Title: The techniques of self help in psychiatric after-care
First published: 1943
Description: Volume I: Recovery's Self-Help Techniques, History and Description [136 pp]
Volume II: Group Psychotherapy: A Record of Class Interviews with Patients Suffering from Mental and Nervous Ailments [88 pp]
Volume III: Lectures to Relatives of Former Patients [125 pp]

The three books under discussion are not separate treatises but are continuations of one another and deal in the main with two problems: group psychotherapy and the menial hygiene care of patients after discharge from mental hospitals. Since the first world war psychiatry may be said to have passed from the strictly symptomatic and custodial type of treatment of mental illness and is attempting something by way of effective psychotherapy. From the standpoint of such treatment the problem forever confronting the psychiatric hospital is the small size of the staff that can devote its full time to psychotherapy as compared with the very large number of patients who need such treatment. The most effective form of psychotherapy so far devised is psychoanalysis, but it is based primarily on a very intimate personal relationship of the psychotherapist to the patient, so that with one patient being handled at one time the total number of patients that can be so handled must of necessity be very small. While the few patients under such care profit a great deal by the therapy, the rest remain untreated. For this reason there have been from time to time attempts on the part of psychiatrists to circumvent this rather luxurious form of treatment and devise means whereby a large number can be treated with sufficient effectiveness to make it worth while.

In 1920 Dr. Edward Lazell, then at St. Elizabeths Hospital, Washington, D. C., attempted psychotherapy by discussing general psychotherapeutic problems before a group of patients. Later on Dr. Louis Wender, then at Hastings Hospital, New York, did quite effective work in group psychotherapy, of which he has published reports. At about the same time Schilder made like attempts at Bellevue. It is this type of work that Professor Low has been doing since 1937. It is realized, of course, even by those not necessarily committed to the psychoanalytic approach, that, at best, group psychotherapy can be effective only at a superficial level and can never reach the depths at which the basic conflicts are formed. The reason for this is that the most intimate aspects of a person’s life could hardly be revealed in the presence of others, for such presence acts as an inhibitor for fuller catharsis. Withal, and in spite of its limitations, group psychotherapy is a decidedly profitable endeavor if one only bears in mind that it is not basic and final. It can no doubt reach a certain type of patient who needs but little push to start him on the road to recovery. To other patients it can provide partial insight that may help them to be discharged as improved or socially recovered—not complete cures to be sure, yet sufficient to help toward rehabilitation.

The brochure dealing with group psychotherapy is written in a fine and fluent style and can be easily understood by any one with only a high school education. The other two brochures take up a problem primarily of patients who have already recovered. This is really an extension of mental hygiene work: a type of extramural psychiatry, however, which has been practiced but little. It attempts a follow-up of patients who have been confined by an illness to a psychiatric institution. Many of the discussions are reprints of articles published in a previously published medium, "Lost and Found Journal," which accounts for a great deal of repetition; yet one does not object to these so much because these repetitions really tend to emphasize the problem. This “after hospital care" helps to reduce the number of relapses which often come from the social isolation due, in turn, to the stigma that is as yet attached to the problem of mental illness. It must be a pleasure and satisfaction to see the many men and women coming together without a consciousness of stigma and embarrassment. Admittedly, this “recovery self-help project” has not entirely eradicated the stigma connected with mental disease, but certainly it has robbed it of a good deal of its malignant force. The remark made by others may hurt the past patient and may even make him feel unhappy, but it does not make him feel guilty and certainly not abnormal.

In the third booklet, “Helpful and Healthy Advice,” the same is given to relatives of former patients—what are the best things they can do to steer the patient toward complete mental health. It is attractively and delightfully written.

In all, these three booklets represent a real advance in our understanding and treatment of psychiatric problems. The reviewer wishes they could be reprinted in quantities of thousands, distributed to relatives of patients after the patients have been discharged or, for that matter, before discharge. It would go a long way toward the better management of mental illness and remove what prejudice and stigma still exist in the public mind.

[[Book Notice][1] in JAMA. 1944;124(17):1229. doi:10.1001/jama.1944.02850170065026]


  [1]: https://jamanetwork.com/journals/jama/article-abstract/267928?redirect=true
Subjects: Psychotherapy