Great Britain

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At the end of the nineteenth century, British psychiatry was more neurological than psychological. Neurology (John Hughlings Jackson) taught that disorders of brain led to mental disorders; psychiatry accepted this position (Henry Maudsley). Psychiatric treatments showed the influence of the French schools—Pierre Janet, Jules Déjerine, Hippolyte Bernheim. In 1913 the Brunswick Square Clinic, the first to offer psychotherapy, based its treatments on the theories of Janet.

Interest in and research on depth psychology centered in the Society for Psychical Research. Many leading scholars and intellectuals supported attempts to identify whether there was psychic survival after death, an agnostic effort to fill the fearful gap left by the loss of religious belief through the rise of scientific materialism and positivism. The first contacts with Freud's writings were through articles by Frederick W.H. Myers on hysteria in 1893. Myers proposed his own theory of a "subliminal" subconscious derived from his observations of cases of multiple personality and hysteria. The ground for receiving psychoanalytic ideas was prepared by Havelock Ellis through his encyclopedic writings of the psychology of sex (Hinshel-wood, 1991).

As Victorian ideas gave way to those of the Edwardian era, there was an upsurge of liberal agnostic writings that can be seen in novels, essays, and philosophical writings of the time, in particular from the Cambridge group of intellectuals who formed the nucleus of the Bloomsbury Group (Pines, 1991a). Leonard Woolf, the future husband of Virginia Woolf, was a very early reviewer of Freud's writings and a short story by Lytton Strachey was titled "According to Freud." From the members of the Bloomsbury Group came the analysts James and Alix Strachey (the future translators of Freud); the younger brother of Virginia Woolf, Adrian Stephen: and his wife Karen. In contrast to the Viennese analysts the great majority of the early British analysts were middle-class Christian professionals.

Within psychiatry, Ernest Jones takes pride of place in introducing psychoanalysis to Britain. Jones turned from neurology to psychiatry and his encounter with Freud's writings led to meeting first with Carl Gustav Jung in 1907 and with Sigmund Freud in 1908. Jones devoted his life to developing and protecting psychoanalysis in Britain. Initially regarded by Freud with some suspicion, the Welshman Jones gradually found acceptance. He founded the London Psycho-Analytic Society in 1913, attracting a mixed group of interested physicians, but dissolved it in 1919 because several members, especially David Eder, declared their adherence to Jung. For some years, having failed to obtain recognition in London, Jones had worked in Toronto and was one of the founders of the American Psychoanalytic Association. Though Jones must be regarded as an outstanding figure in the development of the psychoanalytic movement, he was not alone. David Eder gave the first paper on psychoanalysis to a medical audience in 1911 at a Congress of the British Medical Association; the audience left in disgust before he had finished speaking. Henry Butter Stoddart, a distinguished psychiatrist who became a convert to psychoanalysis, was better received. He gave a series of lectures titled "The New Psychiatry" in Edinburgh in 1915. There he found converts as well as opponents, the most significant of the former being George Robertson, Professor of Psychiatry at Edinburgh, who thereafter declared himself a Freudian. Stoddart, a stout, good-humored man, played a quiet yet important role in establishing psychoanalysis within psychiatry, through his well respected textbook "Mind and its Disorders."

In these early days psychoanalytic ideas were supported and propagated by important psychiatrists and psychologists who nevertheless maintained a critical attitude and did not become members of Jones's reformed British Psycho-Analytical Society (1919). Eder was accepted as, after some analysis with Sándor Ferenczi, he left Jung. Bernard Hart was significant both because of the respected position he held and as author of a textbook, "The Psychology of Insanity" (1912), which ran through many editions and was the principal textbook in support of psychoanalysis. The influential psychologist William McDougall, the research psychologist Sir Cyril Burt, the well-known clinician William Browne, all made Freud's ideas accessible to their professions. Perhaps the most brilliant figure was William Halse Rivers, psychiatrist, research psychologist, and anthropologist, who died prematurely in 1922. Rivers, along with other dynamically-minded psychiatrists, treated psychiatric casualties during World War One with a psychotherapy that was strongly influenced by psychoanalysis. Rivers's work and personality became well known through the autobiography of the poet Siegfried Sassoon who had been Rivers' patient during the war. The novelist Pat Barker used Rivers as a central character in her three novels about psychiatry and the First World War: Regeneration, The Eye in the Door, and The Ghost Road (London, Viking).

