Looking back on the history of his profession, the psychiatrist Dr Ronald Sandison (1916-2010) wrote that ‘during that all-too-brief post-war period it seemed that a golden age was developing in psychiatry’.[i] Undoubtedly, the mid-twentieth century was an era of unprecedented experimentation in this branch of medicine, which had failed to keep pace with other medical disciplines in the pursuit of scientific certainty and technical advances. The world wars, however, brought the psy-disciplines (psychiatrists, psychotherapists and psychologists) recognition as an indispensable body of expertise capable of providing guidance and interventions in the conduct of human affairs, with potential applications in areas such as the military, advertising and marketing, industrial relations, education, politics and international relations, as well as promising treatments, even cures, for mental illness. There was increasing integration of psychiatry into general medicine, which was greatly assisted in Britain by the inclusion of mental hospitals within the administrative framework of the National Health Service, created following World War II. The post-war period in psychiatry was an era of unmistakable therapeutic optimism, administrative reorganisation, changing professional and social attitudes towards mental illness, and diverse clinical and research developments. It was also a time when some psychiatrists were increasingly prepared to offer commentary and analysis of social, cultural and political matters, with a few gaining the high profile of public educators, social commentators and critics.[ii] But for the patients of Powick Hospital in Worcestershire, where Ronald Sandison worked in the 1950s, it followed darker, less hopeful, times.

Writing in his unpublished autobiography, Sandison notes that ‘it is sad to recall that some of the attempts to substantiate the doctrine of a universal organic basis for mental illness were naive, often to the extreme’.[iii] When Sandison joined Powick as consultant psychiatrist and Deputy Medical Superintendent in 1951, he ‘observed the tragic results’ of such an attempt inspired by Dr Thomas Chivers Graves.[iv] Dr Henry Felix Fenton, the Medical Superintendent at Powick from 1920 to 1950, ‘had been a fervent disciple of Graves’.[v] Sandison points out that Graves was elected President of the Royal Medico-Psychological Association (RMPA) in 1940, but suggests

“Perhaps the best one can say about that distinction is that most of his more distinguished colleagues were in the Armed Forces. His presidential address is almost impossible to understand. He strung together a group of widely differing physiological processes, including his views on the mode of the spread of infection through the body, which suggest a mind far removed from reality. Furthermore, he gave no hint that the drastic surgical and chemical measures he subjected his patients to did any good.”

— Sandison, In-Tide-Out, Chapter 2 ‘My Training Years (Continued): Making Sense of Madness’. p. 3. PP/SAN/A/1.

In the year prior to Graves’ election at the RMPA, the famous Swiss psychiatrist Carl Gustav Jung had come to the Royal Society of Medicine to address the Section in Psychiatry. There he recalled that twenty years earlier he had given a paper to the Society on ‘The Problems of Psychogenesis in Mental Disease’, noting that ‘what I had said then about psychogenesis could safely be repeated today, for it has left no visible trace, or other noticeable consequences, either in textbooks or clinics’.[vii] Although Sandison had served as a physiologist in the RAF during World War II, studying the medical problems of flight, he found that the young pilots he worked with often felt able to unburden themselves of many problems which troubled them. Sandison had a capacity to listen to and empathise with them. His approachability served him well in the long career in psychiatry which followed his war years in aviation medicine; but it also encouraged him to gravitate towards the approach of the talking therapies employed by psychodynamic psychiatrists, who were more prevalent on the continent during his formative years as a trainee psychiatrist, than in England, where psychoanalysis was often disparaged. As a student in the 1930s, Sandison had attended lectures on psychoanalysis by J.A. Hadfield, ‘a religious man’ who ‘tried to combine psychodynamics with an exploration and understanding of spiritual values’.[viii] Sandison was fortunate to begin his career in psychiatry at Warlingham Park Hospital, an institution ‘where almost every shade of current psychiatric practice was present’ and where many training opportunities were available, especially due to its close proximity to London and other nearby centres of psychiatric and psychotherapeutic teaching and innovation.[ix] There he met and worked alongside a number of Freudian and Jungian analysts, including some influential refugee psychiatrists from Europe. There was ‘a very strong psychotherapeutic flavour to the hospital culture’.[x] When Sandison joined Powick in 1951, he had only been working in a mental hospital for five years. It was a rapid career rise, but he would not have had the opportunity had it not been for the failure of his Powick predecessor as Deputy Superintendent to live up to expectations, leading to the predecessor’s dismissal within a year of being appointed. Dr Arthur Spencer (1907-1979), the Medical Superintendent appointed to Powick in 1950, allowed his new Deputy, Sandison, to assume a role of great responsibility, allowing him to take the lead in the clinical direction of the hospital. Although they came from different backgrounds personally and professionally, during the 1950s and early 1960s, Spencer and Sandison worked as a partnership when they sought to transform Powick from a dismal backwater into a modern hospital.

Sandison was a Shetland-born man who came into psychiatry as he was approaching his third decade. In a similar way, Arthur Spencer, a Welshman, came into medicine late, following a short career in pharmacy. These outsiders, like many who came to Worcestershire, were seduced by its rich religious and cultural heritage, and they fell in love with the beauty of its landscape. Spencer was a Baptist lay preacher and had been a socialist activist, though Sandison described him as a ‘realist’.[xi] Although his political outlook seems not to have been explicitly expressed in the course of his work at Powick, Spencer’s efforts towards social improvement clearly carried over to his management of the hospital. Spencer qualified in pharmacy at Bath and later graduated with a BSc at Cardiff University while practising as a dispensing pharmacist. He had been attracted to medicine as an intending missionary and qualified at Bristol University in 1937, winning the gold medal in surgery. Prior to his appointment at Powick he held resident posts before becoming Deputy Medical Superintendent of St David’s Hospital in Camarthen, Wales. His main interests outside his work were music and the theatre. Sandison, on the other hand, had a distinguished wartime career as head of the Physiological Development Panel at Central Fighter Establishment. He was demobbed in the rank of wing commander and was mentioned in despatches, an unusual honour for a non-combatant. At the end of the war, he returned to Warlingham Park, where he had started his medical career at the beginning of the war as house physician to the Emergency Medical Service. He had won the prize for surgery in his year as a medical student, but he wrote that ‘something strongly held me back from pursuing it’.[xii] Sandison also had a passion for the arts and music, and he was involved in developing art therapy at Warlingham, where he also worked alongside Arthur Zanker, a refugee from Vienna and Adlerian child psychiatrist who had been a member of the Viennese Philharmonic Orchestra, and was developing music therapy. These experiences and interests fitted well with Powick’s cultural tradition of music in the nineteenth and early twentieth centuries, when all male attendants appointed to the asylum had to be able to play a musical instrument and where Sir Edward Elgar had worked for seven years in the 1870s and 1880s, including a spell as bandmaster. The tradition of music continued at the hospital with the encouragement of the new leadership, and Powick had its own resident pianist ‘touring the wards in the afternoons and evenings playing for the patients’.[xiii] On more strictly medical matters, Spencer’s background in pharmacy made him open to experimentation with the burgeoning pharmacological agents becoming available to psychiatrists in the 1950s and 1960s, and representatives from pharmaceutical companies frequently attended Powick to promote their wares. Sandison was not averse to employing the so called physical treatments either, and he had much experience of electro-convulsive treatment and insulin coma therapy at Warlingham, but he always took great pains to emphasise the need to employ these treatments in conjunction with psychotherapy. When Sandison and Spencer were brought together at Powick, they had a mutual respect for one another, some shared cultural interests and a common goal to improve social conditions, human relations and medical treatment at the hospital. Their commitment to a holistic social medicine and their insistence on seeing patients’ problems in a wider context, from the situation of the family nexus to the wider social and cultural environment, enabled them to see eye to eye in their pursuit of reform at Powick.

