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A Jewish contribution to Britis psychiatry: Edward Mapother, Aubrey Lewis and their Jewish and refugee colleagues at the Bethlem and Maudsley Hospital and Institute of Psychiatry, 1933-66

Claire Hilton

<plain_text><page sequence="1">Jewish Historical Studies, volume 41, 2007 A Jewish contribution to British psychiatry: Edward Mapother, Aubrey Lewis and their Jewish and refugee colleagues at the Bethlem and Maudsley Hospital and Institute of Psychiatry, 1933-66* CLAIRE HILTON Psychoanalysis, psychotherapy, psychology and psychiatry are related and overlapping but distinct disciplines. Psychoanalysis and psychotherapy, the 'talking therapies', have their roots in the work of Sigmund Freud, but many sub-types and schools developed during the twentieth century. Psychology derives from the study of the normal mind. Psychiatry is a branch of medicine, a career path for medically trained doctors with an interest in mental illness, some of whom choose to specialize in psychotherapy. The contributions of Jewish people to the development of psychoanalysis and psychotherapy are well known, beginning with the work of Freud. The important contributions of psychiatrists of Jewish origin to the develop? ment of mainstream psychiatry in Britain in the middle of the twentieth century are less well recognized. Their work hinged on the ideals of two professors of psychiatry, Edward Mapother and Aubrey Lewis. They were determined to create at the Maudsley Hospital in Denmark Hill, South London, a centre of academic research and clinical excellence for their speciality. Opened in 1923, the Maudsley was the only postgraduate psychiatric teaching hospital in England for several decades. In 1948 the academic Institute of Psychiatry was founded, adjoining the Maudsley Hospital. On the establishment of the National Health Service in 1948, the Bethlem Royal Hospital and the Maudsley Hospital were amalgamated into a single teaching hospital, often refered to as the Joint Hospital or, more colloqui? ally, just the Maudsley. This study focuses on Jewish and refugee psychiatrists working at the Maudsley under the leadership of Mapother and Lewis, their contributions * Paper presented to the Society on 15 February 2007. 2og</page><page sequence="2">Claire Hilton to the development of the specialty of psychiatry and whether they brought any of their religious or European cultural heritage to their work. Edward Mapother, Germany and the refugee psychiatrists: 1933 Edward Mapother was not Jewish. Born and brought up in Ireland, he was appointed as the first professor of psychiatry at the Maudsley in 1926. He was determined to model his teaching hospital on that of the psychiatric institutions of the German-speaking countries, then leading the world in both clinical and academic psychiatry. With the rise of Nazism, in 1933 he secured funding from the Academic Assistance Council, Commonwealth Fund and Rockefeller Foundation to bring three eminent Jewish psychia? trists to the Maudsley. These three immigrant psychiatrists were Eric Guttmann, Alfred Meyer1 and Willi Mayer-Gross.2 Guttmann (1896-1948) had had an international reputation in neurology before 1933, and at the Maudsley was a valued clinician and major influence in the establishment of psychiatric postgraduate education until his untimely death.3 He was remembered for research such as 'Anxiety and the Heart'4 and 'The Psychology of Pain',5 and for his support of junior staff: 'he was so helpful and supportive to a young doctor, particularly one like myself who was naive, incompetent and ignorant. I was indebted to him and always will be.'6 He is also remembered for the Guttmann-Maclay Picture Collection of art related to mental health, a collection started by Guttmann and his colleague Walter Maclay in the 1930s, now housed at the Bethlem Royal Hospital at Beckenham in Kent. After his death his wife Dr Elizabeth Rosenberg established the Eric Guttmann Memorial Trust to help develop the Guttmann-Maclay Collection and for educational purposes in the train? ing of psychiatrists.7 Aubrey Lewis, professor of psychiatry at the Maudsley at the time of Guttmann's death in 1948, also paid tribute to him in a postscript to his obituary, highlighting his dedication and other quali? ties, but also reflecting character traits and ideals which Lewis appeared to 1 G. Pampiglione, 'Professor Alfred Meyer', Bethlem Maudsley Hospital Gazette (hereafter BMHG) II no. 6 (1956) 196. 2 H. Freeman, 'William Mayer-Gross 1889-1961', in H. C. G. Matthew and B. Harrison (eds) Oxford Dictionary of National Biography (Oxford 2004) 3 'Obituary: Eric Guttmann', British Medical Journal (hereafter BMJ) 8 May 1948, p. 908. 4 E. Guttmann and W. Mayer-Gross, 'Anxiety and the Heart', Lancet 25 May 1940, pp. 979-80. 5 Ibid. 'The Psychology of Pain', Lancet 20 Feb. 1943, pp. 225-7. 6 A. Baker interviewed by H. Freeman in G. Wilkinson (ed.) Talking about Psychiatry (London 1993) 192-206(193). 7 Bethlem and Maudsley Hospital Medical Committee Minutes (hereafter Joint Hospital Med Com Min) General Purposes sub-committee, 13 Oct. 1949. 210</page><page sequence="3">A Jewish contribution to British psychiatry value in himself: 'No one could replace Eric Guttmann in the affection of his friends, and it is very doubtful whether anyone can replace him in the remarkable contribution he was making to psychiatric research and the training of psychiatrists. ... a man of outstanding capacity ... who was prepared to devote all his gifts, without thought of personal advantage, to the furtherance of sound psychiatry in this country.'8 Alfred Meyer (1895-1990) became professor of neuropathology and achieved a formidable scientific output. He had a particular interest in temporal lobe epilepsy, and published work on circulatory disturbances in the brain and on brain pathology in Down's Syndrome.9 Meyer worked closely with the neurosurgical unit at the Maudsley Hospital. In 1954 he also published, with the fellow refugee Elizabeth Beck,10 a laboratory scien? tist, an important monograph, Prefrontal Leucotomy and Related Operations: Anatomical Aspects of Success and Failure.n Willi Mayer-Gross (1898-1961) was professor at the influential Heidelberg school of psychiatry by 1929.12 He arrived in Britain in 1933, worked at the Maudsley for six years, leaving at the beginning of the Second World War, and spent many years at Crichton Royal Hospital in Dumfries as director of research. There he worked closely with several fellow refugee colleagues, including Liselotte Frankl13 who had gained her PhD in Vienna and went on to become a child psychotherapist,14 and F. Berliner who had gained his MD in Berlin.15 The refugees Erwin Stengel16 and Frederick Kr?upl Taylor17 worked with him at Crichton Royal, both of whom later became leading psychiatrists at the Bethlem and Maudsley Hospital. Mayer-Gross also wrote academic research papers with Eric Guttmann.18 Some of his research was on controversial, unpopular or new issues at the time, such as electro-convulsive therapy19 and dementia.20 For 8 A. Lewis, 'Postscript' to obituary of Eric Guttmann (see n. 3) 908. 9 Pampiglione (see n. 1) 196. 10 NC, 'Obituary: Alfred Meyer', Psychiatric Bulletin (hereafter Psych Bull) XIV (1990) 247. 11 A. Meyer and E. Beck, Prefrontal Leucotomy and Related Operations: Anatomical Aspects of Success and Failure (Edinburgh 1954). 