Psychiatry in Action

The emergency medical services cover the entire country from the smallest village to the largest town with a network of ambulance depots, first aid posts, and hospitals. Our hospitals include centers at which teams of specialist doctors are concentrated to deal with particular problems. There are centers for burns, for injuries to the eyes, to the head, to the chest, to the spine. Centers for orthopedic and facio-maxillary injuries, centers for plastic surgery. There are also centers for neuroses. From the point of view of national efficiency and morale, the neurotic who has broken down under the stress of war experience must be reinstated into the structure of society as quickly as possible. The seven hospitals devoted to the treatment and rehabilitation of the neuroses are all placed near large towns which are liable to bombing. For as in the last war, it has been found that the neurotic can best be treated near the scene of enemy action. This film is about one of these neuroses centers. It is a hospital of 550 beds handling some 3,000 patients a year who stay on an average 6 to 8 weeks. Patients, both civilian and from the armed forces, admitted from hospitals and from outpatient clinics. The hospital itself has an active outpatient department with many associated clinics from which patients are admitted. The fact that the hospital is situated in the grounds of a large school which has been evacuated allows it to be divided into units of about 50 beds, each set aside for different kinds of illness and the treatments required. For example, there are units for acute anxiety states, hysteria, and effort syndrome. One unit is set aside for men whose conduct or failure to respond to treatment would otherwise affect hospital morale. There are separate units for men and women, for civilians, and for the armed forces. The hospital is equipped with the usual ancillary departments such as a small surgical unit, an X-ray department, and laboratories for pathology, biochemistry, and psychology. Research, especially into war problems, is active. We are concerned solely with the treatment and rehabilitation of patients with neuroses and mild psychoses of good prognosis. The majority are men and women in the armed forces with neuroses due to the stress of active service or due to its service conditions. Civilians are also cared for. They may be of the type normally found in peacetime or those who have neuroses directly attributable to the war. Bombed citizens, children, national fire service, police, ARP personnel, merchant seamen, and ex-servicemen. The ex-servicemen are those who have been discharged from the forces but need further treatment before they are fit for work. Our object in every case is to get a return to useful function either in the forces or civilian life. With this aim in view, the routine of the hospital is carefully organized to provide a background against which individual and special treatments can be applied to suit each case. Patients may be admitted from several sources. After admission, each patient is assigned to his doctor who investigates the case, plans treatment, and controls its progress. Treatment is completed by proper disposal. All patients spend the first 24 hours in the admission house. This first day is important as an introduction to the hospital. I wonder if I might have your attention for a few moments, please. I want you all to read this booklet very carefully. It tells you all about it here. What the hospital expects of you. Nurse, this man said he can't say. Then I had better read it to you. You have been sent to this hospital because it is believed that your illness is wholly or partly nervous. Such illness as yours is due either to the way a man is constituted or to the experiences he has been through at various times in his life. It will therefore be in your own interest to explain as much as you can about yourself to your doctor and to confide in him. This pamphlet also gives the patient details of the daily routine of the hospital, of the rules, canteen arrangements, leave and passes, the library, the chapel, and recreation. Oh, nurse, about this number four. Yes. Uh where it says hobbies or interests, do you think it means any type of hobby? Yes, of course. Now that we've finished with this, is there anything you would like to ask me? Well, sister, there is something I would like to ask your advice upon. Yes. I'm very worried about my wife. Your wife? Yes. She's expecting a new baby fairly soon. Yes. And I'm in hospital and I'm unable to be with her and she she gets proper attention. Well, what am I to do? Well, I don't let that worry you. We have a special department here of social workers. You go along and see one of them and you'll find they can help you with your problem. Now, is there anything else? Uh no, sister. Uh at least uh Yes. Uh sister, this isn't a mad hospital, is it? No, of course not. What made you think of that? Well, my father's been away in a mad hospital and I worry. Your father? Yes, he's been away in a mental hospital. Yes. Yes. And I get these pains in my head. Doctors say I imagine them, but that's why they sent me here. Now, you mustn't think of it