Perhaps no other hospital typified the winds of change blowing through mental hospitals in mid-twentieth-century Britain as much as Warlingham Park did. Sandison had quite a prototype to work from when evolving his therapeutic ethos and devising his clinical plans for Powick. Warlingham’s Superintendent T.P. Rees (1899-1963) had made a great impression on Sandison, and it was from him that he learned something about how to run a mental hospital. According to Sandison, ‘he was my mentor, my father figure, my teacher and just full of words of wisdom’.[xiv] ‘There was’, he said, ‘a side to Percy Rees that was expansively at home with risk taking’ and ‘this extraversion was controlled by an intuition which somehow magically ensured that he nearly always did the right thing at the right time’.[xv] For Sandison, Rees was ‘a man of great intuition’ and ‘a great man for introducing the latest innovations into his hospital’.[xvi] These were traits which rubbed off on Sandison, and they were evident when he began to work closely with lysergic acid diethylamide at Powick. Sandison notes that Rees’ ‘rather shy, friendly and genial approach appealed to me’—not least because it chimed with his own personality.[xvii] Rees was also ‘convinced that an appreciation of the arts was the road to sanity’.[xviii] Although he wrote little, Rees, another Welshman, had a profound impact on the direction in which mental health services travelled in twentieth-century Britain. He sat on the Feversham Commitee, formed in the 1930s, with a remit to consider the scope and activities of the law affecting existing voluntary organisations rendering mental health services. The findings of its report led to the formation of the National Association of Mental Health and an expansion of psychiatric outpatient services. Rees was awarded an OBE in 1949 and was an advisor on mental health to the World Health Organisation in the early 1950s. His obituary in the British Medical Journal notes that on the day of his appointment as Superintendent at Warlingham, Rees ‘gave orders that the gates of the hospital were to be unlocked and permanently to stand open’.[xix] He was a friend of fellow Medical Superintendent George MacDonald Bell, a pioneer of open-door wards at Dingleton Hospital in Melrose, Scotland. Rees was ‘an early and persuasive advocate of the “open door policy”, with its emphasis on permissiveness, activity and the preservation of the patient’s personality’, and he ‘pursued an “activist” policy, making a trial at an early stage of all the more promising new treatments and greatly improving the morale of the hospital’.[xx] The BMJ obituary remarks that in the historic report of the Royal Commission on Mental Illness (published in 1957) which led to the 1959 Mental Health Act, ‘between the anonymous lines […] it was not difficult to detect the pervading influence of Rees’.[xxi] According to Rees, ‘people come to a mental hospital to learn how to live’. This was a world apart from Powick under the influence of the surgically-minded Graves and Fenton, where people came to the mental hospital to have body parts removed.

The approach which Rees took to running a mental hospital was by no means the norm in wartime and immediate post-war Britain. Sandison would later remark that in 1952, the year he encountered LSD, the presidential address of the newly elected president of the RMPA, Dr P.K. McGowan, ‘was noteworthy only for stating, in effect, that he had no idea where psychiatry was going’:

“He reiterated old ideas such as physical treatments are better than psychotherapy, that early treatment was desirable, and that the only research worth doing was biological and should be stepped up. This barren attitude allowed the latest toy, the electroencephalogram (EEG) to be used for all sorts of investigations for which it was poorly designed.”

— Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 3. PP/SAN/A/1.

Sandison believed that ‘the reporting of the state of psychiatry descended to an even lower point’ later that year when Dr Desmond Curran ‘drew attention to the interest that psychiatrists were beginning to take in the wider world and the major social issues of the day, but he condemned these are irrelevant, while at the same time adversely criticising nearly all psychiatric treatments, especially psychoanalysis’.[xxiii] Even then, Sandison recognised that Warlingham Park, where he had trained, ‘belonged in the vanguard of that movement whose essence was experiment and the breaking of boundaries’.[xxiv] It was his belief that ‘dismantling cultural and physical boundaries has much to commend it provided that the affected individuals are able to replace these with a psychic and personal morality’.[xxv] In a 1959 lecture he declared that ‘the modern experiment of psychological and “moral” treatment for psychosis is T.P. Rees and we are indebted to him for a brilliant survey (1956) in which he traces the degeneration of the psychological methods of the 18th and early 19th centuries into physical care and materialisation concepts from which they have only recently been rescued’.[xxvi] Rees had called for a return to moral treatment of early Victorian times in his RMPA presidential address in 1956, but as medical historian Michael Neve has noted, ‘in general and especially in Britain, psychotherapies were seen by mainstream psychiatry in the first half of the twentieth century as inadequate in one crucial regard, that of the long-term chronically ill asylum patient’.[xxvii]

However, like many psychiatrists of that immediate post-war era, when the social and psychological consequences of war were keenly felt and when greater attention was paid to how the setting of the mental hospital could contribute to patients’ problems, Sandison was acutely aware that ‘one of the most important factors to emerge is that almost all conditions are influenced by the environment, some to a most significant degree’.[xxviii] In an undated essay from the 1950s or 1960s which served as an introduction to a discussion with Powick staff on the effects of the environment on the outcome of psychiatric treatment, Sandison remarked that ‘recent papers indicate that much study is being carried out and that more is needed on the social groups forming the background of the patient’s treatment’.[xxix] He stated that ‘it is well understood that it is mental illness that first robs the patient of his drive and initiative, but that later it is the environment of the hospital that prevents the patient from recovering and turns him into a chronic slow-moving automaton’.[xxx] What was remarkable about Warlingham Park was the sheer range of interventions being undertaken. There was no dogmatic adherence to any single theoretical or practical model. But, as well as being open to eclectic experimentation, T.P. Rees was very much taken by the therapeutic community movement then emerging in psychiatry, which sought to return to the ethos of the asylum as a community to which patients contributed. According to Sandison, ‘Rees, considering as he did, the hospital as a whole, was much influenced by the work of Tom Main, Maxwell Jones and Joshua Bierer, which made him determined to manage the hospital as a therapeutic community’.[xxxi] The diversity of approaches to which Sandison was exposed as a trainee was reflected in the early research papers he wrote in the late 1940s and early 1950s, covering topics including the psychology of electric convulsive treatment, the group and insulin coma treatment, social rehabilitation, social clubs, art therapy, Jung and group therapy. These early unpublished essays, lectures and published articles from his period at Warlingham and the early years at Powick, help to shed light on the vision Sandison had for Powick Hospital in the 1950s. They also reveal much about the manner in which he became the leading, but low-key, pioneer of LSD therapy in Europe. Sandison embraced modern experimental treatments and was engaged in activities aimed at social rehabilitation, but he was also committed to returning to, and reviving, forms of therapeutic relationship, social organisation and moral community, which had for some time lain dormant within and beyond the walls of the asylum. In order to understand why Sandison and Powick led the way in LSD therapy in Britain and Europe, one first has to understand the vision he had for the hospital, which was pivotally shaped by his training years.

