Psychiatric Social Work

Maudsley Hospital

I cannot really recollect what it was that drew me into social work although I am conscious of some drawing from particular quarters, looking back I realise that there is a tradition in the family going back to my grandfathers activities of what might be called social work intervention for he was party to founding a friendly society under the friendly societies act of 1900s. On a more personal level I think I was conscious of the fact that I was driven by a sense of anger about the lot of people who were victims of Authority and the Establishment, and that being for the most part better educated and to some extent more intelligent than they there was a duty to help them not be defeated by these particular powers and it was this sense of anger which led me to intervene on their behalf. If you like, I was in this sense revolutionary without a revolution, and it was after I graduated that I began to think about the probation service, to a large extent as a result of a brief experience of some months with a probation officer in Birmingham.

I was also at this time interested in why people did such extraordinary things which even they would acknowledge were pretty damn foolish in their calm and reflective moments. And this aspect of human behaviour certainly was a source of interest to me long before I began to become a social worker in any sense and I suppose also in some sense there was a kind of amorphous vague benevolent interest in children, and putting all these together you begin to get a mix become interested in crime and delinquency amongst the young in particular. Although as the years wore on I very rapidly found that the greater interest lay in the middle to older adolescent and the young adult broadly speaking the 15 to 25 year olds.

The upshot of all of this was that I applied to join the Probation Service and along with accepting me for training, they decided to send me, with my consent, off to do the Mental Health course at the London School of Economics. Each year the Home Office did send one trainee here, and in the preceding year to meet with Hershal Prince. The training was essentially that for Psychiatric Social Work. This meant that the NSC in conjunction with fieldwork placements supervisors, recruited people who were 27 and over and who had a wealth of previous experience in some aspect of social work practice. I was neither of these and because I was the Home Office sponsored student, somewhat different rules and regulations seemed to apply.

The result was that by the time I had finished I had a dual qualification first as Probation Officer and as a PSW. The experience of the mental health course is that you have more academic training two days a week in college and field work experience – under close supervision with an agency for the other three with some block periods to boot. For my part the first placement was the mental hospital placement and this was at the Maudsley, with Elizabeth Howarth as my supervisor and if I remember rightly Margaret Lane was the Senior PSW. There was also a childrens’ department at the Maudsley and that counted as the child guidance placement, and my child guidance placement came secondly when I went to the Child Guidance Training Centre in Osnaburgh Street, near Gt Portland Street station. I was particular fortunate I suppose in that I had probably the two best placements on the course and at the end of the course there was then an extended placement which for me was at the Adolescent Unit in St Ebba’s Hospital, although given that this was only some six weeks long and happened to be in the summer months there was in fact very little activity taking place.

The benefits from these two placements were considerable. In the first place from an intellectual point of view my knowledge and understanding, academic and practical of the strings of human behaviour and something of the relationships between inner pressure and outward expression of them began to develop. And I certainly learned a lot about the importance of patience; of waiting; of listening; observing and observing in great detail; of non judgemental attitudes; and so on.

I shall remember always the very first client I ever saw at the Maudsley hospital, (have I said this before) who was essentially a burned out schizophrenic, and I was really turned loose on her because I couldn’t do any harm, but I was doubtful if I could do her any good. But after about twenty minutes M said to me, “you are the first person in this place who has just sat and listened to me and not taken notes all the time and never looking at me” – it was a lesson which thanks to her I never forgot.

The experience at the Child Guidance Training Centre, focusing very much as it did upon the development of children, was I suppose regarded by the probation service as being particularly irrelevant. In both of these placements where was an involvement with outside agencies, schools in the one case, and employers in the other, which was also part of the training, but an important aspect of it for me and I realise in later life, was the experience of professional relationships on the basis of equality.

This was particularly true with the Child Guidance Training Centre. There the word “training” applied not to the children, but to the staff. There were three consultant psychiatrists, three consultant educational psychologists, three consultant PSW’s and some thirty students made up of these three disciplines. The students, regardless of the discipline of origin, were likely to be bawled out by any one of the consultants, if the students had got it wrong. It was a salutary experience to see the young doctors being told off by our dragon, the PSW supervisor, but one learned to deal with doctors on an equal footing and to understand how psychiatrists thought and worked.

After the mental health course, I had a finishing placement in the probation office in Cardiff. I had previously had a short six weeks with the probation officer in Paddington, really just to fill in my time I think. But in this six weeks the probation officers working there took their followers to camp and I was sent along. This was an enjoyable and very rewarding experience from from which some memories still survive.