quite like that. The doctors meant there was no physical basis for your pains. That doesn't mean they're not real to you. We know that they are. The doctors think you must have nervous worries which are causing the pains. And that's why they sent you here because we specialize in treating people like you who have got pains and worries all mixed up together. Thank you, sister Queen. The main point of my interviews with the new patients is to give them immediate reassurance that their worries, which are very real to them, will receive sympathy and understanding. Very often these men have been in a number of hospitals for physical investigations, and by the time they reach us, they're in a thoroughly disgruntled mood. They are being accused of being malingerers or shirking their duty, as indeed some of them are. Or that they are suspected of being insane. My job is to reassure them, and so try and induce a receptive state of mind so that they will begin at once to cooperate with their doctors. Once the patient has been introduced to the hospital, a start can be made on the medical problem. During these first 24 hours in the admission house, the patient is given a series of examinations and tests for a preliminary assessment of his physique, personality, and ability. First of all, a thorough physical examination is made to exclude or assess the importance of organic disease. In the general overhaul, special stress is laid on a competent neurological examination. Routine blood tests are made. Research items are incorporated into this routine examination. For example, anthropological measurements are made. What is the relationship between physical habitus and personality? Next, psychological examination. Two group tests are given, one verbal and one matrix test non-verbal. Now, you've all got your books. This is test of observation. Open your book to the first page. You see what it is? The upper figure is a pattern with a piece left out. And these pieces are all the right shape to go in there, but they're not the right pattern. You see how the pattern goes? It's three, two, one that way, and one, two, three that way. So, the piece to come here is one line that way, and three lines that way. That is number six. So, the right answer is six. Will you write six against number one in column A on your form? Right? Now, go on like that right through the book. Look at each in turn and decide which piece is right. Put it on your form. I am aided by Professor Spearman. I designed these tests as means of estimating a person's ability to form comparisons and reason by analogy. Inability to form comparisons and reason by analogy is probably one of the chief visual failure. Matrix tests have proved to be a reliable means of estimating a person's mental ability and are now used as the standard intelligence test at medical examinations throughout the services. The vocabulary test has been developed at the hospital. It is the verbal complement to the matrix non-verbal test, and the two together give a good indication of intellectual ability and educational attainment. With the information so far obtained, the medical superintendent, after a short personal interview, sends the patient from the admission house to the hospital unit and doctor most suitable for his particular case. During the interview, the doctor seizes on any clue and follows it up by all available means. He may ask for a special clinical or pathological investigation or a psychometric testing by the psychologist. Or he may arrange for the social worker to make a home visit. In many cases, these basic interviews, together with a general regimen of physical and occupational rehabilitation, are enough to bring about a return to normal status. In others, the formulation of the case is more complex and special methods may be employed in the plan of treatment. Long-term psychotherapeutic procedures are seldom undertaken, since the time spent must be related to the urgent practical needs of war. Every interview with a patient is organized both to elicit information and to strengthen therapeutic rapport. This soldier developed hysterical tremor after being severely dive-bombed. This woman of 52 took up a munitions job. While she was at work, her home was bombed and her husband killed. She carried on, but after some months she became sleepless, agitated, and depressed. She collapsed at work and was referred to the special outpatient clinic for industrial cases held at the hospital. She was admitted and is improving on the general treatment. The patient being interviewed by this doctor is a foreman fitter. Three years ago, he received severe head injuries in a blackout accident and was in a general hospital for 4 weeks. Lately, he began making mistakes in his work and it was thought that the long hours were causing fatigue. He was treated as an outpatient for some time with no improvement. On admission for investigation, the doctor established the presence of early cerebral deterioration and concluded that he must be reposted to a job requiring a lowered efficiency level. This formulation was confirmed by psychometric testing. What should you do if, whilst sitting in a cinema or a theater, you were the