Depression.
Within a year of qualifying in 1937 I was offered a house job at Bethlem Royal Hospital, a venerable hospital in a new building on the Kent/Surrey border in south London, one of a small group of "registered hospitals" providing psychiatric care for modest fees, and concentrating on early and treatable cases.
Abstract
Within a year of qualifying in 1937 I was offered a house job at Bethlem Royal Hospital, a venerable hospital in a new building on the Kent/Surrey border in south London. It housed about 250 patients. At that time Bethlem was one of a small group of "registered hospitals" providing psychiatric care for modest fees-about £5 a week, but often reduced-and concentrating on early and treatable cases. Patients with chronic illnesses were not admitted. The chief diagnoses were, firstly, schizophrenia in all its forms, including Kraepelin's category of paraphrenia; and, secondly, psychotic depression in its several forms-simple endogenous, recurrent, manic-depressive, and involutional. At that time, clinical interest was focused on schizophrenia because Sakel's insulin treatment, fresh from Vienna, had been introduced to Britain in 1935 in Edinburgh. By 1938 every self-respecting go-ahead hospital had its insulin unit. Depressive illnesses, on the other hand, were in the shadow. Depressed patients went into hospital only if their illnesses were severe, and quite often they were under compulsion. Patients with milder depressions were looked after as outpatients or remained in the care of their own doctors, often with vague and less opprobrious diagnostic labels. Admission was sought not for any specific treatment-there was none-but to prevent suicide, for skilled nursing, and for the relief of symptoms.