There was the small boy who was so impossible to manage that it was decided to send him home, and the other probation student there who was Geoffrey Parkinson, later “tail gunner Parkinson” of the New Society, who was the other trainee. He got the job of taking the boy home. I got the job of getting the boy out off the camp as unobtrusively as we could. It is probably true to say that we more or less frog- marched him out of the camp with one of us on each side, his feet scarcely touching the ground poor fellow; nonetheless he was full of enthusiasm and subsequently seen back in London told of what a wonderful time he had had.

There was another lad who had got into a fight and at one point when I was sitting next to him to try and calm things down, he bit my hand and when I felt I had suffered long enough, I said to him “this is where you lose control” and the pain and the anguish which was in the tone of his voice when he replied, ” yes I know “will always be with me as a reminder of what people feel when they do things that they cannot stop themselves from doing.

In the second placement after the mental health course at Cardiff, the focus was I suppose on learning the ropes of day to day management of life and work as a working probation officer; whether this meant getting used to working in court, giving evidence, writing court reports, so on and so forth, rather than the emphasis on what you actually did from a social worker point of view.

I then went to work in Birmingham and was there for three years and during this time reached the point which I think most reasonably well trained probation officer reach, of learning to do the job very well on a day to day basis, they learned to get started in their work with their clients but what happened next? Later on I would use the words “diagnosis and treatment” to distinguish between these two stages but I don’t think they were actually available to me at that time.

Also while I was in Birmingham I did work for two half days a week as a PSW at a Child Guidance Clinic. This was greatly to the annoyance of the City Treasurer who felt I was being paid twice over. But it had enabled me to continue to be acquainted with work in child guidance and to continue to develop the interest and so on and so forth that had already been developing.

What particularly developed during Birmingham, was my wish to, matched by my in inability to, grapple with the inner problems of my charges. Sometimes I was particularly successful, other times I suspect I probably wasn’t and it was the opportunity to go and work to the Portman Clinic in London which was important at this time.

The Portman Clinic was the treatment arm of the Institute for the Study and Treatment of Delinquency. With the establishment of the National Health Service in 1948 the Portman Clinic became a national health service clinic and it specialised, self evidently, in the psychological treatment of crime and delinquency and perhaps because of the kind of referrals it got, particularly work with sexual offenders.

The experience of the Portman certainly gave me a lot of understanding of the ways in which criminal behaviour fitted into, and was for better or worse, part of the person’s total makeup. And sometimes what passed for their normal social behaviour was in fact just as delinquent as anything they were caught and in quotes “done for” .

I began to learn then something of what I now call the “delinquent mechanism” in which the internal pressure finds an external manifestation, and in so doing the internal pressure is dissipated and what was a kind of volcanic eruption in the psyche now smooths over and all appears to be normal again. And this is why so often, those who came to probation offices in my time appeared to be inaccessible.

I learned here at the Portman to observe and to wait for those brief moments when you could engage the interest of the client in his own behaviour; raise his curiosity about it if it wasn’t there already, and use that to begin to develop some insight into their behaviour so that they could if they so chose, control it.

I certainly learnt a lot about sexual offenders, male and female, and I certainly learned a lot about psychiatrists, and psychoanalytical ways of looking at crime, and I learned to recognise that there was a distinction to be drawn between the theoretical approach and the method of treatment and that you could do one without the other and that to think analytically was to be helpful. It doesn’t necessarily mean that you intervened in that way. If nothing else particularly with delinquents who are not very bright, sometimes was it worth the hassle? And if you did find out, what are we going to do with it if they weren’t bright enough themselves to involve themselves in it? So although you could think in a psycho -dynamic way, the response was going to be in the fairly traditional methods of probation officers, during what was then fifty years of their existence.

I also learned particularly something about psychiatrists and psycho- analysts. One of the things that struck me was the very considerable degree of humility with which psychiatrists viewed their patients. The idea of God being manifest as a doctor, even more so as a consultant, was totally absent. I had never met a psychiatrist who took that view, even those psychiatrists who were pharmacologists rather than doctors, would not have taken this view.

In the learning about the distortion of inner forces manifesting themselves, I learned to summarise it in a phrase that ” large forces hide behind small signs”, and this comes back to the question of detail, in order to understand what the pressures might be.

The backwash to this was that the very first two pre-sentencing enquiries I did on juveniles, once I left the Portman and returned to the probation service, was to look at those two offenders and think they were mad, and indeed one of them was so bizarre that I was positively alarmed, particularly since they had been charged with breaking into and stealing from the local armoury of the TA! So I referred this young boy to the foreman ,who rang me up pretty damn quick and said “this boy is really very very disturbed etc etc “so I felt somewhat vindicated.

The flip side to this was that the boy was taken on by the clinic, turned up at the Portman clinic, with a .303 rifle which he had stolen from the Armoury. The Portman clinic rang and said ” for God sake come and get this out of gun out of here”; and I rang my Principal who said, no I didn’t ring my principal, I spoke first to the usher in the court as to how I could dispose of this when I got it, and I had a word with CID and I rang my Principal to see what was on offer, and he said I could take a taxi back to court, and I remember climbing into the taxi carrying this .303 rifle wondering what the driver thought, and I said to the police if we had an accident they would want to know what I was doing with this gun. All good stuff by the way.