first one to notice a fire? I should walk out quietly and inform the person who is in charge. Here is the Wechsler-Bellevue scale being used by a senior male nurse. Such an individual intelligence test is used when the results of the preliminary group tests, the matrix and vocabulary tests, are not in accord with the patient's past school and work record. This patient is an intelligent man who has been through severe bombing experiences. He was anxious and tremulous on admission, and this evidence of emotional upset accounted for his poor performance in the group tests. His scores were far too low. Later, when he had settled down after some weeks of treatment, retesting showed his real level. This man scored surprisingly highly in the group tests and cheating was suspected. The individual Wechsler test showed him to be dull and backward. What is guillotine? I don't What is fable? I don't know. Personality tests are the concern of the psychologists themselves. Rorschach test reveals deep-seated personality traits. This man's responses were grossly abnormal and gave support to the clinical diagnosis of schizophrenia masquerading as a neurosis. A new projection test has been developed at the hospital. The psychologist asks the patient a series of questions while the patient is drawing in response to a set picture. When each of two expressive mechanisms, talking and drawing, are concerned at the same time in separate tasks, much fantasy material is revealed. This youth regards the trunk as a coffin housing the dead. He is an unstable psychopath with much pathological mental content and would have been a problem in peacetime. From the point of view of diagnosis and treatment, it may be important to know whether a patient is suggestible. Stand quite still and relax and shut your eyes, will you please? Just keep standing like that for a few minutes. Right now. Now, just keep standing there, please. Quite still and relaxed. Don't think of anything in particular. Just listen to me and keep standing quite still and relaxed with your eyes closed. Now, I want you to imagine you're falling forward. Just imagine you're falling forward. Falling. Falling forward. You are falling. Falling forward. You're falling forward all the time. Falling. Falling forward. You're falling. Falling. Falling forward. Falling. You're falling forward. Falling forward. You're falling forward now. You're falling. You're falling forward. Thank you, nurse. Tell me, were you trying at all to resist the suggestion? What were you trying to do? Exactly what you told me to be doing in the beginning. That is to stand quite still. Yes. By yourself, I see. Uh what did it feel like to you? I was being pulled forward the whole time, sir. Oh, I see. Right. Thank you very much. Thank you, nurse. Good morning. Good morning. Kohs blocks are used as a standard performance test. This boy was trapped in a bomb shelter and suffered from carbon monoxide poisoning. A resulting cerebral impairment was suspected. He would not cooperate in the usual tests, but took readily to the Kohs blocks. The O'Connor tweezer test gives information on manual dexterity. The Minnesota form board shows up form appreciation. The Karl Hollow Square indicates special management and planning. The Tripel Tester scores speed and accuracy of sensory motor response. These and other tests used are all under constant assessment and research is carried on continually into new methods. Acute anxiety states, particularly when restlessness is a feature, are treated by continuous narcosis. For success, close vigilance by the nursing staff is required. Nurses are taught to estimate depth of sleep and to take blood pressure readings. Sleep is induced with somnifaine given in twice a day. Other sedatives are given orally as required. Sleep is maintained for 20 out of 24 hours. The treatment lasts for 10 to 14 days and may be followed by a modified type of insulin treatment. Modified insulin treatment is reserved for the more chronic and exhausted types of anxiety states, for depressive states with loss of weight, and for acute cases following continuous narcosis. A mild hypoglycemia, which does not reach the depth of coma, is induced for 3 hours by the injection of from 20 to 60 units of insulin at 7:00 a.m. The effect is checked by the doctor so that the next day's dosage may be adjusted as required. At 10:00 a.m., the treatment is interrupted by breakfast of sugared tea, bread, and potatoes. By this method, there is a valuable wartime economy both in insulin and sugar. An hour later, patients get up and in the afternoon resume normal activity. Electric convulsion therapy is reserved for depressions of the endogenous type, particularly involutional depressive states. It's used in carefully selected cases with due regard to possible complications. This is the last of a series of six convulsions. The patient is not apprehensive and loss of consciousness is immediate. Oxygen is given to speed up the recovery period. The treatment leaves no unpleasant hours rest. The patients resume their normal activities. Narcoanalysis is reserved for hysterical patients with acute memory disturbances or conversion symptoms. This man has such a