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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    was discharged from the hospital in February, 1942, and has been doing this work ever since without further depression or recourse to alcohol. The following patient presents a further example of progressive rehabilitation which would not have been possible but for the changed labour condition brought about by the wrar. Case 2.—Miss C., aged 28, was admitted to the hospital on account of headaches and insomnia. She was the only daughter in a family of five, her child¬ hood was normal, though she was rather spoiled. At the age of 15 she had an epileptic fit. She was working hard for an examination at the time and she was also taking part in many athletic activities. A consultant advised that she should continue to lead a normal fife, but that she should restrict her activities slightly to avoid fatigue. Unfortunately, her mother took note of the second part of his advice but not the first, with the result that the patient was treated like an invalid. She did hardly any useful work although her fits were of a minor character and very rare. She gradually became more and more self-centred, introspective and over-anxious. In hospital she w^as given a most thorough physical examination and this was followed by explanation, reassurance and re-education. She was caused to lead a normal fife in hospital, taught what things (e.g., alcohol and too many late nights) she had to avoid and shown that she must develop her interests and ambitions in order to be happy. On discharge she was able to get a part-time job in a library owing to shoi'tage of staff. This proved to her that she was capable of earning her own living and probably did more to help her than all our reassurance. Indeed, it is probable that if such “ fight ” work had not been available (as is usually the case in peacetime) she would not have succeeded in making a start at all. After a few months in the library she took up secretarial work and now has full-time employment in the office of a chartered accountant. She is well and happy. In both these cases the neurosis depended to a considerable extent upon the lack of adequate and fruitful occupation leading to boredom and dissatisfaction. In one patient the reaction was to seek refuge in alcohol, in the other anxiety symptoms developed. There is one further factor in these and other cases which certainly deserves mention. Both the patients quoted have improved, or at least main¬ tained their improvement, as a result of satisfactory occupations. It is doubtful, however, if the occu¬ pations considered as ends in themselves, would be sufficient to account for the change. There is in both these patients a sense of pride in being a part of the national war effort which is a source of gratifi¬ cation to them and gives them the feeling of belonging to a larger pattern. They are not fighting just for themselves but for their country. This is a spirit of wrhich too little was heard before the war, but in our experience it is a powerful incentive for a neurotic patient who is being asked to give up many old sources of gratification in order that he may become a useful member of the community. 2. DEVELOPMENT OF REHABILITATION AT SUCCESSIVE STAGES OF TREATMENT. Stage 1. In connection with Stage 1, which is roughly synonymous with the period of hospital treatment or at least of intensive medical treatment, certain points have already been mentioned. These may now' be amplified. Early Treatment. With regard to the problem of early treatment, experience in wartime has taught the psychiatrist a very valuable lesson, namely, that acute symptoms of anxiety which if untreated might readily become persistent and incapacitating can often be relieved by appropriate treatment undertaken within a few hours or days of their onset. Moreover, having been thus quickly eliminated they show much less tendency to recur than do anxiety states which have become chronic. This is in fine with peacetime experience in this hospital which led us to the conclusion that the early treatment of an anxiety neurosis was a matter of the utmost urgency. Indeed it appears likely that certain cases would never have suffered a neurosis at all if adequate steps had been taken to counter their fears at the beginning. This applies particularly to patients whose psychological difficulties followed a physical illness in the first place. Whenever a patient is ill, from whatever cause, he is bound to feel anxiety. His anxiety may take many forms, it may be mainly financial and be concerned with his family or his job, or it may be personal and concern his own future. Whatever the cause, the doctor should be trained to watch for this anxiety and be prepared to deal with it. There is at the present time a growing and thoroughly con¬ vincing body of evidence concerning the morbid effects which unpleasant emotion may produce upon the physiological functions of the body. The cardio¬ vascular, respiratory and alimentary systems are all affected in quite obvious ways and there are other less evident associations. For example, T. B. Layton has pointed out the fallacy of a strict policy of isolation for children suffering from chronic suppu¬ rative condition of the ears. Shut up in little cubicles these children are thoroughly miserable and, as a consequence, the tone of the muscles of their face and neck (i.e., of the muscles of facial