Psychoanalysis made great strides through the treatment of psychiatric cases during World War One, and there were many chronic cases of these war casualties who had to be treated after the war. The Ministry of Pensions set up clinics to deal with these patients and their senior psychiatrist was the analyst David Forsyth. Attacks upon psychoanalysis came from many psychiatrists, notably a disciple of Hughlings Jackson, Charles Mercier. He attacked psychoanalysis as a German importation that would corrupt the minds both of doctors and of children. In his attacks he was supported by many other psychiatrists, amongst whom was the first Professor of Psychiatry in England, Shaw-Bolton. In a critical article, "The Myth of the Unconscious Mind" (1926), Shaw-Bolton stated that it had been a repugnant task to write but that psychoanalysis was an insidious poison being inserted into the minds of the young.

Jones reformed his Society more carefully and retained a strong control over its development for over two decades. Its outstanding supporters included the brothers James and Edward Glover. James, who died early, had been to Karl Abraham in Berlin for analysis and on his return dissolved the Brunswick Square Clinic which had been an important training institution for psychotherapy that was not psychoanalytic (Boll, 1962). Amongst its students who later became analysts were Mary Chadwick, Ella Freeman Sharpe, Nina Searl (a pioneer in child analysis), Iseult Grant-Duff and Marjorie Brierley, the last of whom was to become a very influential psychoanalytic theoretician.

In the 1920s psychoanalysis increased both in popularity and notoriety. The British Medical Association set up a committee to investigate and report on the subject of psychoanalysis following public disquiet over breakdowns and suicides said to be the result of psychoanalysis. This committee sat for three years and took evidence from both supporters and opponents of psychoanalysis. Ernest Jones represented psychoanalysis, and his impressive performance carried the day for the cause. The result was that the British Medical Association acknowledged psychoanalysis as an authentic form of treatment and determined that the term psychoanalysis should not be used for any other technique or theory than that of Freud. However, the committee did not record its support of psychoanalysis, solely its recognition.

In the 1920s and early 1930s the Psychoanalytic Society remained quite small and London remained the only training center. Some British analysts went to Vienna for analysis (the Stracheys, Money-Kyrle, Riviere), some to Berlin (James and Edward Glover, Ella Sharpe), some to Budapest (David Eder). Interest grew in child analysis and Nina Searle began to write on this topic before Melanie Klein's arrival in 1926 at Jones's invitation. Klein was introduced through Alix Strachey who had gone to Berlin for further analysis with Abraham, being dissatisfied with her experience in Vienna with Freud. The correspondence between James and Alix Strachey gives a vivid picture of the two cities, Berlin and London, and their psychoanalytic communities.

It should be recognized that a distinct "English" school of psychoanalysis had begun to emerge. The distance from Vienna led to independent thinking: consideration was being given to the psychic consequences of bereavement and mourning following from the great number of casualties and bereaved families left by the war. This led to a consideration of object relations in addition to libidinal forces. John Carl Flugel, who held an academic position at London University, wrote the influential "Psychoanalysis of the Family," and John Bowlby researched the psychological and socially deprived backgrounds of juvenile delinquents. Donald Winnicott applied his extensive experience as a pediatrician to child analysis.

Melanie Klein made a powerful impact in Britain through her writings on early psychic development. She was supported by Susan Isaacs, Joan Riviere, Ernest Jones and others, although many analysts considered her ideas to be unsystematic and overly speculative. Among them, her clearest critic was Marjorie Brierley. Ronald Fairbairn, working in isolation in Edinburgh, was considerably influenced by Klein, and in turn Melanie Klein recognized that she also learned from him; impressed by his work on the schizoid personality she added "schizoid" to her "paranoid" early infantile stage, hence "paranoid-schizoid." Fairbairn was the strongest revisionist of psychoanalytic theories, establishing a full object relationship theory.

