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Merit in past practices

73 Canford Cliffs Road, Poole, Dorset BH13 7AH

Sir: I read with great interest the elegant contribution of Henry Rollin on ‘Psychiatry at 2000’ (Psychiatric Bulletin, January 2000, 24, 11-15).

He gives the impression that the decimation of the old mental hospitals was the direct result of Enoch Powell's policy of promoting community care, whereas the process had started in the 1950s by Joshua Carses ‘Worthing Experiment’, and had been enthusiastically espoused by many clinicians. The Victorian asylums had been built to house patients with serious disturbances, difficult to envisage in this neuroleptic age, and the appearance of effective antipsychotic medication made the sort of therapeutic milieu they offered both inappropriate and unnecessary. Enoch's vision has failed, not from lack of judgement, but from underfunding.

Dr Rollin writes of the enthusiasm for the physical treatments of the 1950s, which he thinks were illusory and regards his use of them ‘with more shame than pride’. In taking this view, I think he does himself less than justice. I came into psychiatry in 1954, and although chlorpromazine was reported on, nobody believed that there could be a drug that controlled schizophrenia; it was much as if today it was claimed that there was a medicine that could cure mental impairment. The wards were full of violent, suicidal and deeply disturbed people. The majority were overwhelmed by hallucinatory experiences and their behaviour unpredictable, in spite of the gallons of paraldehyde that were dispensed. The relief afforded to ‘involutional melancholics’ by electroconvulsive therapy (ECT) was dramatic, and the treatment worked like magic on people suffering from catatonia. Although, the remission produced in schizophrenia by ECT usually lasted only a matter of months. However, it could last as long as a year, and permitted some patients to live outside hospital. But the real point is that uncontrolled schizophrenia causes its victim immense suffering, tormented as he or she is by false perceptions, and anything which could relieve the condition was not, in my view, illusory.

In the past all of us made mistakes, but it might be worth considering if some of the old discarded practices did not have some merit.

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