12 Freeman (see n. 2). 13 L. Frankl and W. Mayer-Gross, 'Personality Change after Pre-frontal Leucotomy', Lancet 6 Dec 1947, pp. 820-4. 14 CY, 'Obituary: Liselotte Frankl', Psych Bull XIII (1989) 334. 15 F. Berliner, W. Mayer-Gross, R. L. Beveridge and J. N. P. Moore, 'Pre-frontal Leucotomy: Report on 100 Cases', Lancet 15 Sept. 1945, pp. 325-8. 16 R. Barton, 'Professor Erwin Stengel', BMHG II, no. 5 (1956) 162. 17 MS, 'Obituary: Frederick Kr?upl Taylor', Psych BullXIII (1989) 395. 18 Guttmann and Mayer-Gross (see nn. 4 and 5). 19 W. Mayer-Gross, 'Electric Convulsion Treatment in Patients over 60', Journal of Mental Science (hereafter JMS) XCI (1945) 101-3. 20 W. Mayer-Gross, 'Arteriosclerotic, Senile and Pre-senile Psychoses', JMS XC (1944) 316-27. 211</page><page sequence="4">Claire Hilton several years Martin Roth (1917-2006), son of a Hungarian cantor and brought up in the East End of London,21 previously a junior doctor at the Maudsley, later Professor Sir Martin Roth, also worked with him at Crichton Royal. The textbook Clinical Psychiatry was written by Meyer Gross, Eliot Slater and Martin Roth. First published in 1954, it became a standard postgraduate text for many years.22 In 1991 Roth recollected: T went to the Crichton Royal ... I was invited to take part in the textbook of psychiatry after a year ... Clinical Psychiatry, translated in to many languages ... played a great part in the evolution of biological psychiatry. ... Our text book got a major article in The Times. It had a superior literary quality, and it is still bought.'23 At the Maudsley, Guttmann, Meyer and Mayer-Gross were remem? bered as 'an immense addition to our society', and Mapother's energy in encouraging their immigration to England was 'one of the most far sighted things he ever did, and it has made a historic difference to British psychia? try'.24 They helped create a structure for clinical methodology.25 The three of them showed how rigorous methods could be applied to clinical research, and they provided a conceptual framework for research previously unknown in psychiatry in Britain.26 Many years after his time at the Maudsley, in i960 shortly before his death, Mayer-Gross was described as 'surely the greatest academic psychia? trist in this country'.27 This was written in the context of the introduction to a series of tributes to Mapother on the twentieth anniversary of his death, for which Mayer-Gross wrote 'Recollections of a Refugee' in the Bethlem Maudsley Hospital Gazette: Nissl and Kraepelin, my former teachers, were rather spiky and apparently inaccessible - neither would, however, have greeted me with the shining eyes full of friendly pleasure as Mapother did ... The refugees he had accepted to his staff, he treated as comrades in arms, and tried to smooth their adjust? ments to English life, supported by his wife who by her versatile and warm interest easily bridged the moat to Mapother's defences. One of many stories showing his original ways of reaction seems worth 21 M. Roth interviewed by Professor Margot Jefferys as part of the 'Oral History of Geriatrics as a Medical Specialty' project, National Sound Archive, recording call number F3313-3314 (1991). 22 W. Mayer-Gross, E. Slater and M. Roth, Clinical Psychiatry (London 1954). 23 Roth (see n. 21). 24 E. Slater interviewed by B. Barraclough in Wilkinson (see n. 6) 1-12 (7). 25 W. Meyer-Gross and E. Guttmann, 'Schema for the Examination of Organic Cases', JMS CXXIII (1937) 440-51. 26 Freeman (see n. 2). 27 Introduction to 'Mapother Memorial', BMHG III, no. 10 (i960) 5. 212</page><page sequence="5">A Jewish contribution to British psychiatry recording. It happened before my arrival in England. A German research fellow working at the Maudsley came to see Mapother after the Reichstag fire ... He wanted to discontinue his fellowship and to return to the Fatherland: 'If 92% of the German people have voted for Hitler, he must be a great man'. Mapother replied: 'I am of Irish stock. If 92% of the Irish would vote for one man, I would be certain that he was worthless'.28 A fourth Jewish refugee psychiatrist joined the Maudsley with Guttmann, Meyer and Mayer-Gross. He was Eric Wittkower, who arrived in 1933 having been dismissed from his post at the University of Berlin earlier that year.29 He worked as a research fellow at the Maudsley from 1933 to 1935 before re-qualifying with the Scottish Triple qualification. This was proba? bly the least tortuous route to re-qualification at that time, for a British qualification was an absolute necessity if one was to continue to practise medicine in Britain. With the Scottish Triple, there were no examinations in anatomy or physiology; materia medica and pathology examinations could be taken immediately and the final examination one year later. Other exam? ination bodies required two years' clinical work and examinations to be passed in anatomy and physiology before sitting the final examination.30 In 1949 he was listed in the newly established Institute of Psychiatry Annual Report as an 'occasional lecturer'.31 Wittkower emigrated to Canada in 1951, where he carried out extensive research in transcultural psychiatry, a little-explored field at that time.32 Aubrey Lewis, his personality and his Jewish identity Mapother died in 1940,33 but Aubrey Lewis was not appointed as his successor at the Maudsley until 1946, although he was the clinical director through the Second World War, when the Maudsley was evacuated to Mill Hill in north London. He was Jewish, from Australia where he had been educated at a Jesuit college34 and medical school in Adelaide. He came to Britain at the end of 28 W. Mayer-Gross, 'Recollections of a Refugee' (see n. 27) 7-8. 29 H. A. Strauss and W. Roder (eds) International Biographical Dictionary of Central European Emigres igjj-ig^ II (Munich 1983) part 2: L-Z 1254. 30 K. Collins, Go and Learn: The International Story of Jews and Medicine in Scotland (Aberdeen 1988) xx and 135-6. 31 Institute of Psychiatry Annual Report (hereafter IOPAnn Rep) (1949-50) 30. 32 Strauss and Roder (see n. 29) 1254. 33 R. Hayward, 'Edward Mapother 1881-1940' in Matthew and Harrison (see n. 2) 34 E. Slater interviewed by B. Barraclough in Wilkinson (see n. 6) 1-2 (8). 213</page><page sequence="6">Claire Hilton the 1920s, accepting a post at the Maudsley in 1929.35 A member of the Liberal Jewish Synagogue in St John's Wood, he held tenuous links with the Jewish community, but it was noted that he 'was always very kind to someone who was religious, of whatever denomination'.36 He also wrote 'Psychiatry and the Jewish Tradition', an article published posthumously, but based on a lecture delivered at Leo Baeck College, London, in November 196837 and adapted for publication by his colleague Michael Shepherd. Shepherd, professor of epidemiological psychiatry at the Institute of Psychiatry, was also Jewish.38 Yet Lewis's colleagues recollect little or no mention of his Jewish background in the clinical or academic work environment, also reflected in the absence of personal content in the published 'Psychiatry and the Jewish Tradition'. He did, however, in a postscript attached to the obituary of Emmanuel Miller, under the author? ship AJL, pay a compliment to Miller (a colleague at the Maudsley for many years and founder of the first child-guidance clinic in the British Isles) which suggests that he listened with interest to Miller's explanations on Jewish