severe hysterical stammer that he's almost mute. Well, Cot, how are you today? You feel all right apart from the stammer? Well, I have explained to you that the stammer is due to the fact that your muscles are all very tense, you see. And in particular, the muscles of your neck, uh face, and tongue. Now, this injection which you're going to receive today will help you to get over your stammering. It will make you sleepy and will enable you to relax more easily. And in particular, the muscles that we must get relaxed are the muscles of the neck, face, and tongue. Now, the injection won't hurt very much. Just a pinprick and you'll find it quite pleasant. Will you put the tourniquet He stammered as a child and had recovered, but after Dunkirk, he became much worse. Under the influence of an intravenous barbiturate, he will be more open to strong suggestion attacking his symptom. This method of treatment is also used for the recovery of lost memory and exploration of the psychological causes behind it. Right, will you take your coat off and Did you sleep all right last night? You're not getting more sleepy, are you? Are you feeling happier? I don't want you to go to sleep, actually. So, I must try to keep awake. And I want you to do exactly as I tell you. Now, I want you to get all your limbs relaxed. Relax the legs and the stomach and the neck. Let them go quite loose. As much as you can. And now, when you speak, I want you to let the words roll off your lips quite easily and without effort. I want you to repeat after me. Um Monday. Monday. That's right. Tuesday. Tuesday. Wednesday. Wednesday. Thursday. Thursday. Friday. Friday. Saturday. Saturday. Sunday. Sunday. Well, you see, you're speaking perfectly well, and that is because you're now properly relaxed. The removal of the symptom by this means is only a prelude to dealing with the difficulties that caused it. If these difficulties are not resolved, the patient will break down again. This is a timid man, very dependent on his family. On call up to the army, he was unable to adjust. In the course of his ordinary duties, he fractured his left ankle, and subsequently hysterical symptoms supervened in the form of a weakness and tremor in the left leg. There are financial difficulties in the background. Right, will you take your boots off and get onto the bed. Right, will you release these for me then? As I give the injection, you will get more sleepy, and I want you to relax your limbs. You see, you just let everything go slack. Let all your muscles become relaxed including your legs. And when you're relaxed, the trembling in your leg will pass off. It will disappear completely. Let your leg get more and more relaxed till all the trembling goes. I think it's gone. The trembling is entirely gone. I want you to move the left leg first of all. Just Just straighten it out. Straighten it out at the knee, you see? That's right. That's fine. All right, put it back. Straighten it out again. Right, and the other leg. In cases of this type, the abolition of the symptom must be followed by extensive re-education in the use of the limb. In this case, there is too some residual stiffness due to the original fracture. I want you to walk to the corner and come back, you see? That's fine. That's very good. All right, turn round. Back again. That's right. Up. And again. Right, keep on doing it until I tell you to stop. Group talks are given by the doctor three times a week. This part of the brain is the controller. And it controls the actions of all the organs in the body. You remember we've talked about the heart the lungs the stomach the blood vessels changing color and so on, and that is all done without you having to think about it at all. It's done from that part of the brain. And it's done extremely well. Now, let's have any questions any of you have to ask about them. Uh yes, sir. I quite understand what you mean by excitement or worry making your heartbeat faster, and also that there's no heart disease. But surely these blackouts and dizziness mean something, sir. Yes, that's just the point, doctor. Take my own case, for instance, yesterday. I was on PT I had a blackout. Not only a blackout, but I completely fainted. And now, surely that's not due merely to nerves. Well, I understand the difficulty that you have, and we will be discussing fainting and giddiness at some other lecture. But previously, you probably remember that we discussed the nervous control of the blood vessels and I gave you as an illustration the cold blue hands and the blushing that many people have. Uh normally, when one stands up the blood vessels in certain parts of the body become narrower to offset the effect of gravity and to make sure that sufficient blood gets to the brain. In nervous people, this mechanism may be upset. A small decrease in the amount of blood getting to the brain will result in giddiness. A greater decrease may rather result in fainting. The point that I really want to make is that fainting is the result of nervousness. And it is not any reflection on the person at all. I don't want you to think that you're abnormal because you faint. In fact, none of the symptoms that you have is uh really an illness