Professor Edward Mapother
Character and Personality, Vol. IX/1, September 1940
The work of the late Professor Edward Mapother remains after him in a form both material and abstract. The buildings of the Maudsley Hospital were designed largely under his inspiration, and represent an English adaptation of the University Psychiatric Clinic of the Continent. The hospital was opened to serve a need which until that time had not been met at all – the treatment of the early and noncertifiable psychiatric case; but under Mapother's direction it came to serve the wider purposes of postgraduate clinical teaching in psychiatry and clinical psychiatric research. The clearing‑house activity which is usually a large part of the work of the continental psychiatric clinic could be safely left to the observation wards; but Mapother had the wisdom to see that there could not be effective teaching or research unless every kind of psychiatric case, including severe ones, could be handled; and the hospital was therefore equipped to investigate and treat every type of illness, neurotic or psychotic. The hospital is now empty and, apart from its outpatient department, out of use; but its existence is a guarantee that once we return to normality the special and valuable functions for which it was designed will once more be worthily fulfilled. The hospital is a concrete symbol of Mapother's view, for which he long fought, and which may now be regarded as established, that there is no fundamental difference between the psychoses and the neuroses, and that it is absurd to allocate the treatment of the one to mental hospitals, of the other to psychotherapeutic outpatient departments. The hospital, in fact, symbolizes the larger work Mapother did for English psychiatry, which survives not in brick and mortar, nor even in the printed word, but in the minds of colleagues and pupils, and in a tradition of learning.
Mapother gathered round him young men for the most part without much previous psychiatric training, and therefore without psychiatric preconceptions, but men he had chosen for their ability and training in general medicine and in neurology. They were given temporary appointments in the hospital and were encourag to go their own way, learning their psychiatry from the bedside more than from books and lectures, and from discussion with their colleagues, both informally and at the regular weekly clinical conferences. These conferences had indeed a much wider attendance than from the hospital staff alone, and it was at them that Mapother exerted his chief influence as a teacher. His inquiring, skeptic but practical mind required to be fed on a full diet of facts. Speculations would be met with a somewhat impatient interest, providing the facts were there, but woe to the unfortunate who dared speculate without having troubled to discover the facts. The account of the patient was given in two stages, the history, starting with the family history, and then the physical and mental state at the time examination; and, finally, the patient himself would be seen at critical points of clinical importance checked. No discussion could bh started, let alone a decision reached, before all the available evidence had been gathered. When Professor Adolf Meyer attended one Maudsley conference, he raised a protest at an account of the family history being given at the very beginning of the history, its receiving in fact any prominence at all, as it only tended to defeat therapeutic optimism. Such a view would have been incomprehensible to Mapother. He would have disputed the notion that treatment could be adversely affected by an appreciation of the constitutional element in a case; he would have been shocked by the idea that anyone could desire less than the completest possible knowledge of all the relevant facts.
Mapother's preference for verifiable fact and his dislike of speculation led him into an antagonism to psychoanalysis and to kindred schools of psychiatry. In his presidential address to the Section of Psychiatry of the Royal Society of Medicine in 1933, he attacked the psychoanalytic and other conceptualist, idealist, ar animistic schools, as he termed them, and raised a plea for a psychiatry founded on a philosophic nominalism, i.e., for a psychiatry that concerned itself solely with the observation and study of directly perceptible phenomena. His attack on psychoanalysis, which was conducted with great vigor, was based on cogent but familiar arguments; his plea for a psychiatry that would be concerned with the whole of human behavior, that would seek every opportunity of collaboration with other biological sciences, that would seek to ba itself as closely as possible on observed fact and eschew unnecessary speculation, becomes of increasing importance with time. It seems that the attempt to seek the causation of psychological events solely in other psychological events has advanced as far as is possible at present for this technique, and the psychiatric advances of the near future will have to be sought in other fields. By training and inclination Mapother was very sympathetic to such a view, and he desired always the closest possible collaboration between the clinical side of the hospital and the Central Pathological Laboratory, which was housed in the same building.