matters: 'No one could be long in his company without realising that intellectual enterprise and adventure were the breath of his nostrils - whether he found it in elucidating a Talmudic tract or in dissecting the basic problem of classification in psychiatry.'39 In terms of the Jewish identity of the academic leadership of the Maudsley, Professor Raymond Levy also recalled in 2004: 'Some of them did not actually say that they were Jewish. ... Aubrey Lewis ... was I think a practising Liberal Jew, so far as you can be that, he looked Jewish, he looked like a Jewish tailor ... But he never talked about it. Shepherd was also Jewish. He didn't talk about it either. But this big influx from Germany and Eastern Europe and so on, had a tremendous [effect].'40 Lewis's memorial service took place at the Liberal Jewish Synagogue in 1975 and was reported in the Bethlem and Maudsley Gazette, the address being given by his close colleague and co-religionist Dr David Davies (see below).41 Some say that Lewis had a reputation for being particularly sympathetic to refugee doctors, but this may not be a correct perception.42 Indeed, he 35 M. Shepherd, 'Aubrey Lewis: The Making of a Psychiatrist', British Journal of Psychiatry (hereafter BJPsych) CXXXI (1977) 238-242. 36 J. Howells interviewed by H. Freeman in Wilkinson (see n. 6) 218. 37 A. J. Lewis, 'Psychiatry and the Jewish Tradition', Psychological Medicine VIII (1978) 9-19. 38 G. Russell, 'Obituary: Michael Shepherd', Psych BullXX (1996) 632. 39 'Obituary: E Miller' and AJL, 'Postscript', BMJlll (1970) 350. 40 R. Levy, tape-recorded interview with the author, 2004. 41 D. Davies, 'Address delivered at the Memorial Service for Aubrey Lewis at the Liberal Jewish Synagogue 17 April 1975', Bethlem and Maudsley Gazette (hereafter BMG) (Spring 1975) 5-6. 42 F. Post interviewed by B. Barraclough in Wilkinson (see n. 6) 155-77 i1^!) 214</page><page sequence="7">A Jewish contribution to British psychiatry had the power and influence to make or break careers, but may have been alert and sensitive to discrimination facing colleagues. In his own experi? ence, despite an outstanding early career in medicine and an international training in psychiatry on a Rockefeller Foundation Fellowship, 'it was made clear that opportunities would not, after all, be made available [in Adelaide]'.43 The reasons were unclear, but this rebuttal was associated with his departure from Australia. In view of the huge achievements of many of those he did appoint to the Maudsley staff, it is likely that he made an effort to judge fairly on clinical and academic merits alone, whether or not job applicants had been victims of persecution or were likely in the future to be victims of discrimination. However, there almost undoubtedly were some personal influences in the recruitment procedure at both the Maudsley Hospital and the Tavistock Clinic in Hampstead after the Second World War, although this does not directly imply positive discrim? ination. The evidence for this is based on the observation that both these establishments had relatively high proportions of Jewish psychiatrists, in marked contrast to other London teaching hospitals where consultant psychiatrists of Jewish or refugee origins were rare.44 Elsewhere, in other London teaching hospitals, even those achieving some eminence did not become consultants, such as Eric Strauss (German-born Jew converted to Catholicism45) at St Bartholomew's Hospital, who remained as a lecturer in psychological medicine, and Hyam Shorvon, who remained as an assistant psychiatrist at St Thomas's Hospital.46 Like Mapother, Lewis had a high regard for the German practices of psychiatry of the 1920s and early 1930s. He was also passionate about the academic development of the Maudsley and Institute of Psychiatry. Many refugee doctors had difficulty in establishing themselves in the more presti? gious specialties of medicine, surgery, obstetrics and gynaecology, espe? cially during and after the Second World War, probably because of considerable anti-German and anti-Semitic feelings.47 48 There were other major recruitment issues. Immigrant doctors were likely to be competing for jobs with doctors of British origin recently demobbed from the Forces and saw themselves at a disadvantage. Some volunteered for the Royal 43 M. Shepherd, 'A Representative Psychiatrist: The Career, Contributions and Legacies of Sir Aubrey Lewis', Psychological Medicine Monograph Suppl. 10 (1986) 9-10. 44 J. Cooper, Pride versus Prejudice: Jewish Doctors and Lawyers in England i8go-iggo (Oxford 2003)227. 45 A. Limentani interviewed by H. Maxwell in Psych BullXVUl (1994) 346-56 (348). 46 Cooper (see n. 44) 227. 47 H. Rollin and P. Merry, 'Obituary: Julius Merry', Psych Bull XXVIII (2004) 107. 48 C. Hilton, 'St Bartholomew's Hospital, London, and its Jewish Connections', Trans JHSE XXX (1989) 21-50 (33). 215</page><page sequence="8">Claire Hilton Army Medical Corps (RAMC) because of this.49 But the negative effects on refugee doctors were partly counteracted by some established consultants being less willing to work within the newly formed National Health Service in 1948,50 so creating vacancies. Thus a number of high-achieving, well qualified doctors needing to earn a living were considering working in psychiatry, a low-status speciality, rather than competing in the more pres? tigious fields. The difficulty for Jewish doctors in gaining employment in prestigious teaching hospital jobs has been well documented,51 such as for Max Hulbert at St Bartholomew's Hospital,52 and Julius Merry (ne Lustigman), qualifying in 1946 from University College Hospital. Merry dicovered that the difficulties he experienced in obtaining employment were due to anti-Semitism only when 'a sympathetic member of a commit? tee that had failed him took him aside and advised him to change his name'.53 Lewis had a reputation for carefully selecting staff who he thought would help in developing the teaching, academic and clinical excellence which he sought. Thus a series of extremely well-qualified doctors were among those appointed to the Maudsley Hospital, some from immigrant families who had come to Britain before the War, others of whom had trained in England, and still others who were Jewish refugees or persecuted for their Jewish ancestry, despite the fact that they lacked practical Jewish affiliation. Many people ran into conflict with Lewis and were highly critical of his acerbic and authoritarian manner. Hugh Freeman, a Jewish junior doctor at the Maudsley in the 1950s, commented on the bimodal distribution of people's relationships with Lewis ? either seeing him as benign, helpful and kind, or as hostile, destructive and sinister. He recalled that he himself left the Maudsley in part because of'the destructive influences which emanated from Aubrey Lewis. He and I had a rather adversarial relationship, and I left after two years because I felt that under his leadership, the institution was completely out of touch with important developments that were going on outside, particularly in the social and community fields. ... He made some people's careers, but destroyed other people's, unless they got away.'54 Max Hamilton (born Himmelschein, from a Jewish family in Offenbach, Germany),55 is today remembered in particular for the develop 49 F. Post interviewed by B. Barraclough in Wilkinson (see n. 6) 155-77 C1^). 50 Ibid. 166. 