I think also both from the Portman I got, the Portman showed my strengths and my weaknesses. It brought out what I think is a characteristic that I tend to move too quickly, and I certainly irritated one of the psycho- therapists when I got a client with whom she was heavily involved, by moving too quickly with his mother. On the other hand having learned my lesson on that and moving much more slowly with another patient, I can remember three weeks of her talking about nothing, before I spent the fourth week discussing with her that I had spent three weeks talking about nothing. Before finding on the fifth week she began to open up on the story against which she had been defending during the previous month.

And it was this patience in approach, this observation of detail, which I learned very much working at the Portman, and this learning process was fortified by my own analysis at this time which was expected of me by the clinic because of the emphasis on psycho-analytical approach. Certainly I learned that it could be used and how it could be used.

After about ten years working in the field as an probation officer and a senior, I then began to teach on the university- based probation officers’ course. In my own preparation for this and reflecting on my experience, certain issues began to strike me as significant in the way in which they had not done at the time that they occurred.

The first two of these were in my early days as a probation officer when I was a frequent visitor to the local University Settlement and the youth club there, and asked by the warden to play a more active part in the youth club, finally agreed, and said to the half dozen young probationers in the immediate vicinity, that if they came in regularly to the youth club on the Wednesday evening, I would regard this as their reporting to me instead of them coming to see me in town in a dull and dusty office on a Tuesday. So I was able to develop this small group of youths in a much more normal and natural relationship, and to see them also working as a group.

Another experience which was relevant was that, because at this time I was doing two half days a week as a PSW in the local Child Guidance, I was able to refer to the clinic a boy recently placed on probation about whom I was very concerned.. At the end of the diagnostic and referral process the feel of the psychiatrist was that the mother was very disturbed, and he wanted to take her on. As a result with mother and child accepting weekly appointments at the clinic, the psychiatrist seeing the mother, I saw the boy as his probation officer, and in this way we completely reversed our normal roles.

The importance of staying out of predetermined roles, increasingly seemed to be important, and that these boundaries which are often so helpful, could also be a considerable hindrance and prevent people from working.

I also began to crystallise my thinking about what makes a delinquent delinquent. And I became increasingly certain that somewhere tucked into every piece of delinquent behaviour there was a depressive mood at the time of the offence. To some extent this approach was confirmed by and also had it’s roots in my reading of Delinquency and Human nature by D. Stott ; published by Glasgow University in 49: Searchlights on Delinquency by Kurt Eisler which is a collection of papers published about the same time, and August Aichhorn Wayward Youth ; published somewhat earlier.

I also became quite clear in my own mind of the distinction between how you think, and what you do, and that the connection between them might be somewhat tenuous, but what you did had to relate to the client’s world and had to be meaningful to the customer, but you were free to think how you chose, and could think as widely as you chose, and look for ways in which you could use the understanding gained from your thinking in a way which was acceptable and understandable to your client.

It became part of my task it seemed to me, to convey this to the Oxbridge graduates who made up the bulk of the entrants to this Probation Officers’ Course. Despite their good upbringing, their intelligence, and their cultural background, they suffer from the same strengths and weaknesses as the dullest and most deprived.

When it came to a seminar at the beginning of their training, I said “why shouldn’t we steal?” I got all the usual answers I got from my customers, “wrong because your mum didn’t like it,” “the police knocked you off,” and so on and I got all these various answers as I went round the table, carefully omitting to ask the Irish nun who sat at the far end, until as and I expected somebody said to me “why shouldn’t you steal,?” and I answered “what is wrong with the fifth commandment?” The Irish brogue came down the table ” it’s the fourth commandment” and I thought “oh dear here am I trying to bring about the relevance of morality, of offending against the unwritten codes of society that simply, it is wrong to steal, and that is all there is to it, with the consequence of a sense of guilt and shame, and here she is obsessed by my getting the right number”.

However over the course of the succeeding weeks we returned time and again to this issue and the way in which the only real protection against delinquent behaviour or any kind of wrongdoing is the sense of shame which certainly should precede it ,and sometimes shame which should follow it, and sometimes the sense of shame which precedes it as you begin to think about the wrongdoing which you might do.

Developing this in your probationers is no easy task but it can be done and part of it involves arousing in the probationers some interest in their behaviour and their wish to be different and this appeared over the years in very different ways.

It seemed to me that when my ten year old probationer told me when I asked “Oh yes, what were you stealing?” “oh I wasn’t stealing I was one of the cops”. I blinked and thought oh perhaps he really does want to improve his behaviour, but of course made no comment about this, just accepted it.

