Student mental health during the 1940s
Concerns regarding the mental health of students grew after World War II. Before the war, there had been more interest in students’ physical health, but the war focused the attention of doctors and the government on psychological conditions. Young people and students were perceived as crucial to the future of society – as potential professionals, teachers and parents – so their mental wellbeing was of paramount importance. It was also recognised that the strain of intensive study and exams could cause psychological problems among some students. This was certainly true at Oxford University where the suicide rate among students was significantly higher than the average for their age group, and where mental illness was cited as the reason for half the illnesses causing students to miss at least one term.
The following case studies are of students who were admitted to the linked Park and Warneford charitable mental hospitals during the 1940s. Three were Oxford University students and one was studying at Wycliffe College in Gloucestershire.
Patient A:
Patient A was at the Park Hospital for around 3 months, from March to June 1942. He was 21 at the time of admittance, and was a medical student. Clinical notes suggest that he was very afraid of his father, who was 60 at the time of his admittance. Prior to coming to the Warneford, he had been diagnosed as a schizophrenic in London, but this diagnosis was ruled out at the Warneford.
He had come to Oxford in 1939 to study medicine “against his will”. He was, however, unable to get on with work owing to mood-swings that involved “ecstasy-like elation, followed by depression and uncontrollable weeping”. At this same time, he became preoccupied with religion and received instruction under a Catholic priest. Notes suggest that he would have even been received [as a priest], had his parents not been so against the idea. In November 1939, he left Oxford to join the Royal Air Force, but was hospitalised with suspected tuberculosis four months later and later discharged on medical grounds. Thereupon he took up medicine again and went to Cambridge for his pre-clinical studies, expecting to go on as a clinical student to the London Hospital. While at Cambridge, he suffered from “effort syndrome”, depending on his emotional state. He was also found to be shop-lifting, became irresponsible with money, and was judged unable to “adjust to the realities of life”.
In April 1942, he took to playing the piano, and Dr McInnes, then the Physician Superintendent who was overseeing the case, suggested to his father that piano lessons could be arranged for him in Oxford if his family could pay. The father, however, refused to pay for these lessons (and other extravagances such as golf equipment) since he considered them useless indulgences during a time of war. A significant aspect of this case includes a series of exchanges between the student’s father and Dr McInnes on the question of mental illness, military discipline, and the place of modern psychiatry in a war-ridden society.
The father suggested that since the schizophrenia diagnosis had been ruled out and what the son seemed to be suffering from was a failure to “adjust to realities”, he should be sent to join the Grenadier Guards to build his “character”. Interestingly, the father himself admitted to having had a similarly rough and difficult time when he was the same age as his son. He credited his discovery of how to cope with life and the development of his character to fighting in the Boer War (1899-1902) and then the First World. McInnes, however, disagreed with his proposal. While the father believed that military discipline would ‘fix’ his son, McInnes did not consider that the son was ready for the army, and that neither the student nor the army would benefit from his enlistment. McInnes recommended a course of psychotherapy.
The notes indicate that the student was transferred to the Crichton Royal Hospital in Dumfries, Scotland. He left the Crichton Royal after 3 to 4 months, having found the routine too monotonous.
Patient B:
This student was able to return to university life after spending some time at the Warneford. Treatment, in this case ECT, was successful and the student wrote to Dr Seymour Spencer (then an assistant doctor at the Warneford) after taking her final exams, thanking the hospital for putting her back on her feet and outlining her future career prospects.
Patient B was a student at St Hilda’s College, Oxford. She was admitted to the Warneford in October 1947 and discharged two months later, in December. At the onset of the War, she had been evacuated to Rickmansworth where she had attended a convent school. She was found to be suffering from low self-esteem. Clinical notes suggest that this stemmed from childhood, but had worsened whilst at Oxford, where she felt that she wasn’t working hard enough, and that her work had “stagnated”.
Despite her worries, she secured a Distinction in her first year (1944). But this was also the year when she recognised her mental health struggles, confiding her depressive thoughts in a friend rather than in her moral tutor.
She signed a consent form to undergo Electro-Convulsive Therapy (ECT) in October. This treatment showed some signs of success; she started showing more positive emotions and even confronted her mother about some older, unresolved trauma. After being discharged, she joined college again in the next term, and took the final exams in June, 1948.