51 Cooper (see n. 44) 90-1, 222-3. 52 Hilton (see n. 48) 33-4. 53 Rollin and Merry (see n. 47) 107-8. 54 H. Freeman interviewed by G. Wilkinson in Wilkinson (see n. 6) 310-34 (313). 55 H. Rollin, 'Max Hamilton (1912-1988)' in Matthew and Harrison (see n. 2) www.oxforddnb. com/articles/70380. 2l6</page><page sequence="9">A Jewish contribution to British psychiatry ment of the Hamilton Anxiety and Depression Scale (HADS), still used widely in clinical and research assessments in psychiatry. He recalled work? ing as a junior doctor at the Maudsley around 1945 and the dislike Lewis took to him: 'When he looked at me with those rather prominent eyes of his, I trembled. Instead of doing an ordinary ward round, he went through every one of my patients in detail. He was gunning for me. Why he did it, I don't know. I got three months notice.'56 Martin Roth, Max Hamilton, Hugh Freeman and Erwin Stengel (see below57) were among eminent psychiatrists of Jewish or refugee stock to leave the Maudsley at least in part because of Lewis. Various other of the mid-twentieth century's leading psychiatrists without Jewish backgrounds, such as William Sargant, also left also because of conflict with him.58 Anthony Storr, also without a Jewish background, described as 'Britain's most literary psychiatrist', was Lewis's first senior registrar and left after two years. He described the experience of presenting a patient at Lewis's academic case conferences: 'I owed Lewis one thing, at least. Once you had suffered the experience of presenting a case at one of his Monday morning conferences, no other public appearance, whether on radio, TV or the lecture platform, could hold any terrors for you.'59 Lewis clearly recruited to the Maudsley numerous brilliant psychiatrists. One cannot but suspect that some of these psychiatric thinkers were likely to have posed a real or perceived threat to Lewis's autonomy with which he may have been unable to cope. His teaching methods were perceived by many to be humiliating or intimidating. However, it is also claimed that he was not fully aware of his impact on his colleagues. 'Aubrey Lewis was quite unaware of this effect he had on junior doctors. He believed it when told of it but failed to understand it. It arose in part from his Socratic style of teaching which makes great demands on those who are taught. In part it also arose from his disconcerting habit of transferring the bulky file of case notes to his lap, to thumb through meticulously while not missing a word of the lengthy case presentation which the registrar had to make from memory.'60 In effect, the outcome of his rigorous selection of staff was the strengthen? ing of British psychiatry even further: just of those psychiatrists already mentioned, Roth became professor in Newcastle-upon-Tyne, Hamilton professor in Leeds, Freeman in Manchester and Stengel in Sheffield, each 56 M. Hamilton interviewed by B. Barraclough in Wilkinson (see n. 6) 15. 57 F. A. Jenner, 'Erwin Stengel: A Personal Memoir', in G. E. Berrios and H. Freeman (eds) /50 Years of British Psychiatry (London 1991) 436-44. 58 A. Dally, 'William Sargant 1907-1988', in H. Freeman (ed.) A Century of Psychiatry (London 1999) 177-9. 59 A. Stevens, 'Obituary: Anthony Storr', Psych BullXXV (2001) 365. 60 Davies(seen. 41) 5. 217</page><page sequence="10">Claire Hilton spearheading the development of additional academic departments of psychiatry. Pursuing his ideals of academic excellence, Lewis was looking for those who could contribute to his grand plan under his leadership, regardless of religious affiliation. It is difficult to conclude that he took a stance of positive discrimination specifically towards refugees. My emphasis on Lewis's relationships with his colleagues may create an overly negative impression of his personality, and may not do justice to the overall contribution he made to British psychiatry, which would probably have developed far more slowly without his academic impetus. A detailed biographical study of Lewis is needed to evaluate his contributions further. Those on the staff: the war years onwards The Maudsley was evacuated from central London during the War to two sites: Mill Hill in north London and Belmont Hospital in Surrey. A number of Jewish psychiatrists worked at the Maudsley in Mill Hill, some for only short periods and some possibly only to deliver lectures. Among them was Elizabeth Rosenberg, a Major in the RAMC,61 researching the effects of war on civilians in inner London (she later married Eric Guttmann).62 Emmanuel Miller was remembered at Mill Hill by Annie Altschul,63 a refugee nursing student, possibly in the context of delivering lectures on her training course. Rudolph Freudenberg was also temporarily at Mill Hill.64 He was later Medical Superintendent at Netherne Hospital in Surrey, where he played a large role in modernizing the care of the mentally ill, as well as being senior principal medical officer and head of the mental-health section at the Ministry of Health. Freudenberg had had the good fortune to have worked with Manfred Sakel in Vienna on insulin coma therapy, and his expertise in this new form of treatment had led to him being invited to Moorcroft House, a private mental hospital in Hillingdon, Middlesex, in 1936.65 Amadeo Limentani, an Italian Jewish refugee who had experienced internment as an enemy alien on the Isle of Man (as did his fellow Maudsley psychiatrists Felix Post and Eric Guttmann), was briefly at the Mill Hill Maudsley, later becoming consultant psychiatrist at the Portman Clinic in London.66 It is ironic that he was at Mill Hill treating 61 WHG, 'Obituary: Elizabeth R. Zetzell', BMJIV (1970) 690. 62 E. Rosenberg and E. Guttmann, 'Chronic Neurotics and the Outbreak of War', Lancet 27 July 1940, pp. 95-6. 63 P. Nolan, A History of Mental Health Nursing (London 1993) 101. 64 Medical Directory 114th Annual Edition (London 1950). 65 DHB, 'Obituary: Rudolph Freudenberg', BMJ CCLXXXVII (1983)1758. 66 M. Glasser, 'Obituary: Amadeo Limentani', Psych BullXIX (1995) 62. 2l8</page><page sequence="11">A Jewish contribution to British psychiatry casualties from Dunkirk when in the post-Dunkirk anti-foreigner furore, at the time Italy joined Germany in the War, he was arrested and interned.67 Limentani summed up his view on Aubrey Lewis as follows: 'To me, Aubrey Lewis was the most helpful person that you can think of because I really fell in love with British Psychiatry and I never lost it.'68 Felix Post, who later became a pioneer of old-age psychiatry, was also at Mill Hill in his first psychiatric job, from 1941 to 1942, after a period of internment. In 1947 Post was appointed to the Maudsley as assistant physi? cian, the same day as Frederick Kr?upl Taylor was appointed senior regis? trar.69 Both remained at the hospital throughout their working lives, both being promoted to consultant grade. Post was born in Berlin in 1913 to a mother who was Jewish but had converted to Christianity on marriage. Although defined as a Jew under the Nuremberg Laws, she survived the war in hiding in Germany. Felix was not brought up as Jewish, nor did he identify himself as Jewish. In 1933 he came to England as a refugee and trained at St Bartholomew's Hospital Medical School. He entered psychia? try, rather than the more prestigious field of general (internal) medicine, out of the need to secure employment to support his family. However, in 1947 Lewis had