Although Warlingham was ‘in the vanguard’, Sandison believed the mental hospital could provide a ‘stable and traditional culture’, and was a ‘solid pillar of wisdom of the utmost value to the patient who can accept it and gain help from it’.[xxxii] He recounts that ‘from the beginning the care of the insane has been a matter for cultural and religious centres’ and that ‘in earlier times the monasteries cared for the mentally ill, directing their work towards this cause in the case of certain orders, such as the Monks of Bethlehem’.[xxxiii] But, he writes, ‘following the dissolution of the monasteries, and later, in the eighteenth century, the asylums became degenerate and mostly devoid of tradition and culture’.[xxxiv] Alluding to the community at the York Retreat, established by the Quakers, he noted that a ‘revival towards the original principle occurred in the last century which had religious roots in one instance’.[xxxv] Of his time at Warlingham, Sandison suggested that it was there that he ‘understood how the modern mental hospital of the day had evolved from monastic institutions’ and he thought that those with whom he had trained ‘were deeply committed in a monastic sort of way’.[xxxvi] Worcester’s history as a cultural and religious centre was one of the things which attracted him to Powick. Located in the ancient border country of Worcestershire, the hospital was at the centre of what he termed an ‘ecclesiastical triangle’, close to the sites of ancient religious communities and cathedrals, ensconced deep in the heart of ‘quintessential visionary England’.[xxxvii] Sandison remarked that when he went to Powick, he ‘wanted to create a decent hospital, which was modelled on Warlingham Park, but a bit more than that’: ‘I wanted to get a therapeutic community group, I wanted to get some group work going. And I wanted to get some individual psychotherapy going’.[xxxviii] Powick he said, was ‘a monastery that God had abandoned, and the monks were automatons obeying the last vestiges of ancient traditional rites’.[xxxix]

Sandison was particularly struck by remarks in a 1953 World Health Organisation report of which Rees was co-author, and made much of this in the instructions he gave to the hospital staff at Powick and his overall approach to changing the hospital culture. In The Community Mental Hospital Third Report of the Expert Committee on Mental Health, it is argued that ‘the need to provide more psychiatric hospital beds is being over-emphasised at present in some countries of western Europe and North America to the detriment of the provision of other services which would reduce the need for the admission of patients into psychiatric hospitals or alternatively reduce the length of stay of those patients who must be admitted’.[xl] ‘There is no doubt’, claimed the report, ‘that in the past too much attention has been given to the mere provision of further psychiatric beds and too little to the development of a real community mental health service’.[xli] The report went on to state that ‘too many psychiatric hospitals give the impression of being an uneasy compromise between a general hospital and a prison’; ‘whereas in fact, the role they have to play is different from either; it is that of a therapeutic community’.[xlii] Powick fitted the mould of a place which appeared to strike a compromise between prison and hospital, not least because the design of its main elevations were modelled on Pentonville Prison. Sandison was impressed by the WHO report’s description of what makes a good hospital, namely, that ‘the most important single factor in the efficiency of the treatment given in a mental hospital appears to the Committee to be an intangible element which can only be described as its atmosphere’.[xliii] Papers and talks by Sandison in the 1950s indicate that this was something he was keen to impress upon hospital life at Powick.[xliv] Inevitably it would have to evolve in an organic way, but he also saw it as something to be reflected upon and integrated into a way of seeing, a vision for hospital life, which could be shared by all who worked there. It was the sort of situation that had to be cultivated carefully over time, rather than something that could be quickly or easily enforced by an act of will, by technical means, or procedural rules alone. This ‘atmospheric’ element and its intangibility, so far from any notions we have of ‘efficiency’ today, was at the forefront of Sandison’s mind in his attempts to develop the therapeutic ethos of Powick Hospital. He pursued this in what he described as an ‘oblique’ way, and he believed the pervading mood and tone of the place formed the backdrop against which the hospital’s therapeutic endeavours were undertaken, and helped to determine their success or failure.[xlv] For Sandison ‘the concept of the therapeutic community means that the activities, thoughts, ambitions, emotions and private lives of every member of the hospital, staff and patients alike, are bound up in the treatment situation and that for better or worse, they influence the mental condition of the patient’.[xlvi] Tom Main had coined the term ‘therapeutic community’ and the concept had been developed by others such as Maxwell Jones and Joshua Bierer, from whom Sandison had learnt on visits to their units in the late 1940s, early 1950s.[xlvii] Jones’ unit at Belmont Hospital was only a mile from Warlingham, and was for Sandison ‘a great, if charismatic, resource’.[xlviii] Sandison ran therapeutic social clubs at Warlingham modelled on those conceived by Bierer, in which his aim ‘was to involve every member in some aspect of the functioning of the club, to promote social relations between members, and to encourage members to take responsibility’.[xlix] These principles supported changes in the power structure of mental hospitals, encouraging more open communication, which ‘resulted in some flattening of the hierarchical relationship between doctors, nurses and other staff, and the patients’.[l] When the American psychoanalyst Harry Wilmer came to England and visited Belmont Hospital, the Cassell Hospital (where Main worked) and Warlingham Park, he later remarked that there he ‘saw what I believed was the future hope of psychiatric hospitals’.[li]

Sandison suggested that ‘methods of treatment may fail unless the environment of the hospital is at once secure, permissive, and mature, unless the staff are working as a harmonious team and some part of the organisation is directed towards helping the patient to reestablish himself outside hospital’.[lii] The emphasis on purposeful work was a significant feature of Jones’ model of the therapeutic community, and this was very much mirrored at Warlingham, where great effort was made to build links between the hospital and the community it served in Croydon. Writing at the beginning of the 1950s, Sandison asserted that ‘there is no panacea for making a patient at one with society’.[liii] But, he claimed, ‘there is, however, a kind of transcendent function which, once obtained and used, enables a man to relate himself to the various aspects of his social life. We may compare this function to the mysterious inner power of subjective understanding that the more introverted patients have’.[liv] He believed that ‘one of the dangers of mental hospital recreations is that they place the patient in an altogether too passive role’:

“It is a vital matter that the patient shall work. I do not just mean by this that he shall be physically employed, although there is great value in occupation. I mean he shall make a positive contribution to the group to which he is a member. Only thus can he work out his salvation and adjust to his fellow men and women.”

— Sandison, The Re-socialization of the Psychiatric Case, p. 90.

Occupational and recreational therapy, therapeutic social clubs and group therapy were then in the ascendancy and were introduced at Powick, but Sandison was also very interested in Jung and he lectured on him at the beginning of his time at the hospital. He saw Jung as a great source of understanding and inspiration, not only in addressing individual psychological problems, but also in facing problems of wider ethical, social and cultural import, which he recognised as having great impact upon the spirit, vitality, health and well-being of the wider population. Jung, he said, reminds us that modern man ‘is constantly struggling to make two adjustments’, one ‘towards his own psyche’ and the other ‘towards the external world’.[lvi] ‘These two paths’, wrote Sandison, ‘are to some extent antagonistic’.[lvii] Anyone who ‘neglects one in favour of the other is in danger of becoming one-sided’.[lviii] Sandison recognised that the pursuit of the good life, of health and wellbeing, must satisfy those sometimes antagonistic, but distinctly human needs, for inner personal and spiritual growth on the one hand, and for meaningful relationships, for belonging, communal participation and the fulfilment of social obligations, on the other.