One of the most interesting aspects of this case is a heartfelt exchange of letters between the student and Dr Spencer, written between June and September, 1948. Spencer had overseen her case and been responsible for her treatment. In a series of grateful letters, the patient acknowledges the ways in which her treatment at the Warneford had been helpful. The second letter was written after her results were declared. She was awarded a second class degree, which she was very happy with, telling Spencer that she was finally feeling pleased with herself for the first time in one or two years. The letter also indicates her career plans, and ends by thanking Spencer for his help, especially with the ECT therapy, noting that her final result is a “testimonial” to Spencer’s treatment.
The case demonstrates the hospital’s success not only in helping a student recover sufficiently to gain her degree, but also in mapping out a future career path.
Letter from the patient to Dr. Spencer, sent from St Hilda’s College, Oxford, dated 14.6.48
Dear Dr. Spencer,
I must apologise for not having got in touch with you this term. With Schools just ahead of me, I was reluctant to do anything which might possibly disturb the precarious equilibrium which I had achieved & which would, I hoped, carry me through the examination. However, Schools are now safely over. I shall be going down on June 23rd, and I wondered whether it would be possible for me to see you sometime before then. I should be very glad to do so, if you can spare the time, on any day which is convenient for you.
Yours sincerely,
Letter from the patient sent from [address in New Maldon, Surrey], 30.7. 48
Dear Doctor Spencer,
You asked me to let you know the result of Schools. The results came out on Wednesday, and I have been given a Second.
I needn’t tell you how very surprised I am by this unexpected result. I did think, in moments of wishful thinking, that I might, by a fluke, get a Third, but I never dreamt of a Second, and it is incomprehensible to me. However, it is none the less satisfactory, and the feeling of pleasure and relief is delightful. In addition, I do feel rather pleased with myself, and that is pleasant after a year or two in which I hadn’t been able to be anything of the kind.
The interview with the Appointments Committee was useful. One suggestion, which I already had in mind, was the L.C.C; their entrance exam is a more a test of general intelligence [illegible] knowledge than a schools-type exam, and I am writing for more detailed information. A job of that kind would be what I want at the present, if I can get it. Incidentally, the salary scale is good.The move has been accomplished without any serious trouble. The house is small and my mother dislikes it, but I think that things will settle down in time. For the next week, I am going on holiday to [illeigble] with Pat. It ought to be pleasant.
I’ll write again if anything important occurs. Meanwhile, I should like to thank you for the help you have given me during the past nine months, and particularly for your care of me while I was in the Park, when I most needed it. As for the E.T.C [misspelt E.C.T], you made a terrifying experience as little disagreeable as it could have been, and I am very grateful. I think my school’s result an adequate testimonial to your treatment.I hope that your wife is well, and the baby flourishing.
Yours sincerely,
[italicization mine]
Spencer’s reply(?), dated 1st September 1948
Dear _____,
Your letter of the 30th July must have just missed me, departing for my holiday, and was awaiting upon my return today. I hasten to say how delighted I am that you did so well in the schools. Indeed I am hardly less gratified than you are at the results, and I think considerably less surprised. I feel sure that but for your illness it would have been a First. The job at the L.C.C sounds an excellent idea, and I do hope you have obtained it successfully, and enjoy the work. I do hope your mother settled down in your new house. Please give her and your father my kindest regards. I feel very sure your good news will act as a fillip and do hope that all will continue to go well with you. I shall be very glad to hear from you at any time.
With best wishes.
Yours sincerely,
Patient C:
Patient C was a student at Brasenose College, Oxford. He was born in China in 1924, and had attended kindergarten there. While at Oxford, he had received a scholarship to study Classics. He was admitted to the Warneford on 25 May 1947, aged 22. His brother, a student at New College, Oxford, who had served in the Navy, brought him to the Warneford. He had two other brothers, one studying at Cambridge and another at Exeter. Clinical notes suggest that the student’s father, a clergyman, was a man “liable to worry…especially after being exposed to the bombing of London”. Prior to joining Oxford, the student was a member of the Royal Armoured Corps, R.T.R, from 1945 to 1946. He had spent some time in Greece as part of the tank corps, and had also been a Lieutenant at the W.O.S.B Camberley. He had been conscientious about the army, making some good friends there.