earmarked Post to establish the Geriatric Unit at the Bethlem Hospital, which he duly did. Embarking on research into various aspects of treatment for psychiatric illness in older people, he firmly estab? lished by his clinical treatment trials that older people with depression and schizophrenic-like illnesses responded as well to treatment as younger people.70 Also working on mental illness in older people in the 1950s and 60s was Sir Martin Roth. He clearly established that depression and schizo? phrenic-like illnesses were independent of dementia, whereas psychiatric disorder in older people had previously generally been attributed to demen? tia and considered untreatable.71 Between them, Post and Roth laid vital scientific foundations for the treatment of mental illness in older people, allowing tremendous strides in this clinical field to be made, ahead of progress in other countries. Like Lewis, Post rarely revealed his Jewish or refugee background to his colleagues, although occasionally he made comments in Yiddish72 or German73 to Jewish or other refugee colleagues. Indeed, to one colleague with whom he remained in close contact through 67 Limentani (see n. 45) 348. 68 Ibid. 69 F. Post interviewed by B. Barraclough in Wilkinson (see n. 6) 255-77 (I04). 70 F. Post, The Significance of Affective Symptoms in Old Age: A Follow-up Study of 100 Patients (Oxford 1962); Persistent Persecutory States of the Elderly (Oxford 1966). 71 M. Roth, 'The Natural History of Mental Disorders in Old Age', JMS CI (1955) 281-301. 72 K. Shulman, tape-recorded interview in the author's possession, 2004. 73 K. Bergmann, tape-recorded interview with the author, 2004. 219</page><page sequence="12">Claire Hilton out his retirement, he first spoke about his past just two weeks before his death in 2001 at the age of 87.74 His refugee background was known to others, however, and may have been associated with him having a consider? able entourage of female emigre Jewish patients from northwest London by the time he retired.75 Frederick Kr?upl Taylor, a refugee from Czechoslovakia, had, like Post, given up hope of specializing in internal medicine due to discrimination76 and only after emigrating to England developed an interest in psychiatry. His psychiatric training was partly at Crichton Royal, where Mayer-Gross was director of research, and partly at Netherne Hospital. Kr?upl Taylor instigated and developed both the day hospital and a social club for patients at the Maudsley,77 emphasizing the importance of long-term support for those who were chronically ill.78 In 1958 an important issue was taken up by Post and Kr?upl Taylor. Highly sensitive to the issues of racial labelling being used as a form of discrimination, they were the first to point out to the Medical Committee of the Joint Hospital their objections to the way 'Negro' patients' notes were being marked on the front sheet by a rubber stamp bearing the letter 'C for Coloured. It was redolent of the way Jews' passports had been stamped in Nazi Germany with a prominent red 'J'. 'To us this seems an undesirable method of recording the racial and cultural background of our patients', they wrote.79 It was suggested that accurate information on the country of origin should be obtained, rather than the letter 'C. So important was this issue considered to be that further discussions were held and it was decided that there should be a list identifying place of birth in all patients' notes and the appropriate option should be ticked.80 Thus, although the pattern at the Maudsley was not to identify strongly with any religious or refugee group, both Kr?upl Taylor and Post were clearly advocating on behalf of those potentially at risk of discrimination. Both Post and Kr?upl Taylor were remembered by Professor Alwyn Lishman in 2004: Kr?upl Taylor. He was phenomenal. He was a small man with a rather hunched demeanour. And he was like a little bird really, sitting there. He had an enormously generous approach to his friends. A very humble man. As was 74 A. Lishman, ibid. 75 R. Jacoby, ibid. 76 MS (see n. 17) 395. 77 Joint Hospital Med Com Min, GPD 6/50 MCD 9/50, Memo from Dr F. K. Taylor, 'The Establishment of a Social Club for Patients' (1950). 78 MS (seen. 17) 395. 79 Joint Hospital Med Com Min, GPM 69 MCD 46/58, 22 Sept. 1958. 80 Ibid. GPM 80,10 Oct. 1958. 220</page><page sequence="13">A Jewish contribution to British psychiatry Felix. No pretence at all, just a humble friendly, nice person to be with. People were worried about his confrontational approach with patients, and this idea - prokalectic therapy - where you challenged patients, 'I expect you are doing that because ...' and you made some fantastic explanation that shocked the patient into altering their behaviour. It always seemed to me strange that such a kind and peaceful little man should have this rather aggressive form of ther? apy, but it was done very much to help people. And I think it did.81 At the Maudsley, Erwin Stengel was reader in psychiatry from 1949 to 1956.82 He eventually left, at least in part because of conflict with Lewis, and single-handedly founded the Sheffield department of psychiatry.83 However, even after moving to Sheffield he remained a close friend of his refugee colleague Felix Post whom he had met many years earlier, in the early 1940s,84 when they were both working in Edinburgh.85 Stengel appeared to be one of the Maudsley leadership who was more inclined than others to talk of his past, and his reminiscences of his days in internment on the Isle of Man were remembered in 2004 by a then junior colleague, Norman Kreitman.86 Kreitman recollected Stengel's light hearted comments on his experiences, saying that Mrs Stengel ran the camp, waved to her husband through the wire fence and brought him cakes, and told the camp commandant what he should do. Stengel even wrote about his experiences in an unpublished lecture to psychoanalysts, 'Considerations on some experiences during a short period of intern? ment'.87 He also lectured on anti-Semitism and was a popular speaker to Jewish societies.88 Stengel's epidemiological studies in psychiatry and in particular his work on suicide and attempted suicide are well known.89 By i960 he was one of only five professors of psychiatry at the twenty-one medical schools in England and Wales. In this capacity, as well as his research and clinical work, he pioneered the development of an undergrad? uate curriculum for teaching psychiatry.90 On the social side, some aspects of his former life in Austria influenced his daily working life. His registrars at the Maudsley remembered 'how his ward rounds would finish up at Dr Stengel's house. There, his charming and gracious wife would have coffee 81 Lishman (see n. 74). 82 IOPAnn Rep (1979-80) 29, list of appointed teachers. 83 Jenner (see n. 57) 440. 84 Julian Post (F. Post's son), tape-recorded interview with author, 2004. 85 Post (see n. 42) 162. 86 N. Kreitman, personal communication with author, 2004. 87 Jenner (see n. 57) 437. 88 Ibid. 438. 89 E. Stengel, Suicide and Attempted Suicide (Harmondsworth 1964). 90 E. Stengel, 'Undergraduate Teaching in Psychiatry', BMHGII, no. 4 (1961) 55-8. 