by a CONSULTANT PSYCHIATRIST
The writer is a consultant psychiatrist who has for many years been interested in pioneering ventures with maladjusted youth and in delinquency.
by a CONSULTANT PSYCHIATRIST
The writer is a consultant psychiatrist who has for many years been interested in pioneering ventures with maladjusted youth and in delinquency.
1. THE WEALTH OF MATERIAL OF CLINICAL SIGNIFICANCE contained in Mr. Wills' work, and in his writings describing it, is too extensive for me to attempt to give here a comprehensive survey. My bias therefore has tended towards selecting some of the less obvious points. This means that some matters of major significance that are stressed in his writings receive less attention here than their importance merits, or only one or two aspects are mentioned. Examples of topics to which this applies are: shared responsibility, staff discussions, the elimination of punishments from staff authority, after-care, social work with families, the school curriculum including creative achievements and other activities (art, drama, poetry, nature lore, woodwork). These last may be a vehicle for sublimating instinctive impulses or for displacing anti-social impulses on to constructive ends.
2. The most significant fact, to my mind, about Mr. Wills' work with maladjusted young men and pre-adolescent and adolescent children is that it has continued as a consistent and balanced body of thought, developed and tried out in practice for over 25 years with varying groups, and that it has been found workable.
3. Treatment of emotionally disturbed aberrant persons by a sojourn in a therapeutically planned environment is a form of treatment of immense importance and worthy of serious study.
4. As a balanced whole it incorporates components mutually interdependent. Isolated chips of "good ideas" from this whole, sometimes culled by would-be followers and introduced where they do not harmonize, have led to misconceptions. It is as if an attractive piece of a harmonious coloured mosaic were removed and inserted into another colour scheme with which it clashed. As the art critic Eric Newton suggests in another connection, it is the full orchestration which gives beauty. In spite of occasional misapprehension, Mr. Wills' ideas, where understood, have had a wide influence for good.
5. The most important ingredients of this planned therapeutic environment are the human beings among whom the child is sojourning, on whom he depends and with whom he gradually establishes relationships. (The work has been carried out with young men from 16½ to 30 as well as with children, but for convenience I refer to the patient as "child".)
The grown-ups comprising staff are of paramount importance. Especially is this so of the man or woman who is Warden and is, therefore, chief parent imago and the central object of transference and of identification for the children. But the principles they follow and methods they use are only a little less important. Human nature consists, in its complex diversity, of a larger component of feeling, affects and emotion than of reason and intellect. It is essential to success that the atmosphere be infused with and animated by a spirit of love emanating from the staff, concern for people, sympathy and respect for each child as a unique person. Efforts were made to understand on a deep level the causes of anti-social actions, stealing, bullying, timidity, personal unhappiness, and other symptoms. This was combined with warm, tender feelings, and it was also an aim that empathy be associated with enough detachment to avoid sentimentality and to conserve the adult's own mental health. He must be able to change from partial identification to the position of an interested and responsible observer. But I must resist the temptation to enter more deeply into the contentious realm of staff problems.
Besides warm feeling, this work requires knowledge and intelligence, and has benefited by the fruits of years of experience possessed by the Warden, and his ideational standpoint and faith. There needs also to be a significant ingredient of that uncommon commodity paradoxically called "common sense", and a sense of humour. The régime remained flexible and was used subject to spontaneity and intuition.
6. David Wills started his work of principal of therapeutically oriented residential centres for maladjusted persons more than 25 years ago. He was already an experienced, trained, and qualified social worker, who had specialised in problems of delinquency, and was the Warden of an educational settlement, so that his experience of training students is still longer. There is as yet no recognised training or qualification intended specifically for the profession of Warden-Principal of a residential institution for maladjusted children.
Since the work of Homer Lane, who came from America to England in 1912, and the classic work of Aichhorn in Vienna there have been established a number of comparable residential centres for the maladjusted with a "progressive" therapeutic outlook. Each has its own special character and a comparative study would be valuable.
The late Alexander Bloom established and ran, as headmaster, for the last ten years of his life, a day school where the interpretation of "progressive methods" were so closely similar to David Wills' interpretation that it is quite strange to remember that they were at no time associated. This school was St. George-in-the-East secondary modern school, Stepney, under the LCC. It is in a cosmopolitan and reputedly rough neighbourhood. I mention this school in support of the contention that closely similar methods are workable in many fields and. under different leaders.
