(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.