Jones continued to be the dominant figure in British psychoanalysis, as a result both of his writing and his personality. Influenced by Melanie Klein's exploration of early psychic development, he wrote on female sexuality in a way that Freud perceived as a challenge both to himself and to his daughter Anna. Jones tried to achieve a balance between the innovative British work and the more conservative Viennese mode, instituting a series of exchange lectures in an attempt to build bridges.

Edward Glover was Jones's close collaborator and for many years the presumptive next president of the Society. He produced the first enquiry into the theories and practices of psychoanalysis by issuing a questionnaire to members of the British Society which later he elaborated into his authoritative textbook on the technique of psychoanalysis. Though Glover had supported Melanie Klein for some years, later he strongly opposed her, and for this reason found himself against strong opposition when preparing to succeed Jones as president.

British psychoanalysis was dramatically changed by the flight of Sigmund and Anna Freud and their supporters to London in 1938. It is not pleasant to find it on record that Melanie Klein thought it unfortunate that the Freuds had come to London as it would prejudice her intellectual hold on the Psycho-Analytic Society. Indeed, conflict soon broke out between the Viennese and the supporters of Melanie Klein which in wartime led to the famous "Controversial Discussions" that set the scene for the tripartite division of training in the British Psycho-Analytical Society after the war, the three groups of Kleinians, Freudians and the Middle, later Independent Group. This group consisted of those who did not wish to be identified with either of the warring camps. Influential teachers during this period included: for the Klein Group, Susan Isaacs, Joan Riviere, Paula Heimann, Roger Money-Kyrle; for the "Middle Group"; Ella Freeman Sharpe, James Strachey, Sylvia Payne, Donald Winnicot, William Gillespie, Marjorie Brierley, and later Michael Balint; for the Anna Freud Group were Kate Friedlander, Ilse Hellman, and Willie Hoffer. Anna Freud virtually retired from the British Psycho-Analytical Society to build her own training center in child analysis at the Hampstead Child Therapy Clinic, though on the international scene she retained her pre-eminence in psychoanalytic theory.

British psychoanalysis has been regarded as leading the way in child analysis. This is due to several factors. The Hampstead Child Psychotherapy Clinic provided thorough training in child and adolescent analysis, as systematically organized by Anna Freud and her close collaborators. Research initiated by Joseph Sandler on the Hampstead Index (representing the Clinic's collection and collation of clinical experience) has lead to several important publications. Anna Freud's concept of "developmental lines" has been a significant clarification in the study of child development. Melanie Klein's theories have had a major impact and many child analysts have adopted her theories. The training in infant observation and child analysis at the Tavistock Clinic is largely Klein-oriented. Some of her ideas have eventually been partly accepted by those who previously opposed them, including Anna Freud's followers. Klein retained a stronghold on the writings of her followers, which eventually led Paula Heimann to leave her group. In contrast to Anna Freud, Klein did not develop a systematic training in child analysis, though her influence on the Tavistock training is noticeable. Donald Winnicott's writings represent a distinct and different viewpoint. His vast experience as a pediatrician and his acute observational powers led him to the concepts of transitional space and transitional object, tracing the infant's move away from total dependence on the maternal environment. His original concepts such as holding, the use of an object, and the object's survival of the infant's destructiveness, have been influential internationally. Originally a supporter of Melanie Klein, he became a strong critic of what he saw becoming a proselytizing movement within the British Society. Khan, an analysand of Winnicott, was a blazing comet who burnt himself out. His sparkling, erudite papers, which also bridged British and French psychoanalysis, were notable contributions though his polemical debating style demonstrated an equally noticeable self-inflation. In his later years he became isolated, somewhat paranoid and was asked to resign from the Society because many members were outraged by the anti-Semitic tone of his last book, written during his final illness.