Sandison was ‘seeking to develop in the patient his transcendent capacity to come to terms with the realities of the social and moral structure of our times’.[lix] ‘Furthermore’, he added, ‘amid the disturbed framework of modern society we must count of value only those principles which are in accord with man’s soul’.[lx] He was of the view that, ‘fortunately, it seems likely that certain activities, amongst which art and music have a high place, bid fair to help patients with varied needs towards a common adjustment’.[lxi] The aim of the art group Sandison worked with at Warlingham was to give the creative urges of individuals ‘some direction and to attach them to some real values’.[lxii] It appeared to Sandison and his colleagues that

“the fundamental neurosis of our time in young people involves a clash between material and spiritual values, i.e., the pressing needs of making a living in an industrial and mechanical age come into violent conflict with the urges of the individual toward working out his life in terms of ideas, creative imagination and an understanding of events of universal significance. The increasing demands of materialism and the decline of the tying of spiritual values to the church has resulted in an ever-widening breach occurring in the minds of large numbers of intelligent individuals. Thus the creative urges of these individuals have lacked direction and therefore become diffused or unproductive.”

— Ronald Sandison. 1953. Psychological Disturbance and Artistic Creation. The Journal of Nervous and Mental Disease. Vol. 117, No. 4. p. 320.

In marked contrast to the outlook which prevailed at Powick under Fenton prior to the 1950s, Sandison was attentive to the fact that

“it has long been recognised that man’s social needs as well as his physiological needs are important for his mental health. These social needs are recognised as being needs which stem from the conditions of the human situation, and they are the need for relatedness, transcendence, rootedness, the need for acceptance and love. The great passions of man, his search for truth and love, his destructiveness as well as his creativeness, is rooted in this specific human nature. His solution to his social needs depends for the most part in the way the society is organised and how this society determines the human relations within it. ”

— Ronald Sandison. 1958. Recent Sociological Changes and the Development of Social Service within the Framework of Modern Society. A lecture given to an unknown audience. PP/SAN/D/3.

The values of hard-nosed materialism and possessive individualism were in Sandison’s sights as he considered the pressing need for a social psychiatry which recognised the structural limitations and dislocations imposed on human instincts and communal ties by a modern world unmoored from settled social bonds, untethered from natural, cultural and spiritual roots and values. He saw the Fenton regime as exemplifying a barren Gradgrindian outlook, a cold dissecting attitude and calculating acquisitiveness, devoid of a dwelling spirit or group feeling, and lacking overarching moral purpose or compassionate human relations. Sandison remarked that ‘the aim of the whole social-economic development of the West is that of the materially comfortable life, and yet it is these same countries which show the most severe signs of unbalance’.[lxv] This, he thought, ‘raises the question as to whether there is not something fundamentally wrong with the society we live in and that modern civilisation fails to satisfy the more profound needs of man’.[lxvi] That said, however, even the most basic material needs for warmth, food and physical comfort, were poorly catered for at the hospital under Fenton. On his arrival to Powick in 1951, Sandison found that the hospital ‘was a big contrast to the well-organised institution run on the open-door principle with its strong team of analytically orientated psychiatrists that I had left’.[lxvii] ‘Powick’, he lamented, ‘stood out like a Victorian workhouse surviving into an age when innovation and progress were stirring everywhere’.[lxviii] But, by 1954 the Worcester Evening News was able to report that while in 1950 there had been only 150 admissions to Powick, in 1953 there were 540 admissions, 82% of whom came in as voluntary patients.[lxix] ‘Every year’, the newspaper detailed, ‘90% are discharged, cured or greatly improved within a few months of admission’.[lxx] Out-patient clinics were held at the general hospitals in Worcestershire, with 1000 patients attending each year, and an additional 5000 persons receiving out-patient treatment. The newspaper report concluded that ‘like most other enlightened and progressive mental hospitals, Powick is doing away with the principle of the locked door, and moving towards the goal of becoming a hospital of open wards’.[lxxi]

Reflecting on the time when he first came to the hospital, Sandison remarked that ‘Powick had a family tradition which was both a redeeming feature among the ruins and a bar to progress’.[lxxii] He recalled that ‘generations of families of nurses had been born and nurtured in Hospital Lane, most of whom followed their parents into the service of the hospital’; and ‘as there was no Nurses’ Home, the ward sisters and many of the Charge Nurses slept on their wards, which became their homes’.[lxxiii] ‘The nursing staff were dedicated and kindly’, wrote Sandison, ‘but traditionally they and their sons and daughters had worked all their lives in the hospital, creating an incestuous, closed and monastic feeling’.[lxxiv] He ‘found that the classification of patients was haphazard, there were no admission villas and no provision for the care and treatment of voluntary patients, that is those who suffered form neurosis rather than psychosis’.[lxxv] There were, however, several empty wards which were well designed and suitable as admission wards. ‘The staff’, he said, ‘had to be persuaded that the more civilised the appearance and practice in their ward the better the patient’s behaviour’; and ‘despite years of brain washing under Fenton’, wrote Sandison, he ‘discovered that the nursing and other staff were deeply loyal, anxious to explore new ideas and skilful in their relationships with the patients’:

“F8 was relieved of many patients suffering from neurotic disorders by the opening of F9. The ward above F9 was opened as a nurse training school which the hospital had lacked for many years. I reclassified a small ward F5 as an admission ward for psychotic patients. This ward had been designed on the John Conolly pattern, with many single rooms. Conolly working at Hanwell Asylum, was convinced that disturbed patients could best be calmed by removing them to a single room for a limited period. He ensured that his staff did this in a way which maintained human contact and preserved the dignity of the patient. In my day those single rooms, opening as they did on to the main day room, were much appreciated by both patients and staff.”

— Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 8. PP/SAN/A/1.

