by William Sargant
A Tribute for the Festschrift of England’s greatest living psychiatrist
World Medicine, April 20, 1977
I saw Eliot Slater at a distance when he was a senior, and I a very junior, undergraduate at St John's College, Cambridge, in 1925. I was first to meet him personally when he returned to the Maudsley from a Rockefeller Fellowship in Germany before World War II, and I was by then myself corking there in a junior capacity. As I first knew him he was mich thinner and seemed more tense and distant. But marriage seemed somehow to release him, and make him a mare relaxed and approachable person. Since then he has bean one of my very best friends, end the only "psychotherapist" able to keep me on the straight and narrow pathway to the psychiatric acceptance, in whole or part, of many of my treatment enthusiasms. He has realised and warned me when I have tried to drive ahead too fast in treatment, and has always sought to dampen things down into acceptable pathways within psychiatry. Since his and my ospital retirement I have sorely missed his helpful and restraining hand.
At the Maudsley, when Aubrey Lewis had gone off to tour Russia during the Great Stalin Purge, Slater, taking over Lewis's job, finally allowed me, for instance, to give cardiazol‑fits to depressives when it was still mainly the official treatment of schizophrenia. It worked wonderfully and patients were sometimes furious that they had been kept for so many months on ''suicidal precaution'' before being given this treatment, even “in the raw", and so rapidly getting well again. We couldn’t explain the reason to them. Aubrey Lewis, than as later on, would allow no new treatments that involved any risks. In myview he displayed an intellectual treatment nihilims; Slater was so very different. He allowed us to try new things providing they were really helping patients, but he did note let us move too fast and get too far beyond the psychiatric acceptance of new ideas.
After I had spent a Rockefeller Fellowship year in Boston at the Mass General Hospital in 1938‑39, where I had deliberately chosen to work at a psychoanalytic centre and saw how little analysts could do for really sick patients, World War II started and I returned to a wonderful change of climate. The Maudsley had split in two, and I became deputy clinical director under Eliot at Sutton Emergency Hospital; Aubrev was now well away at Mill Hill School. It was an ideational split as well as a physical one for the staff concerned. At Sutton were most of the “doers” and at Mill Hill the “talkers”. Practically nothing original came out of Mill Hill all the war except Maxwell Jones's group therapy, and he moved down to Sutton as fast as possible after the war rather than go back to more frustration at the Maudsley where in theory we were supposed to rejoin as a group.
In fact this was impossible. Eliot Slater at Sutton had given us all our heads and Lewis kept too tight a rein. At Sutton Denis Full was to do his classical early work on the EEG, Alexander Kennedy was to blossom greatly in ins career leading him, via the army, to Newcastle and Edinburgh, though he would have preferred to have returned and still stayed at the Maudsley. Kenneth Cameron was to flourish at Sutton and returned to the Maudsley to succeed Mildred Creek in the children's department. I, with Slater's help, was to develop "front‑line" sedation, intravenous drug abreaction and modified insulin which soon became the standard treatments of World War II neuroses, and led to the greatly lessened incidence of chronicity compared with World War I, where only psychotherapy was available. Slater and I were also able to start using outpatient ECT and modified leucotomv. When forbidden to do these at Sutton, we did these treatments at St George's where we also worked during the war, and where the Maudsley authorities held no sway.
Eliot trusted us all, but kept an eye on eeervthing we were doing, freely criticised it for our benefit, and only quietly checked us if we were moving too fast in obviously the wrong directions. I managed to persuade him to write Physical Methods of Treatment in Psychiatry with me, for he could make my enthusiasms respectable without dampening them too much. He wrote the last chapter on the relation of physical treatments to psychotherapy in his room at Sutton under the maximum intensity of V1 and V2 bombing, sitting, calm and unmoved, with his ceiling falling all around him.
At the end of the war, the old Maudsley staff could not re‑group. We had been so free under Slater and so very active, we could not really go back to the treatment nihilism which resulted in the Maudsley producing next to nothing original in the thirty years after the war. Hill was appointed to King's, Slater to the National, and I to St Thomas's. We were denied Mapother and our dream of making the Maudsley into the "Queen Square of Psychiatry" by being refused charge of clinical beds there because we could not personally visit our bed‑patients at forty‑eight hour intervals. Who proposed this medical committee motion, which was so extraordinary in the light of subsequent Maudsley happenings? It was the later‑to‑be Dean Davies, who even then was working closely with Aubrey Lewis.
Slater gave up his Maudsley beds and proceeded so to transform the National Hospital psychiatry that the best way to get on the staff of a general teaching hospital in London was to have worked with him and not have gone to the Maudsley. One generally moved on from the Maudsley to become a committee‑ridden professor, a tragic fate for anybody really anxious to go on learning how to get patients well again.
Slater helped me in my campaign to abolish medical superintendents in mental hospitals and through the RMPA to improve the sluggish methods of treatment in those hospitals. Both of us were also able to show at the National and St Thomas's how even the most acute psychiatric patients could be treated in psychiatric units attached to other hospitals, which we had started to learn about when attached to the general emergency hospital at Sutton where any suicidal and other precautions were out of the question. To succeed, this poiicy has to be supported by really active treatment and it has worked so well that it has now become the Ministry of Health's official policy. Unless things change, in any, future severe economic crisis, the Maudsley, as an isolated entity, which Mapother was always striving to alter, could now easily become "redundant", or find itself amalgamated with a nearby general hospital.
It is no secret that so successful had Slater been at Sutton that he was implored to apply for Lewis's job at the Maudslcy when the appointment was being made. He would most likely have obtained it. But he refused to consider it and preferred to carry on with his genetic research and helping those working with him clinically at the National. Later, as editor of the British Journal of Psychiatry, he was kind and thoughtful to those submitting papers and personally helpful in offering guidance to so many would‑be authors.
If Slater had taken the Maudsley appointment, few whom Mapother had so carefully chosen as his future "National" team would have left. Most would have stayed on. As it was there ws shortly none of them left on the clinical side, except Sir Aubrey himself. Psychiatry will take years to recover from this, especially as both recent presidents of the Royal College of Psychiatry also felt they had to leave the Maudsley long before they should have been allowed to do so, as did the present Vice‑Chancellor of York University.
Above all, Eliot Slater made all those who really knew him !eve and respect his fundamental greatness of character, his desire to help others mose than himself, and his bringing to fulfilment so many psychiatrists, like myself, who owe almost everything we have done to him and his constructive encouragement.