The balance between the size and influence of the three groups varies: the "Group of Independent Analysts" is the largest in number, followed by the Klein group and then the "Contemporary Freudian" as the former "B" (Anna Freud) group was called. There is a "gentleman's agreement" that each group should be represented on committees and take turns in the significant roles of President, Scientific Secretary and Chairs of important committees. Total membership as of 2005 was 443 Members and Associate Members, many of whom live abroad. On qualification the student is elected to associate membership. Candidates for full membership are obliged to take part in a membership course with seminars and advanced supervision.

The Institute is responsible for the International Journal of Psycho-Analysis, founded by Jones in 1920; the New Library of Psycho-Analysis, which is the successor to the original library which Jones founded in 1921 and which was published by Leonard and Virginia Woolf at the Hogarth Press; and also for the Standard Edition of Freud's work, which was undergoing a new revision as of 2004. Riccardo Steiner has demonstrated the political aim that Jones and his translators held in "standardizing"' the language of psychoanalysis in the English version. In recent years there has been more activity devoted to making psychoanalysis better known to the general public through systematic courses of lectures and daylong and weekend meetings, which are more directed to interested professionals.

It is obligatory of psychotherapy training institutions to submit to regulation and registration which has brought psychoanalysts into closer collaboration but also into conflict with other psychotherapeutic training institutions. The United Kingdom Council for Psychotherapy was formed to represent and regulate psychotherapy trainings. The British Psycho-Analytical Society, together with the Society of Analytical Psychology (Jungians), the Tavistock Clinic and some other broadly psychoanalytic organizations have broken away from UKCP to form the British Confederation of Psychotherapists, so as to affirm their group identities as "psychoanalytic."

University College of the University of London has a privately funded Chair of Psychoanalysis which must be occupied by a psychoanalyst. Students can gain PhDs for research in the field of psychoanalysis and these students do not have to be members of the Psycho-Analytic Society. The Tavistock four-year training in psychoanalytic psychotherapy can lead to a PhD as well. For several years it has been possible to achieve psychoanalytic training in Scotland through a joint venture of the Scottish Institute of Human Relations and the Institute of Psycho-Analysis in London. Training is also possible in Northern Ireland and may become possible in other regions of the British Isles.

The British Psycho-Analytical Society has coped with great dissention without splitting into conflicting units and is likely to remain one body. Psychoanalysis is still regarded as a prestigious qualification and attracts good candidates, although the number of medically-qualified applicants has diminished. The Institute has always accepted women and non-medically-qualified applicants and has recently declared itself to operate a non-discriminatory admissions policy regarding sexual orientation and ethnicity.

A full account of this movement, principally associated with Ronald D. Laing and David Cooper, has been provided by Digby Tantum (1991). Laing wrote his most famous and influential book, The Divided Self, when he was a senior registrar at the Tavistock Clinic and in training analysis with Dr. Charles Rycroft. Although he was accepted as an associate member of the British Psycho-Analytical Society, he rapidly distanced himself from it and he and Cooper founded their own Philadelphia Association. Together they ran a community named Kingsley Hall on "anti-psychiatric" lines. The basic tenets of anti-psychiatry are as follows: Schizophrenia is not an illness, but a label arbitrarily fixed by society and confirmed by psychiatrists; the symptoms of madness are understandable as communications; what psychiatrists call schizophrenia is either a reaction to a disturbed family or a healing voyage which would be of benefit if it could be completed without interference; and, lastly, psychiatrists and psychiatric hospitals degrade people and cause mad behavior.