Sandison recounts that ‘at the earliest date I established a psychotherapeutic stance both at Powick and in my outpatient clinics in Worcester and Evesham’.[lxxvii] There was a clear change of direction at the hospital, as the new leadership worked at reviving inherited traditions whilst also breaking with the past. But Spencer and Sandison were under no illusions about the limits to reform imposed by budgetary constraints, overcrowding, and shortages of staff and resources. At a meeting of the Birmingham Medical Institute in May 1957, a round table discussion between Spencer, a general practitioner and a prison medical officer, addressed the question ‘What are mental hospitals for?’ Spencer asserted that mental hospitals were ‘unfit for human habitation, and quite inadequately staffed—indeed, because the admission rates had risen and the number of staff if anything had declined, standards of care were going down’.[lxxviii] He added that ‘there was still a pauper outlook; there was no privacy, no culture; people became dehumanised in the vast mid-Victorian wards’; and many ‘people had their liberties restricted because the hospital had to house a few dangerous patients’.[lxxix] He noted that at Powick 90 men were locked up in the only closed ward of the hospital because twelve of them at most might escape and cause trouble.[lxxx] Spencer thought that mental hospitals ‘ought to be a lot smaller—about 200 beds each, perhaps— with the dangerous people segregated in a special hospital and mental defectives excluded’.[lxxxi] Sandison was more wary about wholesale attacks of mental hospitals as they were then constituted. With estimable farsightedness, Sandison noted in discussion with Powick staff about the hospital environment:

“as the hospital in its present physical form, with a few modifications, will remain the milieu of the treatment of tens of thousands of mentally ill people each year during the working life of all of us, it would be profitable to examine these problems of interpersonal relationships within the hospital common to us all. Thus it is not enough to pull down the whole edifice of the mental hospital without knowing with what to replace it. ”

— Sandison. An essay which introduces a discussion on the meaning of the phrase ‘The atmosphere of the mental hospital’. Undated, probably 1950s or early 1960s. Handwritten version in PP/SAN/D/3 and typed version in PP/SAN/D/6.

It is clear from many of Spencer’s pronouncements during his time at Powick that he had no qualms about airing the shortcomings of mental hospitals in public, no doubt motivated by the hope that more support for these institutions, and Powick in particular, would be forthcoming as a result. Perhaps these public comments sometimes risked overshadowing the unmistakable improvements which had been made, and Spencer may have appeared to unfairly downplay, overlook, or diminish, the determined efforts of nursing staff to achieve better conditions. He famously, or infamously, appeared on the World in Action television documentary program in 1968, in which he drew attention to the plight of those long-term patients living in the large impersonal wards at the hospital, allowing cameramen freedom to film, with some patients appearing on camera as they sat on commodes; whilst other patients were captured in states of distress and undress, provoking some controversy at the hospital and beyond. Some of the language employed in the past will sound pejorative and stigmatising to present-day ears, and the images broadcast on the documentary shocked people when it was aired on national television in the late 1960s. The film still has the power to move viewers today and Spencer comes across as man who was looking to raise into public consciousness the kinds of conditions with which patients had to live. He saw national television as an appropriate way to appeal to the wider public to see this as something which they could not wash their hands of. He also communicated the more positive side of Powick via the local press, but his use of the media to carve a place in the community for the hospital went hand in hand with its use for public education, social commentary and criticism, as he hoped to wield some cultural influence. The ordinary mental hospital, Spencer commented back in 1957, was forced to mix psychotics with mental defectives because of a shortage of beds in mental deficiency institutions. But he thought the mental hospital existed for more than active treatment, that it ‘ought to accept the chronic patient who made his relatives’ lives intolerable to them, and it ought to take the mother suffering from a puerperal psychosis’.[lxxxiii] There was also what he called the ‘“inadequate biological variants”, people who could not cope emotionally with the complex responsibilities of modern life and craved an asylum’.[lxxxiv]

When the Berrow’s Worcester Journal published a series of reports on Powick Hospital in 1962, attention was given to what had ‘been achieved in making these brick buildings as pleasant, welcoming and efficient as possible without complete structural recasting’.[lxxxv] It was reported that ‘although much alteration has been undertaken (and still is being done as the plethora of ladders and building material show), the main transformation has been done by the lavish use of paint (light fresh colours with contrasting doors) bright curtains and cushions and other soft furnishings and the provision of TV sets, pianos, radios and other aids to fuller, gayer living’.[lxxxvi] The wards were described as ‘bright, airy and homely—odd, indeed when one considers they retain their long, narrow design, although little rooms once used for the most difficult patients and now single rooms for the least difficult, on one side and a lounge jutting out at angles, give some variety’.[lxxxvii] The journal reported that some wards had direct telephones to the outside world and that ‘patients can, and do, phone their friends and relatives frequently’.[lxxxviii] Most patients were able ‘to wander freely in the grounds, or venture out into the village and even further to Worcester’.[lxxxix] Spencer told the journalist that ‘patients are persons and must be treated as such’.[xc] The report went on:

“Patients were not treated as numbers or as prisoners. ‘We don’t count heads’, one of the charge nurses told me, adding that he could not say where all his patients were at a particular time in the day. They could be with a working group, busy at an art session, just be sitting listening to the radio or reading, or even out enjoying the air.”

— Anonymous. 1962. The Story of Powick Hospital. The Experiments in Freedom for Patients. Berrow’s Worcester Journal. Friday 13 July.

Likewise, the Worcester Evening News reported in 1968 that ‘a programme of internal modernisation and minor extensions’ had been carried out, ‘particularly to let in more light and to give patients views to the Malvern Hills’.[xcii] Given the emphasis placed by Spencer and Sandison on the environment as a determinant of mental health and illness, the hospital was made as comfortable as possible for its inhabitants, by minimising security and jail-like features, and by maximising the potential of decorative features to add to the general positive feeling of the institution. The high prison-like walls surrounding the hospital grounds were knocked down. Most importantly, they hoped to improve the contact between staff and patients, and between the hospital and local communities. They did this through repurposing of existing hospital space, by expansion of outpatient services, by imbuing nursing staff with a more relaxed and accommodating attitude, and recruiting new staff from far and wide; by holding social events such as tea parties and sports days, involving families in the treatment process, and making visiting times and access more flexible. Nevertheless, the fact remained that in the large annexe wards where many long-term residents of Powick passed much of their lives—often without visitors—the beds were closely packed into the barrack-like dormitories, making for an impoverished and restricted existence.

Sandison remarked that ‘in the rural areas nearby many patients still fear our hospital as the “madhouse” whereas they would contemplate entering more distant mental hospitals’.[xciii] He found that ‘in the north of the county, thirty miles away, no difficulty is experienced in persuading patients to come down here; whereas they will not go to the very hospital to which our Evesham patients are always asking to be sent’.[xciv] In line with his understanding of the problems of patients in the context of their familial and cultural milieux, it was Sandison’s belief that ‘one can make certain generalisations concerning the predominating types of neurosis which these different areas produce’:

“In the rural areas, particularly in the east, the pattern of family life is more primitive and less sophisticated than the metropolitan areas. The average market gardener is naturally suspicious in outlook. He tends to break down into a paranoid psychosis. He expects his wife to play an inferior role, to be his workmate and domestic servant rather than his companion and he is intolerant of any neurotic symptoms in her. Neurotic breakdowns amongst these young wives are very common and occur more frequently when the wife is not a native of the district.

In the industrial north of the county neurosis is more frequently of the depressive type. Inadequate personality, the frustration of the confined, narrow industrial towns with little relief except the cinema and television being predisposing factors.

Finally there is the special group of immigrants into the urban districts. These have brought an atmosphere of scientific culture which contrasts strongly with the quiet background of the county towns. This contrast is most striking in that group of towns which surrounds the Malvern Hills, one of the few remaining strongholds of Victorian and Edwardian culture which survive in England today. Here the old and new meet, and it is only here that we see anything like the sophisticated and possibly over-valued metropolitan culture which has come to be associated with so many aspects of our national, social and cultural life.”

— Ronald Sandison. 1955. Group Therapy in a Provincial Out-Patient Department. International Journal of Social Psychiatry. Vol. 1. No. 2. p. 29.

