She got an attack of tonsillitis and had to have her tonsils removed. She became depressed again and was sent to see another consultant who sent her to a nursing home in the country. She had lost much weight and was sleeping badly. After about ten days there she began to tell the doctor in charge about her worry over the money. She felt that at last she was going to find some person who could help her when a relative, a doctor, who was financially responsible for her in this nursing home suddenly came down to see her. Because the patient w^as not having massage as he thought necessary, he removed her at once and put her into a surgical nursing home in London for a form of Weir Mitchell treatment, which consisted in having the patient kept upstairs in a top room with no visitors and no letters. She became exceedingly depressed and ate very little. She made an attempt to communicate with the outside world by throwing a letter into the street. Finally, after about three w'eeks there, the Matron of the home sent for her relative and refused to keep her longer as she wras not a suitable patient. She was then removed into the acute ward of a Hospital for Mental Diseases. She got gradually better there but received the impression that she w'as suffering from a form of nervous illness which was recurrent and though she wTould recover from this attack, there was a fear of it returning several times during her life. She was unhappy at this hospital and insisted on being removed before she wras quite wrell. She went dowm to the country and in a few months’ time wras sufficiently well to resume work. After a while she got a job which she liked very much in a massage clinic, and though she was always very happy there, she was frightened that the depression would return and frightened also at the thought of her previous experience of nursing homes. She worked for about 18 months at this clinic. At the same time she was leading a rather gay life with one or two hectic love affairs, and she finally got emotionally attached to one of her chiefs who was married. She became depressed and sleepless and was seen by several doctors in London who diagnosed the condition as a return of the manic depressive illness. She was sent to a nursing home in the country and remained there for several months before she was admitted to the Cassel Hospital. A superficial view of this history, with the story of depression alternating with periods of extra¬ vagance and hectic social activity, might lead to the view that one was dealing primarily with a series of manic depressive mood swings. From this it would be easy to conclude that the mood changes were themselves the determining factors, and that the other occurrences were secondary to these. A diagnosis of manic depressive illness might be permissible provided that it did not carry with it a special aetiological and prognostic significance. When the case history is considered in detail it becomes evident that the mood changes depended to a very large extent upon psychological factors which were capable of modification. Treatment consisted of a thorough analysis of these factors, during which the patient learned to acquire a much better understanding of her illness and of the difficulties which had led up to it. She also came to realise that the attacks of depression were not things which came upon her without warning or reason but were, on the contrary, the result of her difficulties with which she had not learned to deal adequately. It would be premature to say that this patient is not likely to suffer another attack of depression. It is obviously possible that she may again get into difficulties and react in this way, but at present she is leading a very normal existence, and her whole adjustment to life is now such that there seems to be far less possibility of relapse.