Alex Bloom firmly asserted that his work was a balanced unity and not just a collection of unrelated good ideas. It was co-educational and seen to be infused with a spirit of affection and informal friendliness between staff and children, springing from the attitude of the headmaster. There were no punishments, no rewards and no competition. (The LCC were not let off expenditure on "prizes", but these consisted of a present of a pile of books, given not to individual children, but to each class at the annual school party.) There was "shared responsibility" and each child has an individual time table (which Mr. Wills also advocates), vital "centres of interest" methods and a world outlook, with astonishing achievements in art, drama, poetry and towards the attainment of what Bloom called "a harmonious atmosphere in which right personal relations may come about through the experience of living". The "psychiatric oversight" (in Mr. Wills' sense) within the school was established until the Local Authority intervened and decreed that where advice was needed the child should be sent out to a child guidance clinic. While Alex Bloom's plan was functioning, the psychiatrist watched classes containing children who were afterwards to be interviewed, when invited by the class teacher to do so, and visited once a week. Mr. Bloom could not select children for his school. Besides children of the locality he was asked to take some from outside who were specially difficult. These included a number of backward readers, and opponents of his methods criticised the non-reading as if it were a result of the teaching at St. George's, which seems unfair as they were not admitted until about 11 years old.
7. Mr. Wills is the only person, so far as I remember, who has tried out under his own leadership and on broadly consistent lines several different types of residential centre. I think this testing out has a very valuable side, although it may not have been intended. The first experiment was Hawkspur Camp, which existed before the war, for socially maladjusted young men. The second was Barns, a wartime hostel and school for pre-adolescent and adolescent evacuated maladjusted schoolboys. The third was Bodenham Manor, a postwar co-educational home, which, like the last, incorporated its own school under qualified teachers. This was for maladjusted girls and boys of approximately the same age and type as the last. Mr. Wills has written a book about each of these experiments and careful records were kept. He is preparing to undertake a fourth experiment.
8. Mr. Wills writes "Psychiatrict oversight is in my opinion essential to any school for maladjusted children, and there are different ways of providing it." In order to fit into the very positive environmental therapy provided, with its complex relationships to people and things, its free activities and creative outlets, I think it is essential that the psychiatrists (there should be at least two) visit the centre and become an integral part of the team. They should familiarise themselves with the children and staff among their surroundings, and make themselves acquainted with the regime. It is important that the psychiatrists should be in general agreement with the basic lines of planned environmental therapy in use. If the children from a residential centre of the kind Mr. Wills established are sent elsewhere for specialist psychiatric help, there is likely to be a conflict of influence and transferences in the child's mind. The psychiatrists, moreover, will be hampered by incomplete realisation of the collateral treatment their patients are receiving. A less positive type of environment with a more purely supporting technique would seem to supply a better background for children who are to visit an outside clinic for some form of intensive psychotherapy. Some wardens are qualified psychotherapists and themselves give treatment. This does not apply in Mr. Wills' case. The functions of the visiting psychiatrists should include examining children applying for admission (carried out outside the institution). After a child has been admitted, there should be periodic consultations between the psychiatrists and the Warden, staff discussions, and some individual treatment of children when indicated. The psychiatrists besides being asked to give their opinions on unfavourable manifestations, need also to be interested in the manner in which children get better.
9. I think it was a good thing that the term "maladjusted" was not defined clinically in the Education Act of 1944. Its ambiguity increases its usefulness as a designation for a child, not covered by another classification and likely to benefit from residence at a special school such as those founded by David Wills. Under this classification the Ministry of Health, through one of its Child Guidance Clinics, can ask the Ministry of Education to pay for recommended treatment, on the ground that while he is maladjusted he needs other than ordinary schooling.