Some of the latter group mentioned by Sandison brought problems peculiar to the time and place. Less than ten years prior to the arrival at Powick of Spencer and Sandison, the country’s Telecommunications and Radar Establishment (TRE, later named the RRE, the Radar Research Establishment, then RSRE, Royal Signs and Radar Establishment) came to Malvern and was responsible for radar for the RAF and for the Fleet Air Arm.[xcvi] About 2,000 TRE personnel arrived, consisting of ‘the boffins’ (a term coined to describe the scientists working in Malvern), their assistants, women of the WRAF, electricians, machinists, fitters, administration and clerical staff, plus a large force of building workers at Defford airfield. The scientists were fit, young and intelligent men and women, and they lived either in the former County hotel in the centre of Great Malvern, or were billeted with families. The ‘boffins’ did not wear uniform during the war, and seemed to have no intention of joining the forces or helping the war effort at all. As a result, they were looked upon with suspicion and disliked intensely by the local community, whose young people had either joined the forces or the merchant navy and put their lives at risk, or were engaged in other war work. Of course, the scientists were helping with the war effort, but their work was top secret and could not be revealed to anyone. Their work on radar technology was integral to the success of Allied bombing campaigns, the D-Day landings and the detection of German U boats. The pressures of maintaining secrecy at all times, while incurring the disapproval of local inhabitants who did not know the extent of their contribution, put them under considerable strain and compelled them to lead a double-life. But Sandison, being attuned to such socially determined difficulties, was able to relate to these local peculiarities, not least because he himself had worked in a scientific and technical role in the RAF during the war; and as a Shetlander-in-exile since the age of five, he had acquired a profound sense of being far from his ancestral home, of standing, as an outsider, between, or at the edge of, clashing cultures and ways of life.

Sandison wrote that he and Spencer, for all their differences of background and history, ‘had a mutual rapport and mutual respect which I like to think continued throughout our professional association, which was to last 13 years [from 1951 to 1964]’.[xcvii] There is no question that their combined backgrounds, histories and interests, were conducive to the development of new forms of treatment and care. But wider social and cultural factors, including contemporary social reforms and developments in psychiatry, not to mention chance events, also played their part in the change of direction of the hospital. Sandison repeatedly highlighted that while Spencer had proved adept at securing support for Powick through difficult negotiation, coaxing and prodding of his hospital committee and the Regional Hospital Board, it was Sandison who had determined the clinical orientation of the hospital, encouraging a social psychiatric and psychodynamic approach to patients’ problems. It would be remiss not to remark upon the important fact that both Spencer and Sandison were practising Christians of a decidedly ecumenical cast, and they did much in their time at the hospital to develop close relations with local churches and clergy, which in turn led to the development of a regular Pastoral Theology Group meeting between Powick staff and local priests. There was a distinct pastoral dimension to the therapeutic ethos and practice of everyday life at Powick Hospital, but it was not alone in cultivating such an ethos, and the conversation between psychiatry and religious ministry was taking place in other hospitals in mid-twentieth-century Britain.[xcviii] As remarked upon by Sandison, monastic institutions were amongst the genealogical antecedents of the modern mental hospital, and he made efforts towards reviving some of the inherited features of these ancient communities, which he felt had been lost from the asylums over time. The close association with local churches and clergy led to the creation of the Worcester branch of the Samaritans, in which Sandison had a considerable hand. All these elements which addressed the spiritual, social, psychological and physiological needs of patients, were bound up with a vision of the community as a whole, in which the mental hospital played a part in the wider social body, in tandem with other local and national cultures and institutions. It is evident that Sandison saw spiritual guidance and moral support as falling within the purview of psychiatric care, but while P. K. McGowan may understandably have had no idea where psychiatry was going at the start of the 1950s, it was clear by the end of that decade of post-war social welfare reform that psychiatric treatment was beginning to move in an increasingly drug and brain-centred, biomedical direction.

The psychiatric profession in Britain became consumed by its medical status in the wake of the pharmacological turn of the 1950s, and its power had been significantly enhanced following the 1959 Mental Health Act.[xcix] Around the same time, critiques of institutionalisation were advancing, and calls were gathering from various quarters to close the old asylums built in Victorian times. No doubt the attacks on its traditional territories hastened the breakneck hurtle towards the embrace of psychotropic drug treatments in psychiatry. Notwithstanding the great advances in laboratory and clinical experimentation, and the demonstrable efficacy of novel substances in suppressing symptoms, particularly their success in quietening the unruly hospital back wards, this was driven in part by a status anxiety, a problem of identity.[c] There was a need on the part of some psychiatrists to be seen to be doing proper doctoring, to be recognised as belonging to the wider body of the medical profession; there was a desire to appear to be in the vanguard of biomedicine and the natural sciences, as opposed to being perceived as an outcast, scientifically suspect and technologically trailing, poor relation. As F.M. Martin observed, ‘this claim that psychiatry worked wholly within the traditional framework of medical science was in one sense an assertion of respectability, but it entailed a significant if not very tangible cost’.[ci] Unfortunately this led to a considerable narrowing of possibilities for psychiatric patients following a brief window of wider potential opened up after the war. Referring to both Warlingham and Powick, Sandison later acknowledged:

“We were fortunate to be part of a great post-war movement of social progress which resulted in the creation of many centres of excellence in the mental health field and its associated areas. Much of that urge for social improvement was ideologically led, but for many of us in medicine there was still enough individual freedom left. Thus we were able to take full advantage of new tools and new methods which had been generated by the necessities of war and which were now being debated, used and developed. I think here in particular of group-analysis, therapeutic communities and the new world of substances which, in various ways, allowed psychotherapists to explore the unconscious with their patients more effectively. This demanded a different, more open kind of psychiatric hospital. I already had a vision of what this might be from Warlingham; the rest would have to evolve.”

— Ronald Sandison. Letter to David Healy, 12 July 2002. PP/SAN/B/1/2.

Of the few accounts which have been written about the development of LSD therapy at Powick, little attention has been paid to wider social and material changes, at the hospital and beyond, which impacted upon its evolution; nor have existing accounts delved deeply into Sandison’s personal and professional biography. Without an appreciation of this background, it is difficult to understand why Sandison and Powick were so well-placed to pioneer a potent new drug-assisted psychotherapy which would have far-reaching consequences beyond medicine in Western society, yet had humble beginnings in the rural and peripheral county of Worcestershire. It may appear to be something of a paradox that it was a social psychiatric approach which made possible the pioneering therapeutic work with LSD at Powick, preparing the ground for a psychopharmacological turn. But one of the distinctive features and lessons of LSD research was the important impact of setting on the experience of the person under the influence of the drug, that is, how much the place in which it was given, and the people present, shaped the acid-loosened mind. All the ingredients which combined to make up a distinctive new paradigm of ‘Psycholytic Therapy’, a concept and method of using LSD developed at Powick, had grown up and evolved in the early years of Sandison’s psychiatric career, which, in turn, was fundamentally shaped by his, and British society’s, experience of war. But, as Sandison later stressed, psycholytic or mind-loosening agents, such as LSD, ‘promote mental images, fantasies and memories’, whereas ‘the bulk of psychoactive drugs used in psychiatry today dampen or deaden fantasy material, inappropriate emotional responses and other psychotic manifestations’.[ciii] Sandison emphasised:

“I think it is worthwhile to make the distinction between what I was trying to do and the effects of the pharmacotherapy as understood by the majority of psychiatrists. LSD by intensifying the mental experience of the patient correspondingly heightened the whole doctor-patient interaction. The result was an intensifying of the transference, a deep rapport between the patient’s inner life and the therapist, and a joint participation between doctor and patient in the process as it changed and developed.”

