Biography & Psychology VI: W.H.R. Rivers (2 of 2)

(continued from previous post)

As a clinical assistant at Bethlem, Rivers’ duties were widespread, and would have included regular visits to the wards and completion of the statutory casebooks (the latter administrative task was most often carried out by the assistants rather than the paid physicians), as well as examination of patients, attendance in emergencies and routine medical treatments, and procedures such as force-feeding. There was also a social side to the role: clinical assistants, like all medical and ward staff, were expected to get involved in hospital entertainments, whether by playing in the band or performing in plays and variety shows for patients. Their residence in the hospital meant that, for the six months of the appointment, Bethlem effectively became the focus of a clinical assistant’s professional and social life: we even find records of fiancées, family members and friends appearing alongside them in entertainments.

While it might be tempting, in light of the role he is later perceived to have held in promoting the psychological side of mental health, to read such interests into Rivers’ notes at Bethlem, this is not necessarily the case. Indeed, Rivers’ entries in the casebooks do not differ materially from those of the other assistants, adhering closely to the guidelines of the Commissioners in Lunacy (who inspected all asylum records) and using similar language to his contemporaries. In November 1892, for example, he wrote that Mary Ann Russell “[c]annot be got to say anything about her trouble. Rubs & picks her face and head very much. Is very resistive.” In March the following year, the patient was “[s]till very troublesome to feed, has required tube once or twice lately. Stands about gallery usually rubbing her head. Will not talk.” Such descriptions – “resistive” and “troublesome”– were part of a common psychiatric language, regularly adopted in cases of patients exhibiting particular behaviours. Indeed, such concerns often became used as a general guide to be applied from one individual to another exhibiting similar symptoms, “anticipating” further behaviours before they had even occurred. While Rivers’ 1911 address to the Anthropological Section of the British Association for the Advancement of Science complained about the general tendency within anthropology to use the psychology of the individual as a guide for the collective action of mankind, such correlations (from one individual to all individuals to society as a whole) were often also made within turn of the century psychiatry. Such generalizations would hold enormous resonance in Rivers’ later career in war psychiatry, when the perceived general tendency of human beings to evade duty would be deemed the main motivation behind individual cases of war neurosis, particularly by war office officials. This exacerbated one of the major tensions within psychiatry, whereby the creation of new classificatory approaches to mental illness (related to efforts to uncover universal truths about normal and abnormal psychology) conflicted with the claims of asylum professionals to treat patients individually, and to see the onset of illness as resulting from a combination of biological, psychological and environmental factors, which would be unique to the individual.

Biography & Psychology VI: W.H.R. Rivers (1864 – 1922)

W.H.R. Rivers is probably most famous today for having been the doctor of poet Siegfried Sassoon, when he was treated for “shell-shock” at the Craiglockhart War Hospital in 1917. Pat Barker’s well-known novel, Regeneration, depicts Rivers as a hero of wartime psychiatric treatment, pioneering psychological approaches to mind over the punitive electro-shock methods of Lewis Yealland. What is less well-known is that Rivers’ career in psychiatry began at Bethlem. Born in 1864, William H.R. Rivers trained in medicine, subsequently deciding to “go in for insanity” (as he put it in his diary), following which he gained a position as clinical assistant at Bethlem Hospital in October 1892.¹ These six-month residential (but unpaid) posts were open to fully qualified medical practitioners with a special interest in the field. Although absent from Bethlem over the Christmas period, when he was struck down by an outbreak of scarlet fever in the wards, in March 1893 it was noted that both Rivers and his fellow assistant, Maurice Craig, were “anxious to continue in residence … for another 6 months.” In the event, Rivers only stayed at Bethlem for another two, asking to resign on May 24 when he was offered a Lectureship in Psychology at Cambridge. Yet he continued to lecture at Guy’s Hospital with George Savage, whom he had presumably met while working at Bethlem (Savage, a former superintendent, regularly brought parties of students to the wards for instruction as well as visiting the hospital socially).

Rivers’ interests remained wide, and his career encompassed a variety of elements that may seem contradictory to modern eyes, used to specialism. It is often assumed by historians that neurological approaches to mind required a determinist, “medical materialist” approach, which privileged somatic medicine over psychology and objective physical symptoms of illness above subjective ones. Yet it doesn’t appear that Rivers (or many of his contemporaries) perceived any such conflict between physical and mental medicine. In his early career he combined neurological research with Henry Head (the “nerve regeneration” experiments after which Pat Barker’s book is named) and social anthropology (in the Torres Straits study of 1898, and his own research into the Todas a few years later) with medical and experimental psychology.

(to be continued…)

[1] Rivers quoted in Richard Slobodin, W.H.R. Rivers: Pioneer Anthropologist, Psychiatrist of “The Ghost Road”, (Stroud: Sutton, 1997) , p. 13

Rivers and Head during the nerve regeneration experiment (Rivers seated right)

Image: Wellcome Library, London