221</page><page sequence="14">Claire Hilton with whipped cream ready to welcome them, recapturing, for a brief while, the happy coffee-house atmosphere of old Vienna.'91 Michael Shepherd, born and educated in Cardiff and at Oxford University, spent almost his entire career at the Maudsley and Institute of Psychiatry from 1952 onwards.92 He revered and had a close working rela? tionship with Lewis.93 Whereas today Lewis is largely remembered for his creation and development of the academic environment of the Institute of Psychiatry, Shepherd is remembered more for his focus on the clinical practice of psychiatry at the primary- and secondary-care interface, and his role as founder and editor of the journal Psychological Medicine, with its high reputation and citation ranking.94 Both Lewis and Shepherd are also remembered for their Socratic teach? ing methods, which involved cross-questioning and challenging, and at times intimidating, junior doctors to the point of tears; Tn argument and debate, Michael Shepherd had ... a disconcerting ability to materialise from the shadows and deliver a decisive body blow'.95 David Davies was another of the Maudsley's Jewish consultant psychia? trists. Having been the son of a tailor's machinist in the Cheetham area of Manchester, he gained a place at Manchester Grammar School, then a scholarship to Oxford. Davies had a reputation for teaching and, as a creative administrator, for facilitating new developments and identifying trainees with potential for academic work. Clinically, his expertise lay in the field of alcoholism.96 As dean of the Institute of Psychiatry from 1950 until 1966 while Lewis was professor, he worked particularly closely with Lewis. Both finally retired at the same time. They appeared to work well together, in contrast to the working relationship of their successors.97 Willi Hoffer, Heinz Wolff and Sigmund Foulkes were all psychiatrists specializing in psychotherapy at the Bethlem and Maudsley. Trained in both medicine and psychotherapy in Vienna, Hoffer came to England in 1938, the same year as Freud. In 1954 he joined the Psychotherapy Unit at the Maudsley, in the early days of teaching seminars in psychotherapy for junior doctors. All the psychotherapists at the Maudsley had a responsibility for introducing psychotherapeutic concepts into the general postgraduate training of psychiatrists who were not neces 91 Barton (see n. 16) 163. 92 Russell (see n.38 ) 632. 93 Ibid. 94 G. Wilkinson, 'Obituary: Michael Shepherd', BMJ CCCXl (1995) 868. 95 Ibid. 96 V. Berridge, 'David Lewis Davies (1911-1982)' in Matthew and Harrison (see n. 12) 97 Joint Hospital Med Com Min, MCD 61/70, 25 Feb. 1970, 'Investigation into the academic administration of the Institute of Psychiatry'. 222</page><page sequence="15">A Jewish contribution to British psychiatry sarily going to practise specifically in psychotherapy. Thus they had an important role in the development of psychiatric training in Britain and in the dissemination of these concepts among colleagues. Hoffer's charismatic teaching of psychotherapy inspired many doctors into that branch of psychiatry.98 He also edited the International Journal of Psychoanalysis from 1948 to 1959." At his funeral in 1967, his friend and colleague Anna Freud, the daughter of Sigmund Freud, spoke touch ingly.100 Professor Lishman recalled Willi Hoffer in 2004: He was a god of mine. I worked for nine months for Willi Hoffer in psychotherapy. He was a larger than life emigre. There would be 6 or 7 of us, working in psychotherapy, and we would have a weekly meeting with him, and he would bellow forth with German love songs. He was like many of these psychotherapists extremely extrovert. And I remember on one occa? sion, I'd had supervision with him just by myself, and he said that I had done rather well, with some awfully difficult patient, a fellow of All Souls I was struggling with, who was always one up on me. And he gave me a page of Mourning and Melancholia in Freud's hand writing, the original that Freud had written on sheets of paper, and he said 'You can have this for the morn? ing'. ... and he had a lot of the original manuscripts, I think Anna Freud had given them to him. And it was incredible to read this, because Freud had hardly made any alterations. And he had us round to his home several times, in St John's Wood. We had parties in the garden.101 It is interesting that Hoffer appeared to be one of the refugee psychiatrists remembered for his anecdotes of his early life in Vienna, which were said to have enlivened his Wednesday seminars.102 Whereas Hoffer was the doyen of individual therapy at the Maudsley, Sigmund Foulkes (ne Fuchs) focused on group psychotherapy. Foulkes moved to England in 1933 and, as a Major in the RAMC at Northfield Hospital during the Second World War, was instrumental in developing the therapeutic-community approach to hospital psychiatry, a fruitful and liberating concept from the previously more custodial regime. Later he founded the Group Analytic Society (which became the Institute of Group Analysis) and the journal Group Analysis which he also edited.103 Heinz Wolff, a refugee from Hamburg who arrived in England in 1936, also served in the RAMC and in due course was transferred from working at the Middlesex Hospital to the Maudsley, at the invitation of Lewis. He was also 98 HR, 'Willi Hoffer: A Tribute', BMHGIX, no. 3 (1967) 33. 99 'Dr W. Hoffer', BMHG IV (1962) 291. 100 HR(seen.98)3i. 101 Lishman (see n. 74). 102 'Dr W. Hoffer' (see n. 99) 292. 103 MP, 'Obituary: SH Foulkes', BMJW (1976) 483. 223</page><page sequence="16">Claire Hilton the first chairman of the Institute of Group Analysis. An important figure in British psychiatry, he is remembered for his writing and teaching of dynamic psychotherapy.104 Various other European-trained psychiatrists worked at the Maudsley, as can be seen from an entry in the Medical Committee minutes, listing staff members wanting to change their hours of employment in 1954.105 It is difficult to know the precise context of these requests, or whether these doctors were full-time or part-time, but the list includes the following staff, with their ages and qualifications: M. Balint MD Budapest PhD Berlin Age 58 LRCP LRCS (Ed), Charles Friedman MD Vienna Age 54 LRCP LRCS (Ed), W. Hoffer MD Vienna Age 57 LRCS LRCP (Ed), F. Reitman MD Vienna Age 46 and S. Krauss MD Basle PhD Vienna Age 51. The importance of the clinical role of immigrant psychiatrists at the Maudsley Hospital was emphasized when the Duchess of Kent, patron of the hospital, visited on 23 March 1955. The report of her visit in the Bethlem Maudsley Hospital Gazette lists the names of those doctors presented to her: Hoffer, Foulkes, Post, Rey and Jacobedis,106 all medical practitioners of foreign origin. The first three were refugees from the Nazis, the fourth was from Mauritius107 and the fifth had a grandfather who 'had painted portraits of members of the Royal House of Greece'.108 Although this paper explores in detail only the era until the retirement of Aubrey Lewis in 1966, some of those he appointed remained on the Maudsley staff for many more years. Their impact continued both locally at the Maudsley and more widely through their research and academic writ? ings, as well as by teaching junior doctors who subsequently worked else? where. Towards the end of the generation of the refugee psychiatrists at the Maudsley, Raymond Levy summarized his view in 1979 in a Bethlem and Maudsley Gazette profile of Klaus Bergmann, who had recently been appointed consultant psychiatrist in the department of old-age psychiatry: 'Klaus was born in Dresden and came to England in early childhood. He represents the last of a distinguished group of psychiatrists whose service this country might never have acquired without the Nazi persecution in Europe.'109 Bergmann had not trained at the Maudsley, but his teachers had been those intellectual giants who had left the Maudsley a generation earlier - Professors Martin Roth and Erwin Stengel. 