The alcoholic, who told me at great length about the puppy which had come into the pub where he was a regular, and that the puppy needed to be looked after, and I interpreted this in the obvious way as you tend to do. The role of interpretation often spurned, is really useful if you can catch the right moment.

When I was turning over a large case load of some fifty probationers, half of whom were coming in one Tuesday the other half the following Tuesday it was crystal clear I wasn’t going to know one from the other, and so with some thought every body got asked the same question: “What would you like to tell me about yourself, which you would like me to know?” The youngsters who come straight from school tell me about which school they were at; the men who came straight from work told me the job they were doing; and everybody said what they were on probation for. There was one exception. One young man came not straight from work but had been home first, washed, changed, and came very smartly dressed, and said to my opening remark, “well I am a nice boy”and it was some months before I realised that he had told me a lot about himself. What I knew from the paper was that he was an illegitimate child living with his mother, grandmother and aunt, and that the offence was take and drive away …what’s another one? I’ve forgotten.

Oh no, also this occasion when this vast number of bodies were coming in, was told by one young man about his job and he was a collector of bad debts, “how do you do that ?”I asked. First of all he tried to trace the debtor to where they lived: you made sure you got to the right place by going to the local corner shop and asking if they knew them; you went to the house next door to be told; you went and you got your foot inside the door before you reveal the motive for your calling.

I do not know why I asked the next question, or the next remark, “all this reminds me of something” The young lad thought for a moment and said “it is what I was put on probation for”. I had no idea what he was on probation for and so I asked what was that,”fraud” he said, “false pretences” and I couldn’t believe my own good luck. And I spent the last ten minutes of my contact with him trying to show how his delinquent behaviour had now been socialised into perfectly acceptable, lawful channels, and that he liked this element of false pretence he can make a living out of.

It is this willingness to listen to detail, be receptive to the vibes, this openness which I learned doing fieldwork practice was absolutely essential to being an P.O. and the students did get the message.

One student in his very first placement, interviewing a recently discharged long serving prisoner in custody, greeted him by saying “may I take your coat?” an experience the ex prisoner had surely never had but which to our student was as natural as drinking milk. When this prisoner came the next time he brought with him a drawing he had made of the student; we didn’t know he was something of an artist ;and in the drawing, which was not a bad likeness showed enormous ears, which one of my colleagues suggested related to the fact that the student, like me at the beginning of my experience, not knowing what to do had just sat and listened.

It was for him as for me a useful lesson. I found though that the Oxbridge students although very bright, were less able at the beginning of comprehending the emotional problems which their clients were experiencing and as a course we used to look for ways and means of trying to get them to be more sensitive and imaginative about this. We also sought to develop their powers of observation and I used to advise them to go to the playground which was next door to where we were and watch the children at play and focus their eyes on one child and just watch him or her for the whole of the ten or fifteen minutes of playtime and then come back and write down what they had observed, but unfortunately you couldn’t do that now.

But after the ten years of field experience the crystallisation which is implied in these anecdotes and which are open to more than one interpretation and which may be regarded as simply no more than amusing, or which may be regarded as conveying an element of understanding, or the opportunity to understand, these experiences had to be crystallised and shared, and what I find now when I listen to people in the social work field is that this regard for the individual has been lost, but I am sure it will come back.

We do lose sight of what the past has given us. When I began to teach I was given the job of working with the supervisors of our students in the field, most of whom had little or no experience of supervision, and I did give a lot of thought to what I had to do with them, and how it had to be done, and then after a while I went in to the university library and found on the shelf a book written in 1936 by Reynolds which had everything there that I needed,and which I had laboriously tried to work out for myself, thoroughly summarised very neatly and presented in a coherent and logical fashion and I realised that the principles of supervision really hadn’t changed a scrap in the thirty years, nor should they.

Somewhere or other the principles of social work will have to come back because the present emphasis on social care and on the institution is going to be found to be inadequate which is why the climate of social work which developed in the forties, fifties and sixties took place. Some of the evidence of this is to be seen in the way in which psychiatric social work came about. The roots of the approach, and the relevance of a client centred approach are to be found in the US, the aftermath of war and so on. The history of the child guidance movement is both the cause and the consequence of this client centred focus. Not necessarily only children were the client, and the recognition that the family was important. In fact it seems quite odd that at a time when such an emphasis is being placed upon the family, family care, family support, and so on, that little attention is paid to the emotional problems of the family

After some seven years teaching I decided that the time had come to leave the South college and to go back into the field. This was also the time of the Seebohm reorganisation and the establishment of social services departments and that led me into local government in a post which carried responsibility for training standards of social work and the day to day management of the areas in the department I joined.

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