— Ronald Sandison. Letter to David Healy, 12 July 2002. PP/SAN/B/1/2.

Later he would reflect that ‘LSD came at the end, or a climax, of a smooth progression of endeavours; hypnosis, mescaline, nitrous oxide, insulin treatment in its various forms, narco-analysis, electro-narcosis, ether abreaction, and now LSD’.[cv] But, at Powick in the 1950s and 1960s, it was the reinvigoration of lost traditions, combined with the embrace of recent innovations, including psychotherapy, group work, art therapy, outpatient treatment, and a therapeutic community approach, which contained and cultivated the healing process catalysed by LSD. Retrospectively, Sandison viewed LSD as well-positioned at a time of transition to meet the psychological, social and spiritual needs of people still reeling from the trauma and socio-economic fallout of global conflict. LSD enjoyed only a short time as a routine psychiatric treatment before its medical career foundered on the emerging system for testing drug safety and efficacy, the model of randomised controlled trials, within which it could not be contained. In that fleeting window of time, Powick managed to contain this mysterious and elusive substance; but Sandison would struggle in clinical practice, as well as in his unpublished writings and public pronouncements, to align the healing potential of LSD with the increasingly impersonal and systematising scientific and technical biomedical discipline psychiatry was then becoming.

This research was supported by a Wellcome Trust Research Bursary.

The next blog will look at how LSD came to be at Powick Hospital, how LSD therapy was practised, and the conflicting perspectives of different doctors at the hospital on how it should be used.

Read Dr. Mark Gallagher’s last blog here.

ENDNOTES

[i] Ronald Sandison. In-Tide-Out: The Autobiography of a Psychiatrist and Analytical Psychotherapist. Unpublished undated autobiography from 2000s, Chapter 1 ‘Warlingham Park Hospital 1, 1940 and 1946-1951’. p. 26. PP/SAN/A/1 (at the Wellcome Library (WL), all subsequent references to PP/SAN come from WL).

[ii] See Vicky Long. 2014. Destigmatising Mental Illness?: Professional Politics and Public Education in Britain, 1870-1970. Manchester: Manchester University Press; and Gavin Miller. 2017. David Stafford-Clark (1916-1999): seeing through a celebrity psychiatrist. Wellcome Open Research, 2, 30. (https://doi.org/10.12688/wellcomeopenres.11411.1)

[iii] Sandison, In-Tide-Out, Chapter 2 ‘My Training Years (Continued): Making Sense of Madness’. p. 3. PP/SAN/A/1.

[iv] Ibid.

[v] Ibid.

[vi] Ibid.

[vii] C.G. Jung. 1939. On the Psychogenesis of Schizophrenia. Journal of Mental Science. LXXXV pp. 999-1011.

[viii] Malcolm Pines. 1996. The Development of the Psychodynamic Movement, in 150 Years of British Psychiatry, Vol. 2, The Aftermath, edited by Hugh Freeman and German Berrios. London: Athlone. p. 217.

[ix] Sandison, In-Tide-Out, Chapter 2 ‘My Training Years (Continued): Making Sense of Madness’. pp. 9-10. PP/SAN/A/1.

[x] Ronald Sandison. 2002. ‘LSD and the Birth of a Therapy. Ronnie Sandison’, an unpublished interview with David Healy. PP/SAN/B/1/2.

[xi] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 3. PP/SAN/A/1.

[xii] Sandison, In-Tide-Out, Chapter 1 ‘Warlingham Park Hospital 1, 1940 and 1946-1951’. p. 8. PP/SAN/A/1.

[xiii] Ken Crump. 2015. Edward Elgar at Powick Mental Hospital. The Elgar Society Journal. Vol. 19. No. 2. p. 29.

[xiv] Sandison. 2002. ‘LSD and the Birth of a Therapy. Ronnie Sandison’. PP/SAN/B/1/2.

[xv] Ronald Sandison. 2003. ‘My Consulting Room’ unpublished essay. PP/SAN/D/3.

[xvi] Ronald Sandison. 2001. A Century of Psychiatry, Psychotherapy and Group Analysis. A Search for Integration. London: Jessica Kingsley. pp. 18-19.

[xvii] Sandison, In-Tide-Out, Chapter 1 ‘Warlingham Park Hospital 1, 1940 and 1946-1951’. p. 3. PP/SAN/A/1.

[xviii] Ibid., p. 17.

[xix] ‘Obituary’. British Medical Journal. 1963. June 15, I, p. 1615.

[xx] Ibid.

[xxi] Ibid.

[xxii] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 3. PP/SAN/A/1.

[xxiii] Ibid., p. 16.

[xxiv] Ronald Sandison. Unpublished, untitled and undated handwritten essay reflecting on the history of LSD therapy. Late 1980s, early 1990s. PP/SAN/B/3.

[xxv] Ibid.

[xxvi] Ronald Sandison. 1959. Lecture on the History of Psychology and Psychiatry in Relation to Present Day Trends (part of a lecture series possibly given to psychiatric social workers). PP/SAN/D/3.

[xxvii] Michael Neve. 2004. A Commentary on the History of Social Psychiatry and Psychotherapy in Twentieth-Century Germany, Holland and Britain. Medical History. 48, p. 407.

[xxviii] Ronald Sandison. The Principles of Psychiatric Treatment. Probably written for nurses. Undated, 1950s or early 1960s. PP/SAN/D/6.

[xxix] Ronald Sandison. An essay which introduces a discussion on the meaning of the phrase ‘The atmosphere of the mental hospital’. Undated, 1950s or early 1960s. Handwritten version in PP/SAN/D/3 and typed version in PP/SAN/D/6.

[xxx] Ibid.

[xxxi] Sandison, In-Tide-Out, Chapter 1 ‘Warlingham Park Hospital 1, 1940 and 1946-1951’. p. 16. PP/SAN/A/1.

[xxxii] Ronald Sandison. 1951. The Re-socialization of the Psychiatric Case. A paper read at the meeting of the South-Eastern Division of the RMPA held at Warlingham Park Hospital 4 October 1950. Mental Health (London). 10 (4). p. 88.

[xxxiii] Ibid.

[xxxiv] Ibid.

[xxxv] Ibid.

[xxxvi] Sandison, In-Tide-Out, Chapter 3 ‘Making Sense of Madness II’. p. 32. PP/SAN/A/1.

[xxxvii] Sandison, A Century of Psychiatry, Psychotherapy and Group Analysis, p. 31; Worcestershire inhabitant, playwright and screenwriter David Rudkin, writer of cult BBC ‘play for today’ Penda’s Fen, referred to the landscape formed by the Malvern Hills, the Severn plain and Bredon Hill as ‘quintessential visionary England’.