Laing and Arnold Esterson carried out research on families in 1958 and 1967, partly at the Tavistock Institute of Human Relations and at Villa 21, Shenley Hospital, which was directed by Cooper and which treated young schizophrenics. From their researches they concluded that schizophrenia was a reaction to familial or social pathology and that symptoms were cause by disturbed family communications. Their findings were published as "The Politics of Experience" (1967) and by Cooper as Psychiatry and Anti-Psychiatry (1967). As Tantum described it, "Many readers agreed with Laing that a plausible account of symptoms in terms of disturbed family communication was tantamount to proving that disturbed family communications caused symptoms. 'The Politics of Experience' was written at the height of the 1960's rebellion by young people against their parents generation. It was the apogee of flower power and a year before the Paris Evenements. Drug induced mysticism was fashionable and was presented as a voyage of self-discovery. It was tempting to pretend that schizophrenia was not only intelligible but intelligent" (1991).

Laing's legacy survives in the Philadelphia Association and in the Arbours Association, which is led by his former associate Joseph Berke. Both these organizations have training programs and the Arbours Association provides shelter and treatment for psychotic patients in residential homes, thus avoiding hospitalization. The other legacy of the anti-psychiatry movement is found in the refinement of psychiatric diagnosis and in a more psychodynamic approach to both the schizoid character and to schizophrenia. The movement has also increased the momentum away from psychiatric treatment and toward self-help circles for persons who have suffered psychotic breakdowns and who try to avoid further psychiatric involvement. Laing had relatively little direct influence within the British Psycho-Analytical Society and his theories and practices were marginalized by lack of attention.

The Tavistock Clinic has a reputation for psychoanalytic psychotherapy. Founded after World War I by Hugh Crichton-Miller, it began as an eclectic center for psychotherapy where Freudians, Jungians, and Adlerians, among others, provided psychotherapeutic services. During the Second World War the director of the Tavistock Clinic, John Rawlings Rees, who was not himself a psychoanalyst, was appointed director of British Army Psychiatry. Through his influence, several future leaders of psychoanalysis, including Wilfred Bion, John Rickman, and Thomas F. Main, were given posts of high responsibility. When they returned to civilian life at the end of the war they succeeded in making the Tavistock Clinic a psychoanalytic clinic, no longer eclectic. John D. Sutherland, who succeeded Rees as director, held an early enthusiasm for group psychotherapy under the leadership of Bion (and later of Henry Ezriel). This movement eventually faded and was replaced by individual psychoanalytic psychotherapy. Over the years the Kleinian Movement became predominant and those who did not follow this school were to some extent marginalized. The most conspicuous example is that of John Bowlby, whose research into the links between ethology and psychodynamic theory was regarded as extraneous. Bowlby had created the Department of Family and Children and introduced a systems approach to the pathology of the family and because of his "contamination" by such ideas he was also marginalized in the British Psycho-Analytical Society, of which he had been a prominent member since the 1930s. Before his death, however, the importance of his contribution was recognized internationally and thereby he regained recognition within Britain.

Michael Balint did a great deal to make the name of the Tavistock Clinic known internationally through his work with family doctors. Together with his wife Enid, he carried out extensive research into psychodynamic aspects of general practice, and "Balint Groups" spread worldwide. Balint had succeeded Ferenczi as the Director of the Hungarian Psychoanalytic Institute but came to Britain in the 1930s as a refugee. He quickly established a strong position for himself as a representative of the Hungarian school of psychoanalysis and was recognized as one of the leaders of the "Independent" group, in time becoming President of the Society. He also stimulated research into brief psychotherapy, which was carried out by a group of psychoanalysts drawn from the Tavistock Clinic and the Cassel Hospital.

The Cassel Hospital, too, was founded following World War I, to provide inpatient psychotherapy, and between the wars it became more psychodynamic in its approach. Following World War II, Thomas Main became its director, and the hospital became a center for psychoanalytic inpatient psychotherapy. Many psychoanalysts in training were employed there. The hospital gained a worldwide reputation for its innovations in psychodynamic nursing and for its contributions to the therapeutic community movement. The Cassel can be contrasted to the Henderson Hospital which under Maxwell Jones took an approach to inpatient psychotherapy that was socio-psychological rather than psychoanalytic.