Mr. Wills quotes Dr. Portia Holman's apt description of a maladjusted child as one who is deficient in the capacity to form relationships. Two other distinctive traits may be mentioned as present, viz. emotional immaturity in relation to age and intelligence, and a poor sense of reality. These children's grasp of occurrences in the world around is liable to be distorted by conflicting feelings and impulses and by their imaginations. They are slow to trust others, feeling that they have been let down. In a free atmosphere, where pretence can be given up without fear of ridicule, a child often passes through a period of helpful temporary regression to behaviour, especially in play, more appropriate to one younger in years. In favourable cases he emerges from this more able to accept his true stage of maturity. The foregoing must be distinguished from the kind of pathological regression that is of serious portent.
In connection with the classification "maladjusted" I venture to quote from something I wrote many years ago: "Children have a right to happiness, to security and freedom from fear, to feel themselves loved and to be able to give out love, to feel wanted, to mix in friendship with their fellows and with adults, to play and to work also, to use their intellects and their imaginations in acquiring knowledge and in creative activities …" David Wills puts the aim concisely in the phrase, "the wholeness and happiness of human beings." A maladjusted child has often suffered the deprivation of a normal home life, but not always. We may find one child among healthy brothers and sisters, from a quite good home and loving parents, is more sensitive and vulnerable to comparatively slight psychic happenings and therefore becomes maladjusted. On the other hand most children are wonderfully resilient and many "deprived" children, when put in the way of satisfying their needs, retain the capacity to blossom out gradually. The psychic injury that a maladjusted child has suffered, on the other hand, has gone deeper. It needs skilled treatment and re-education to free him from the inner hindrances that hamper him from absorbing the love and satisfactions that may now be offered.
Much as we try to keep technical terms from the children, some are sure to reach them. A group of boys and girls at Alresford Place once asked me what "maladjustment" meant. I told them that it meant "not fitting in", and that they had not fitted in very well at home and at school before coming. A boy replied, "well, I fit in all right here, and I don't want to leave." It was a short step to explain that we hoped that by fitting in there they would learn to fit in at more places after they left.
10. "Every child is different" is quoted from Miss Eileen Younghusband's presidential address to the Association of Workers for Maladjusted Children. It might be an unwritten motto for the staffs and committees of every school for maladjusted children, and a reminder to keep one's mind from being blunted by apparent similarities. Mr. Wills stresses this uniqueness, and approaches the hostel and school community as being made up of a number of people trying to learn the art of living together while preserving their individual distinctiveness.
Symptoms, including offences, were considered by David Wills as problems of the personality, and the more one knows about the person and the cause of his actions, the better one is able to help.
11. A significant part of Mr. Wills' work is his attitude to punishment. He has come to the conclusion that it is not an educative, or even very effective method of obtaining conforming behaviour, where that is desired — and he probably desires it less, and leaves more to unfettered choice than is done in most institutions. He has devoted a good deal of space to the subject in his books and has written a pamphlet on the theme of eliminating the authority of the staff to punish (see section 5, re Alex Bloom). Here I confine my comments to mild penalties that are not intrinsically harmful. Corporal punishment and penalties which are psychically humiliating or severe are so obviously out of place in work of this kind that I do not propose to give space to discussing them, although Mr. Wills takes up the cudgels on the subject with great effect.
The kind of mild punishment which is not unthinkable in such a community might include repair and restitution, moderately unpleasant deprivation, or penalties which are only unpleasant by their overtones as tokens of disapproval. That kind of penalty (or "sanction") is indeed from time to time given after discussion as a decision of the "meeting" of children and staff that Wills describes under the heading "shared responsibility". It has a different impact on the children to staff authority.
Eliminating punishing from the sphere of staff duties (though staff remain responsible for supervision) in the case of maladjusted adolescents, is a good example of the interdependence of the component instruments of treatment on each other, referred to in section 4 of this article. Used with sympathetic discretion and in conjunction with other components of the whole conception of treatment, applied with full awareness of what is involved, it can be very valuable. By this means the young people are helped to face up to the implications of their actions on others; it enables the staff more freely to see occurrences in relation to the general stage of development, and so on, and it gives a better relationship between staff and child. Members of staff, however, should be aware that in depriving the child of punishment, given them by those they most respect, for acts judged to be wrongful, they are depriving him of a support and a customary mode of escape from guilt feelings ("wiping the slate clean") and perhaps even of a means of obtaining coveted attention. This deprivation must be replaced by something better. If we eschew punishing in a "substitute home" we must put in place of what we take away, the support and prop of love, sympathetic understanding and intimacy and a genuine interest in the child, and kindly encouragement if guilt feelings are too strong. Most of us can think of examples of intense anxiety caused when this is not realised. In my own experience I remember a state of hysterical anxiety being increased when the person in charge refused to punish destructive anti-social behaviour on Principle (with a very large capital P) but was unfortunately not able to make close contact with those children (as he had with others elsewhere) and get them to feel he cared for them.
