Abstract
It is good to have the opportunity to respond briefly to Paul Coombe’s extremely rich article about that period of mythic heroes in the psychiatry of the 1940s. It covers so many facets of its intended focus that one imagines a book to be forming on the slipway. Paul has read widely on the origins of this significant episode in the history of psychiatry. It led to so many eventual outcomes—group therapy, organizational consultancy, the therapeutic community, and social psychiatry (and we might add, this Journal). It is perhaps so widely written about and with such variety of conceptual, and also rivalrous, intents that it may be impossible to encompass everything now know about these events.
What Paul has done is to present a smoothly rounded picture—sometimes a little too smooth. But he has the perspective of a position within Australian psychiatry, whilst remaining someone deeply informed by his own contributions and persisting connections with psychiatry in Britain. As he says we cannot know where we are except by knowing something of where we have come from. I agree strongly with that. In a way, there cannot be too much interest in the formative years of this strand of thinking in our mental health services. It prioritized the experience of patients within their contexts—the war, the hospital. It opposed the approach to a patient as a commodity to be ‘treated’. It is the sadness of modern psychiatry that such a schism still exists within our professions. It is a sadness too that the two strands of psychiatry still remain a schism rather than a collaboration. As Paul indicates, our social context in which we work has changed over the years, and the neoliberal emphasis on alienated commodities has still deeply infected our psychiatric attitudes and work today.
As with any pantheon, I guess we all have our favourites and push one rather than another to the pedestal of acclaim. Maybe the powerful personality of the ex-tank commander Bion, obtrudes in front of the quietist Rickman, or the immigrant Foulkes trying to find a comfortable position in the society being devastated by his home country Germany, or the son of a humble ship’s carpenter posing as the high-up Lieutenant-Colonel Main. We cannot but be fascinated even today by the view into their endeavours and achievements that helped to rescue the British Isles. It is astonishing that such iconoclastic ideas are so vibrant today. The stories Paul gives us are detailed, and though others might tell those stories in slightly different ways with different emphasis, this is a picture of origins of our present-day commitment which we cannot overlook. Connections such as this article even over a longer and longer time dimension with our forebears are vital to keep our present day debates from becoming stale. The argument, elsewhere that the outcome of the ‘experiments’ was a failure because soldiers did not return to battle, is not the only outcome to consider, in fact maybe not the most relevant for a rehabilitation service. In this instance the outcome was not in narrow statistics, but in the unmeasured creativity of the novel idea that a mental hospital patient remains a responsible person all the time he is a passive victim of ‘his illness’. We need to keep owning such a powerful idea. And however remote and god-like they were, stuck in exactly our own predicaments and thinking their way through the same problems and pitfalls, they must be allowed to sit ‘colleaguely’ beside as we engage in the same work, the same problems, and the same kinds of thinking.
It always amazes me that this extraordinary creativity in the 1940s remains a part of us, and we a part of it. The role of the responsible player in the system, remains an elusive target for us in the many professions still influenced; it is equally elusive for our subjects the patients and clients of our various services. And yet, it is with some sadness that I try to ponder the gloomy thought that it takes a horrendous war to get the best, such an amazing best, out of us.