[xxxviii] Sandison, ‘LSD and the Birth of a Therapy. Ronnie Sandison’. PP/SAN/B/1/2.

[xxxix] Sandison, In-Tide-Out, Chapter 3 ‘Making Sense of Madness II’. p. 33. PP/SAN/A/1.

[xl] World Health Organisation (WHO). 1953. The Community Mental Hospital Third Report of the Expert Committee on Mental Health. Geneva: Palais de Nations. p. 4.

[xli] Ibid.

[xlii] Ibid., p. 18.

[xliii] Ibid., p. 17.

[xliv] Sandison. An essay which introduces a discussion on the meaning of the phrase ‘The atmosphere of the mental hospital’. Undated, probably 1950s or early 1960s. Handwritten version in PP/SAN/D/3 and typed version in PP/SAN/D/6.

[xlv] Sandison, In-Tide-Out, Chapter 6 ‘A Therapeutic Community and a LSD Unit Powick Hospital 1951-1964 Part 2’. p. 3. PP/SAN/A/1.

[xlvi] Sandison, The Principles of Psychiatric Treatment. PP/SAN/D/6.

[xlvii] See Catherine Fussinger. 2011. ‘Therapeutic community’, psychiatry’s reformers and antipsychiatrists: reconsidering changes in the field of psychiatry after World War II. History of Psychiatry. 22 (2). pp. 146-163.

[xlviii] Ronald Sandison. 2003. The Changing Face of Psychotherapy: A Retrospect Over the Past Century. An address given to the Wessex Psychotherapy Society, Southampton, January 2003. PP/SAN/D/3.

[xlix] Sandison, In-Tide-Out, Chapter 1 ‘Warlingham Park Hospital 1, 1940 and 1946-1951’. p. 23. PP/SAN/A/1.

[l] D.W. Millard. 1996. ‘Maxwell Jones and the Therapeutic Community’, in 150 Years of British Psychiatry, Vol. 2, The Aftermath, edited by Hugh Freeman and German Berrios. London: Athlone. p. 585.

[li] Ibid., p. 597.

[lii] Sandison, The Principles of Psychiatric Treatment. PP/SAN/D/6.

[liii] Sandison, The Re-socialization of the Psychiatric Case, p. 87.

[liv] Ibid.

[lv] Ibid., p. 90.

[lvi] Ibid., p. 87.

[lvii] Ibid.

[lviii] Ibid.

[lix] Ibid., p. 89.

[lx] Ibid.

[lxi] Ibid.

[lxii] Ronald Sandison. 1953. Psychological Disturbance and Artistic Creation. The Journal of Nervous and Mental Disease. Vol. 117, No. 4. p. 320.

[lxiii] Ibid.

[lxiv] Ronald Sandison. 1958. Recent Sociological Changes and the Development of Social Service within the Framework of Modern Society. A lecture given to an unknown audience. PP/SAN/D/3.

[lxv] Ibid.

[lxvi] Ibid.

[lxvii] Ronald Sandison. 1997. ‘LSD Therapy: A Retrospective’, in Psychedelia Britannica: Hallucinogenic Drugs in Britain, edited by Antonio Melechi. London: Turnaround. p. 73.

[lxviii] Ibid.

[lxix] Anonymous. 1954. Ninety percent go home. Worcester Evening News. Tuesday 15 May.

[lxx] Ibid.

[lxxi] Ibid.

[lxxii] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 5. PP/SAN/A/1.

[lxxiii] Ibid.

[lxxiv] Ronald Sandison. 1991. LSD: Its Rise, Fall and Enduring Value. A New Perspective. Albert Hofmann Foundation Bulletin. Vol. 2. No. 1. p. 8.

[lxxv] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 7. PP/SAN/A/1.

[lxxvi] Ibid., p. 8.

[lxxvii] Ibid., p. 19.

[lxxviii] ‘Who should be sent to a mental hospital?’ British Medical Journal. 1957. June 1, p. 1301.

[lxxix] Ibid.

[lxxx] Ibid.

[lxxxi] Ibid., pp. 1301-1302.

[lxxxii] Sandison. An essay which introduces a discussion on the meaning of the phrase ‘The atmosphere of the mental hospital’. Undated, probably 1950s or early 1960s. Handwritten version in PP/SAN/D/3 and typed version in PP/SAN/D/6.

[lxxxiii] ‘Who should be sent to a mental hospital?’ British Medical Journal. 1957. June 1, p. 1302

[lxxxiv] Ibid.

[lxxxv] Anonymous. 1962. The Story of Powick Hospital. The Experiments in Freedom for Patients. Berrow’s Worcester Journal. Friday 13 July.

[lxxxvi] Ibid.

[lxxxvii] Ibid.

[lxxxviii] Ibid.

[lxxxix] Ibid.

[xc] Ibid.

[xci] Ibid.

[xcii] Michael Grundy. 1968. Pioneers of the Therapeutic Use of LSD. Worcester Evening News. Monday 15 January.

[xciii] Ronald Sandison. 1955. Group Therapy in a Provincial Out-Patient Department. International Journal of Social Psychiatry. Vol. 1. No. 2. p. 29.

[xciv] Ibid.

[xcv] Ibid.

[xcvi] See Spencer Freeman. 1967. Production Under Fire. Dublin: C.J. Fallon; E.H Putley. 1985. The History of the RSRE. Physics in Technology. Vol. 16. No. 1.; E.H. Putley. 2009. Science Comes to Malvern: TRE a Story of Radar 1942-1953. Malvern: Aspect Design; Stephen Burrows and Michael Layton. 2018. Top Secret Worcestershire. Studley: Brewin Books.

[xcvii] Sandison, In-Tide-Out, Chapter 5 ‘Powick Hospital 1951-1964 (Part 1)’. p. 3. PP/SAN/A/1.

[xcviii] See, for example, Gavin Miller. 2012. R.D. Laing’s theological hinterland: the contrast between mysticism and communion. History of Psychiatry. 23 (2). pp. 139-155.

[xcix] See E.M. Tansey. 1998. ‘They Used to Call it Psychiatry’: Aspects of the Development and Impact of Psychopharmacology, in Cultures of Psychiatry and Mental Health Care in Postwar Britain and The Netherlands, edited by Marijke Gijswijt-Hofstra and Roy Porter. Amsterdam: Rodopi. pp. 79-101; and F.M. Martin. 1984. Between the Acts: Community Mental Health Services 1959-1983. London: Nuffield Provincial Hospitals Trust. Chapter 9. Psychiatry and the problem of identity. pp. 125-139.

[c] See Martin. Between the Acts. Chapter 9. Psychiatry and the problem of identity. pp. 125-139.

[ci] Ibid., p. 126.

[cii] Sandison, In-Tide-Out, Chapter 3 ‘Making Sense of Madness II’. p. 32. PP/SAN/A/1.

[ciii] Ronald Sandison. Letter to David Healy, 12 July 2002. PP/SAN/B/1/2.

[civ] Ibid.

[cv] Ronald Sandison. 2004. Lysergic Acid Diethylamide: Its Place in History. An address given to the Wessex Psychotherapy Society, Southampton, March 2004. PP/SAN/D/3.

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