THE ADOLF MEYER LECTURE A MENTAL HEALTH SERVICE
Authors: WALTER S. MACLAY
Journal: American Journal of Psychiatry (1963)

There are times when it is good for us to look with a questioning eye at our brave new world. The historical development of psychiatry is characterized by a series of expectations of high promise doomed to disappointment. Neuropathology and genetics are limited in their contribution; psychopathology has increased understanding but not noticeably the cure of psychoses. Nearly all our treatments, including the physical treatments and the present powerful tranquilizers and stimulants, are empirical and keep changing with changing fashions. Their recent success in shortening the period in hospital and enabling rehabilitation (not cure), to be carried out with much greater success, has allowed many patients to return to their families and to live, even if only for a period, useful and self respecting lives in the community. But this success in rehabilitation and the development of better social services may induce false optimism and blind us to our profound ignorance about what we are doing. Professor Hill(20) writes, A new empiricism seems to have evolved in psychiatry, in which the aim is the cure of the symptoms rather than the development of understanding of the illnesses which give rise to them, which should lead ultimately to the control and prevention of these illnesses. There has been practically no increase in knowledge about the etiology and prevention of the common major and minor illnesses in the last three decades. But enough of the gloomy side. What have we to cheer us? We are beginning to appreciate that not only the incidence but also the forms and manifestations of mental disorder vary with culture. The social scientists and social psychiatrists appreciate the need to study social organisations and social attitudes. Prevalence and incidence studies, even if they do not reveal etiology, are helping administrators to make better plans for hospital and community services. The effectiveness of new methods of treatment, empirical though they may be, has increased the confidence and enthusiasm of doctors, patients, and the public, thereby lessening fear and allowing changes in the hospitals and changes in public attitudes which make it feasible to encourage the trend towards community care. The hospitals themselves have changed so much in their outlook and in their appearance and facilities that people are no longer so horrified at the thought of those they love having to enter them. Our ambition to treat the mentally disordered as well as we treat other patients can be largely fulfilled. In England and Wales 80% of admissions and 90% of those in residence are on the same basis as any medical or surgical patient. The subnormal as well as the mentally ill are taking part in training and industrial schemes which can enable many more to help to support themselves in the community or the hospital with all the self-respect and happiness that this brings. It can be truly said that many more of the mentally disordered are now being offered opportunities of readapting themselves to an acceptable role in the community. So long as we remain aware of the problems and deficiencies that must be faced and overcome, there seems no reason why we should not go forward with a high heart "looking for opportunities to make improvements rather than sins to be overcome, not believing in perfection or omniscience but in doing our best." Adolf Meyer was a wise man. We shall not go far wrong in following his example.