104 MP, 'Obituary: Heinz Hermann Otto Wolff, Psych BullXlll (1989) 584-5. 105 Joint Hospital Med Com Min, MCD 14/54,I954&gt; P 106 'Visit of Her Royal Highness the Duchess of Kent to the Maudsley on 23 Mar 1955', BMHG II, no. 1(1955)7. 107 M. Feldman, 'Obituary: Henri Rey', Psych Bull XXIV (2000) 478-9. 108 'Visit...'(seen. 106)7. 109 R. Levy, 'Profile: Klaus Bergmann', BMG (Spring 1979) 22. 224</page><page sequence="17">A Jewish contribution to British psychiatry Professor Tom Arie, a junior doctor training at the Maudsley in the early 1960s, recently recalled: There was Kr?upl Taylor and he was a very sardonic man, and I never worked with him, perhaps sitting at the same table as him where he used to hold court in the cafeteria. Stengel had just left when I arrived at the Maudsley. He was a much loved figure at the Maudsley ... and yearned for by those who liked a softer approach, but he had left the summer that I came. Willy Hoffer was a name. I had nothing to do with him. There was Fuchs, converted to Foulkes. He was around as a psychotherapist, there again I wasn't into psychotherapy. There was Heinz Wolff, I went to his seminars and supervisions. ... again there was absolutely no reference to [being Jewish]. ... The Maudsley was a curious place. The people who in my day were the key figures were Lewis, Shepherd, Davies the dean - all Jewish heavily disguised - and Jewish things were never alluded to by any of them. ... A lot of the registrars were Jewish but that was different ... But these grandees, Lewis, Shepherd and Davies, never spoke of Jewish things, from the vantage point of a registrar passing through.110 One suspects that being 'Jewish heavily disguised' was in part another influence of Lewis. Held in high esteem by his influential contemporaries, Shepherd and Davies in particular, Lewis was reserved in character, an assimilated Jew from childhood, educated at a Roman Catholic school,111 and a leader whose main objective was achievement in the field of psychia? try and the development of his postgraduate teaching hospital. Revealing anything of his personal identity was likely to have been seen as immaterial and irrelevant to his objectives. However, avoiding revealing any religious identity may in part also have been a cohort effect of his generation, and was particularly common among the medical profession in the interwar years.112 The postwar era was a time when many Jews continued to angli? cize their names, a trend of acculturation that continued into the 1950s and 60s.113 In part this may have been a psychological factor - helping those recently escaping from Nazi Europe to forget the traumas of the Holocaust, and those whose families had arrived in Britain from Eastern Europe a generation earlier, the poverty of their immigrant childhoods. Only with the development of multicultural society in Britain towards the 1980s did the Jewish community feel freer to make its religious and cultural identity more visible.114 110 T. Arie, tape-recorded interview with the author, 2004. 111 Shepherd (see n. 43) 7. 112 Cooper (see n. 44) 90-1. 113 V. D. Lipman, The History of the Jews in Britain since 1858 (Leicester 1990) 223, 230. 114 Ibid. 225</page><page sequence="18">Claire Hilton During the leadership of Aubrey Lewis many doctors from numerous nationalities and religions came to study at the Institute of Psychiatry and at Bethlem and Maudsley Hospitals as part of their postgraduate training. Within the first year of the establishment of the Institute of Psychiatry in 1949, fifty-four students came from abroad, from as far a field as China, Australia and South America, an international academic focus being an important part of the teaching hospital.115 Many Jewish doctors studied and trained in psychiatry at the Maudsley in the 1950s and 1960s then moved to work elsewhere as consultant psychiatrists, some returning to the Bethlem and Maudsley in later years, after the retirement of Lewis. These doctors, some of whom had arrived in Britain as child refugees, would form the basis of another study. Discussion and evaluation This is inevitably a biased study, if only since sources such as obituaries tend to create a favourable image. Similarly, the profiles in the Bethlem Maudsley Hospital Gazette written when a member of staff left the Maudsley generally have a positive slant. This study also focuses on one hospital which was in many ways unrepresentative of most medical estab? lishments. In addition, it attends not just to the medical contributions of the eminent psychiatrists identified but to their experiences as Jews or refugees. There were many non-Jewish leaders in the field of psychiatry and related disciplines, and many who received the same attention - both posi? tive and negative - from Professor Sir Aubrey Lewis (knighted in 1959).116 Jewish staff members remained in a numerical minority at the Maudsley and Institute of Psychiatry, as is apparent, for example, from the list of those attending meetings of the Medical Committee of the Bethlem and Maudsley Hospital.117 This review also cannot claim to be fully compre? hensive. Since it was not generally acceptable to reveal one's Jewish back? ground at the Maudsley, it is inevitable that the Jewish origins of some practitioners and contributors to the field will have been overlooked. Although in the oral-history contributions to this study the Jewish identity of various individual consultants was clearly recognized, there appears to have been few specific links between these senior clinicians with similar religious or cultural backgrounds: their work objectives were the main line of communication between them. 115 IOPAnn Rep (1949-50) 31. 116 Joint Hospital Med Com Min, MCM 36, 22 June 1959. 117 Joint Hospital Med Com Min, 1950-70. 226</page><page sequence="19">A Jewish contribution to British psychiatry The study also reflects little on the contributions made by other psychia? trists not affiliated to the Bethlem and Maudsley Hospital, such as those mentioned by Cooper in his book Pride versus Prejudice^ including Max Glatt, pioneer in the management of alcohol addiction,119 Samuel Last who, as Medical Superintendent, played a major part in the modernization of the St John's Mental Hospital in Aylesbury,120 or Ernst Jacoby, consult? ant psychiatrist in Birmingham, 'a popular colleague and a dedicated clini? cian', known to have been interned as an enemy alien on the Isle of Man.121 Typical of this generation of psychiatrists was that they took a reforming and pioneering attitude to their work. For example, those who became medical superintendents of mental hospitals, such as Rudolph Freudenberg at Netherne, Samuel Last in Aylesbury and Isaac Sutton (Jewish, born in Manchester) in Friern Barnet,122 are remembered for their modernizing policies and practice, while Joshua Bierer (an Austrian refugee) pioneered the foundation of the radical Marlborough Day Hospital, the first day hospital in this country.123 Whether personal experiences such as discrimi? nation, persecution or internment, or those of their families as refugees or immigrants in an earlier generation, influenced them to develop the treat? ment of mental illness into less custodial and more progressive, less stigma? tizing care, is open to speculation. There were also many other refugee or Jewish workers in related disci? plines who contributed to the field of mental health, some of whom also worked at the Maudsley. These included Inge Bergmann124 and Helen Goldschmidt, also working on a Rockefeller Foundation award;125 Annie Altschul, a pioneer of psychiatric nursing;126 and Hans Eysenck127 and Monte Schapiro128 in psychology. Hilde Himmelweit completed her doctorate at the Maudsley and later became professor of social psychology at the University of London, writing such influential works as Television 118 Cooper (see n. 44) 224-31. 