12. In giving scope and encouragement to natural tendencies towards mental health, Mr. Wills rightly emphasises the phenomena of transference. Maladjusted children, as already mentioned (section 8) are likely to be weak in capacity to form genuine relationships, in their reality sense, and in emotional maturity. Their first gropings to form relationships with others are of a kind psychologists call "transference". This means that feelings of affection (and negative feelings too) felt in early life for parents and so on, are carried over on to present day people. It is by wise and gentle handling of transference that treatment is possible. If there is no capacity at all to form transferences (which can occur) I doubt if a favourable outcome from treatment by a therapeutically planned environment is possible. Even with intensive psychotherapy it is difficult. The whole subject of transference is profound and complex and would take us into the deeper layers of the study of mental processes … Early objects of attachment as a vehicle for the love and trust of a child who is recovering, may be an adult ("his adult" as Wills call it) or a child friend, or an animal, or just the place itself. Through this he is helped to emerge from illness to health and to achieve inner freedom.
The way these phenomena are made use of by a psychotherapist in individual treatment and their use of environmental therapy differ. The substitute parents (and supplementary parents) in the hostel-school are men and women the children see and know as friends in everyday life, sharing their interests and occupations. Children (and grown-ups too) model themselves on those they admire, which is sometimes called called "identification". Gradually relationships which start — and always partly remain — as transferences, merge into something more concrete. Grown up companions and comrades of the child's own age come to be seen and accepted with their real strengths and weaknesses and the veil from the past wears thin … In successful cases the whole environment of the centre is found to offer security, interest and satisfactions and the once maladjusted child has been led by transference and temporary regression through phantasy and identification to enjoying the warmth of reality, and thus from adolescence to maturity.
13. Mr. Wills is frank in self-criticism. The saying that "no one is perfect" is a platitude only for a rather mature adult. It is not a platitude, nor even credible for most children. In infancy parents seem perfect in their eyes, and when they cease to seem so the children have a great longing to find the lost perfection. Adolescence is the time of hero-worship and woe betide anyone who disparages the hero of the moment! Obviously there are faults which render a person unsuitable for work with maladjusted children. Obviously, too, sensible. staff do not show their worst side in front of the children. But a mask of spurious impeccability can be very frightening and pedestals are not well thought of where Mr. Wills is in charge. In section 12, on transference, I have tried to show how awareness of inevitable weaknesses in respected adults can even be helpful.
14. Mr. Wills is scornful of puerile exercises in "discipline" for discipline's sake, and of regimes comprising a lot of orders and rules. Such a regime is unlikely to lead to self control, initiative and reasonable conduct when the "discipline" is no longer available. Instead Mr. Wills provides training through the impersonal discipline of experiencing the demands of natural forces. Woodwork succeeds best if it follows the laws of the material, and gardening the laws of growth.
15. "Shared responsibility" or, as Dr. Herman Mannheim called it "inmate participation" (in community management) is an adaptation of a practice widely used since the end of the last century in the more enlightened educational establishments for normal young people. Authority is shared between children and staff, not delegated as in the prefect systems, and Mr. Wills manages to include all staff, domestic, teaching, and out-of-school educators, without social distinction. The form of government is not rigid but changed from time to time and the sphere of responsibility is limited in range but genuine within the limits. The aims are both therapeutic and educational, and it is intended for children over ten. Little children are not burdened with it.
16. I have confined this essay to suggesting some pointers to the internal significance of David Wills' work, for a clinician, and have left it to others to describe the work and its influence.
Finally I would like to express my appreciation of the editor's liberality in allowing freedom of expression to some-one who is uncommitted in relation to the special views advocated by this journal and, indeed, not fully conversant with the nature of these views.