Mapother taught a psychiatry that was robust, practical, and, above all, realistic. Common sense and a healthy skepticism were marked features of his attitude in all psychiatric matters, whether it was the consideration of an individual patient, or of a new treatment or line of research. He was willing for everything to be tried, but wished for an abundance of facts before he would be convinced. As far as possible he sent his young men abroad to gather the newest ideas from other centers of research and learning, and encouraged them to try out their plans on their return, even though he might be personally skeptical of their value. When Professor Gjessing paid a visit to England, and his work was brought to the notice of English psychiatrists, Mapother was one of a comparatively few to remain skeptical and unconvinced; nevertheless, he encouraged a younger man to spend many months of study in Norway working with Gjessing, in order that he might return to the Maudsley and follow up such studies here. When insulin and cardiazol treatment of schizophrenia were introduced from the Continent, he arranged that there should be competent instruction of the medical staff in insulin treatment by an expert imported from Switzerland, though he was extremely dubious of the claims made for both methods of treatment. When experience in these treatments was found to be encouraging, and they were being introduced on an increasing scale into the other hospitals of the L. C. C. Mental Hospitals Service, he produced an excellent plan by which all the hospitals together should co‑operate in a systematic and controlled testing of the effects of such treatment. Unfortunately this plan could never be operated because of the unwillingness of some of his colleagues to allow any outside interference in the hospitals in the matter of treatment of patients. However much any particular development in psychiatry seemed premature, unsound, or in any way to offend his own preconceptions, he was always prepared to reserve judgment until all the facts were available. When they were available, and he had formed his judgment, which he did not do without due deliberation, he would pronounce it with a pithines directness, energy, and wit which were but little mitigated by respect for persons.
Despite his antagonism to speculative psychoanalytic theory and still more to cognate but more woolly‑minded schools, Mapother was appreciative of the benefits that can be obtained in selected cases by psychological treatment. Men of psychotherapeutic training and inclination received very adequate representation on the hospital staff, and arrangements were made for the selection of suitable cases and their treatment along intensive psychotherapeutic lines. In the reconstituted Maudsley Hospital, as he was planning it before the war put a stop to his plans, this department would have been enlarged further by facilities for the study of psychotherapeutic measures and their results, and for teaching in psychotherapy, as a part of a still wider expansion in social psychiatry. In such practic fields, Mapother was a man of great vision, and he foresaw a great development of the use made of advances in psychiatric knowledge in courts of law and other social fields not directly medical.
No account of Edward Mapother can pass without a mention his capacity for arousing the loyalty and affection of his staff. His hospital was his child, and any member of it was one of his family and he was as loyal to it and to his staff as any father might be. Vigorous, forthright, impatient of fools and a hater of shams and pretensions, he was the kindliest of men and, like few chiefs sensitive of the hopes and desires of the least member of his staff, willing to go to any personal inconvenience to further reasonable ambitions. He never sought to dominate, and it is partly because of this inherent modesty that he has not founded a school of psychiatrists of fairly uniform attitude. Everyone was encouraged to follow his own bent, and he saw the promise of the future in a lively and realistic interest in the subject matter of psychiatry, which is the sum total of human behavior. He was quick to see the most fruitful possibilities of future development. Up to the time of the final catastrophe, when his life work was disintegrated beneath his eyes, indeed of necessity largely by his own act, he was maturing plams for the future, which are not forgotten and will one day be the inspiration of a new structure which will be his memorial.
Almost the whole of his work was carried out under the continual burden of ill health, a burden which became in the last two years continuous torture. His illness overtook him as the result of the first great war; it finally overcame him in the to some extent a disappointed man. He had disrupted, redesigned by his own hand for the war emergency, his hospital buildings empty, his plans shelved. Small consolation that he had also seen another child of his brain, a Northern Maudsley, inaugurated. But he also knew that he was surrounded by his pupils that loved him, that they would survive and would deepen and extend the mark that he had made on British psychiatry.