119 H. Rollin, 'Obituary: Max Meir Glatt', Psych Bull XXVI (2002) 397-8. 120 DCW, 'Obituary: Samuel Last', Psych BullXV (1991) 587-8. 121 R. Blueglass, 'Obituary: Ernst Jacoby', Psych BullXXlV (2000) pt 10, p. 398. 122 Cooper (see n. 44) 227-8. 123 RG, 'Obituary: J Bierer', BMJf CCXC (1985) 163-4. 124 'Inge Bergmann', BMHG XII, no. 1 (Autumn 1970) 26-7. 125 A. J. Lewis and H. Goldschmidt, 'Social Causes for Admission to a Mental Hospital for the Aged', Sociology Review XXXV (1943) 86-98; H. Goldschmidt, 'Social Aspects of Ageing and Senility', ./ALS XCII (1946) 182-94. 126 Nolan (see n. 63). 127 G. Richards, 'Hans J?rgen Eysenck (1916-1997)' in Matthew and Harrison (see n. 2) 128 M. Berger and W. Yule, 'Retirement of an Enthusiast: Dr M. B. Shapiro', BMG (Winter 1979)16-17. 227</page><page sequence="20">Claire Hilton and the Child.129 Then there are those who arrived in Britain as child refugees from the Nazi regime, who trained in medicine as adults, or who came specifically to attend medical school in Britain in the 1950s and chose to become psychiatrists in an era when medical careers were less restrictive for Jews. These doctors, some of whom were training at the Maudsley in the early 1960s while Lewis was still professor, have not been included in this study because they were of a new generation of doctors seeking consult? ant posts in the late 1960s and early 1970s, about the time of retirement of those psychiatrists who form the main part of this study. The reasons for which a considerable and probably disproportionately high number of Jewish doctors elected to pursue careers in psychiatry is another topic worthy of consideration in its own right. Some immigrant practitioners arriving in Britain during the Nazi era were for various reasons unable to continue their previous careers. Language barriers, domestic responsibilities or the hurdle of requalifying examinations possibly hindered their progress. Many of those documented as having arrived in Britain as refugees with previous medical experience130 are absent from the pages of the Medical Directory in subsequent years,131 suggesting that their medical careers did not progress. The evidence avail? able and presented in this study therefore also gives a biased view towards those who had successful careers in psychiatry. It was both the low prestige of psychiatry and the opportunities given to Jewish practitioners of the middle of the twentieth century which gave them the chance to excel in the field. For some the move into psychiatry was the result of necessity rather than choice and some never quite came to terms with this. Felix Post, reflecting on his highly successful career in his mid-8os, stated: 'What I regret really is, although I shouldn't say that out loud, that I got stuck into psychiatry, frankly. I'd better be careful, it shouldn't get abroad. My main interest was really in internal medicine, and the physical side. But psychia? try, I've always been slightly ambivalent. Fascinating, but not so satisfying and not so easily brought into a scientific framework.'132 It would have been convenient to have found a minority group in recent history with comparable experiences to those of the refugees of the 1930s and the generations of Jewish doctors from the first half of the twentieth 129 H. T. Himmelweit, A. N. Oppenheim and P. Vince, Television and the Child: An Empirical Study of the Effect of Television on the Young (London 1958); M. Jahoda, 'Hilde Himmelweit (1918-1989)', in Matthew and Harrison (see n.) 130 Biographical database of European medical refugees in Great Britain 1930S-50S, in care of Paul Weindling, Oxford Brookes University. 131 Medical Directory (see n. 64). 132 F. Post, tape-recorded interview by Rainer Heuer, University of Essex (1988), tape in the collection of Paul Weindling, Oxford Brookes University. 228</page><page sequence="21">A Jewish contribution to British psychiatry century. But the most important group which comes to mind is that of the present day, when there are many psychiatrists in training in Britain who are refugees from oppressive regimes. Some have told me that they have been discouraged by senior members of the medical profession from trying to train or retrain in more popular specialities of medicine, such as surgery or obstetrics and gynaecology. Like previous generations of refugees they may have moved into psychiatry as the only option available - psychiatry still being one of the least prestigious medical specialities. They are often intelli? gent and well motivated. Their experience of adverse social and political circumstances and desire to achieve the best for themselves and their fami? lies in their adopted country may also contribute to making them the leaders in psychiatry in the future. The story of immigrants from the 1930s and 40s in this way repeats itself. Today's psychiatrists have to learn from history and help develop the skills of future generations of immigrant doctors. Other aspects of research into the role and contributions of emigre and refugee psychiatrists in the twentieth century remain to be done, such as those whose careers took them away from London and the small number of women psychiatrists trained in Germany and Austria who came to England as refugees.133 The present study could well be regarded as a pilot deserv? ing expansion. In summary, despite its limitations, this study gives some insight into the roles of Aubrey Lewis and Jewish and refugee doctors at the Bethlem and Maudsley Hospital and Institute of Psychiatry between 1933 and Lewis's retirement in 1966. Most such people kept their Jewish and European back? grounds hidden and disguised in the work environment. Their legacy to us in the development of both clinical practice and academic psychiatry in Britain reflects their determination to achieve academic and clinical excel? lence in an unpopular medical speciality which was willing to recognize their potential and welcome them into its midst. ACKNOWLEDGEMENTS Professor Paul Weindling provided me with a copy of a list of refugees working in mental health, from the Biographical database of European medical refugees in Great Britain, 1930S-50S. The research for this study was carried out while I was in receipt of a Wellcome Trust Research Leave Award in the History of Medicine for Clinicians and Scientists. I am also grateful to those people listed in the footnotes who contributed the oral history narratives quoted in this paper. 133 Biographical database of European medical refugees (see n. 130). 229</page></plain_text>

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