The Writings of Ivor Browne: Steps along the road-the evolution of a slow learner

2. An Experiment with a Psychiatric Night Hospital

7 2. An Experiment with a Psychiatric Night Hospital JOSHUA BIERER AND IVOR W. BROWNE The article ‘An Experiment with a Psychiatric Night Hospital’ was included in the Proceedings of the Royal Society of Medicine in late 1959. It was written in conjunction with Joshua Bierer (1901–84), founder and long-time editor of the International Journal of Social Psychiatry. Bierer also pioneered the concepts of psychotherapy and the therapeutic community and founded the Marlborough Day Hospital in London. EIGHTY million working days are lost in Great Britain every year due to psychiatric illness; in comparison, only seven million working days are lost through strikes. In 1952 a pilot project was established to determine how many working days could be saved by providing psychiatric treatment during the night for those patients who are still at work but in imminent need of help. The night hospital occupies part of the premises of the Marlborough Day Hospital. It consists of three three-bed rooms and one single bedroom (used for emergencies or as a treatment room), one small surgery for the sister, a dining-kitchen, bathroom and two lavatories. It functions five nights a week from 6pm to 9am. One consultant psychiatrist is responsible for three nights and a second for two nights of the week. Each consultant has a registrar working with him. The registrar is not resident but is on call after he leaves at 10pm. One sister works two full nights (from 6pm to 9am) and two evenings (from 6pm to 10pm). A second sister works one full night and two nights from 10pm to 9am. A nursing orderly works three nights from 7pm to 11pm, and a ward orderly, who is responsible for the preparation of dinner and breakfast, for twenty hours a week. The Writings of Ivor Browne 8 The Experiment Of the total number of 218 patients treated in two years, 76 were emergency cases (i.e. those kept in the hospital for one or two nights either as a safety measure or as part of their treatment, of which only five were kept for five nights) and fifty-four were treated with LSD and with individual psychotherapy by a consultant psychiatrist. He chose to treat the young to middle-aged and mainly professional men and women of good intelligence, personality and motivation, diagnosed as suffering from psychoneurosis. The remainder were the more chronic patients, including the psychotic or the psychopath. To treat the latter type of patient with LSD appeared – according to literature – inadvisable, contraindicated or even dangerous. Hoch et al. (1952) report that the mental symptomatology of schizophrenic patients was markedly aggravated by Methedrine and lysergic acid, and that they disorganized the psychic integration of a schizophrenic much more than that of a normal person. Working Hypothesis We thought this so-called ‘disorganization of the psychic integration ’ must be a temporary removal of the ego-defences and possibly could be used therapeutically. It was presumed that group participation might provide the atmosphere of security and belonging in which the sensitized patient could achieve a deeper degree of insight. It was therefore decided to combine LSD, or LSD plus Methedrine, with group psychotherapy. The plan was to run several consecutive groups, two of which should meet five nights a week for the first four weeks, two for three nights a week, two for two nights a week and one for one night a week. The seven groups involved a membership of 103 patients but, as the sixth and seventh groups are still running, the report is confined to the first five groups, with a total membership of seventy-five. Tables I–III show the diagnosis, duration of symptoms and work distribution in the various groups. An Experiment with a Psychiatric Night Hospital 9 TABLE I. DIAGNOSIS Groups 1 2 3 4 5 Total Schizophrenia and advanced schizoid states 4 6 7 7 5 30 Depression 4 3 2 1 0 10 Psychopath 2 2 1 2 4 11 Hysteria 1 1 2 1 3 8 Anxiety 1 3 2 1 2 9 Homosexuality 1 2 0 0 4 7 Total 13 17 14 13 18 75 TABLE II. DURATION OF SYMPTOMS Groups 1 2 3 4 5 Total Lifelong 1 4 4 6 5 20 Over 10 years 6 5 4 3 6 24 5–10 years 5 7 5 3 5 25 1–5 years 1 1 1 1 2 6 Total...