Clinical records suggest that his attacks resulted in him talking for several hours on religious issues, and he believed himself to be Jesus resurrected. The records also suggest that his interest in religion had increased since being overseas, as part of his military experiences. His obsession with religion was also attributed to his membership of the Oxford Inter-Collegiate Christian Union, and his “feelings of personal inadequacy in that group”.
ECT was discussed but ultimately it was not carried out. Instead, the patient was transferred to St Ebbe’s Hospital at Epsom, Surrey in July, and in November, he returned to Brasenose. His parents had pushed for his transfer so that they could be closer to him. At the same time, it was argued that his transfer away from Oxford would also decrease the pressure from his brother, who became his de-facto guardian at Oxford. The transfer took place after a series of letters exchanged between his parents and the doctors at the Warneford. Significantly, discussions revolved around the need to bring the student closer to home and whether care at the transferred destination would be as good as at the Warneford. Epsom was finally agreed upon because it was agreed that there would be no reduction in the quality of treatment. In one of the letters, the student’s father wrote, “but if Warneford is the best place then I don’t care two hoots about the price…[the student] should have the best advice available.”
Patient D:
This case illustrates the ways in which the combination of war, childhood experiences and post-war conscription could affect a person’s mental health and subsequent admission to a mental hospital. Patient D was a student at Wycliffe College, Gloucestershire and a resident of Witney, Oxford. He was around 18 years old when he was admitted to the Warneford for the first time, in October 1945. Between October 1945 and February 1946, he was admitted and discharged twice, the second admission being on an Urgency Order. His first admittance had occurred when he had had a breakdown after rebuking one of his teachers at school for punishing another student “unjustly”. Doctors found that his first depressive episode had taken place at the age of 14, when he was in the United States, where he had been evacuated during the War along with his twin brother.
A report dated 3rd November, written during his first admission, suggests that he refused sedatives at that time. However, the notes indicate that in December, his medication included a mixture of morphine and hyoscine sedatives which induced a “twilight sleep”.
The patient was reported to be an adherent of Christian Science, a 19th century movement which emphasised the rejection of medical interventions and focused on the power of prayer and spiritual healing. It is probable that the patient’s interest in Christian Science was prompted by his experience at The Principia—a school in Saint Louis, Missouri, founded on Christian Science principles, where he had studied when he was in America. The interest in Chrisitan Science helps to explain his refusal to accept medical treatments, which was further compounded by his strong belief in individual liberty and justice. [a letter from the President of the school to the Warneford, thanking the UK for supporting the US in the War, is attached to this email].
In September 1946, discussions arose about his status in the context of post-war conscription to the armed forces. Although the War had formally ended in August 1945, the Ministry of Labour and National Service, set up by the Labour Government, declared in 1946 that conscription would continue for four more years to maintain a strong army in peacetime. The Oxford branch of the Ministry enquired of Dr McInnes, who oversaw Patient D’s case, about the patient’s mental health history in this context. McInnes noted that although the patient’s illness had “cleared almost entirely”, the patient had had “poor insight” into his illness. McInnes thus advised against engaging him in the services on account of his “psychiatric history”. Later notes suggest that Patient D was an outpatient from 1952 to 1954.
One of the most noteworthy aspects of this case is a letter that the student wrote during his first internment at the Warneford. Dated 23rd November, 1945 it is both poignant and painful, capturing a voice that is trying to negotiate the currents of circumstance and selfhood. It reads:
Dear Sirs,
Since Doctor Bergere(?) seems to think that I have suffered a relapse and does not respect my point of view, I can only write down my point of view. Why do I have to wait for the Doctor’s orders? I am not taught to rely on medicine, surgery, phsycology [sic] or any other mental mind reading. What authority does he have to dominate my body, my mind and having tried material, mental treatments. I am as sound in my mind as he is, for I wouldn’t attempt to dispute his arguments if my reasoning was conveyed. Physically, I am sounder than most people here. Coercion is not cooperation. My body is not a machine for doctors to find fault with, nor is my mind. If God gave me a conscience, a mind to think with, with a body to serve it, is the Doctor right in challenging my sensibility. Respect earns respect. I cannot respect those who do not respect me. Have I, a fellow human being, no say in my own thinking and actions. If I lack those [illegible], what have I to prove I am a man. I need practice (?) If I can think for myself, did God create me as a tool for others’ use and vote? I am no helot, no serf, no slave bought with money. I am free and therefore act accordingly. [image attached]