unless you make it so. We all have our limitations, and you simply must work within these limitations and do your utmost. And that is all I want to say today. You can go now. The purpose of these talks is to explain to the patients how their symptoms are produced by nervous mechanisms. By displacement from the heart to the nervous system, the patient is denied a neurotic. He is forced to realize that his emotional difficulties are fundamental. Fear and anxiety are brought into the open and patients stop continually talking about their bodily symptoms. There is a gain in morale, and invalidism as an excuse is replaced by acceptance of social responsibility. Nurses, besides being present at the group talks, are trained to take an active part in group treatment and under the doctor's direction to deal with invalid attitudes. For instance, they are provided with standard answers, based on experience, to the questions about physical symptoms which the patients are most likely to ask. Every opportunity is taken within the ward routine to establish friendly contact and augment morale. I'm most more worried about Richardson. Which of you looks after him? He's my patient, doctor. I spoke to him in the ward this morning. He seemed mildly depressed and even hinted at suicide. Wait, has he ever talked like that in the ward? No, never. That's true. No, I haven't heard him. Quite on the contrary, he seems a very bright and active patient. He's very popular among the others. I should say quite the reverse, I think. Yes. I see he's an only child and his father was discharged from the army in the last war with a pension. Does he ever talk about him? Yes, quite often, doctor. He thinks he has the same symptoms as his father and this worries him. He talks about it a great deal. I see. There's a particular point I've noticed. He always says he's feeling tired, but he never seems to do anything to justify it. Why is this? That he suffers from nervous fatigue is probable because after all nothing is more exhausting than emotional conflict. But that does not explain his poor performance on the bicycle ergometer when he was asked to work to exhaustion point. He gave up when he said he was exhausted, but at that time his blood lactic acid showed almost no increase. And from the experimental work here, we know that this indicates that he was not really trying to exert himself fully. However, to get back to Richards, I think probability is that he's hysterical rather than depressed. But it's most important that you should note anything and report to me. Remedial training is an important part of the general treatment of patients in this hospital. As used, it is more than physical training and more than a simple diversionary measure. It is directed as much to the nervous state and mental attitude as to physical well-being. Thus, patients are re-educated to effort despite functional symptoms. Speed of response, active interest, and team spirit are stimulated. All remedial training is carefully graded by experienced instructors. The instructors, acting under medical supervision, spur the men on to develop their maximum effort within the limits of their capacity. The highest grade includes route marches. These men, some of them effort syndrome cases, are returning from a 7-mi route march. The man in the tam o' shanter is a commando who broke down after several raids on occupied Europe. He will be returned to active service. When the doctor orders occupational therapy, it is for a positive medical reason and not simply to keep the patients occupied. The type of work selected for the individual patient depends upon the nature of the illness, the previous employment, and the assessment of vocational aptitudes. Emphasis is laid on the social value of the work done in the occupation departments. The men are encouraged to work for others. Furniture and toys are scarce. In the carpentry shop, they make furniture for the hospital and toys for the local war nurseries. Gardening provides a valuable contribution to the hospital's wartime food supplies. Beneficial occupations for depressed patients are weaving, basket making, and bookbinding. These tasks combine stimulation and automatic activity in the right proportions. To some women, call up to the services means the loss of artistic opportunity. This may be merely incidental to a neurotic breakdown, but it is taken into account by the doctor in prescribing occupational treatment. The sign writing shop also works for the hospital. Uh will you please try and keep your mouth stick further down the wrist? It gives you much more freedom, you see. Otherwise, you're cramped in style. You try and practice at your format quite all right. That's just Yes. That's just the thing. That's right. The personality of the instructors in all these shops is most important. They work in close cooperation with the doctors and the reports that they make are of great value in assessing the patients' potentialities and progress. A development of the facilities for occupational therapy aided by cooperation with the local county council. Every day, 60 selected patients travel on their own to the nearby technical institute. Here, they can get practical tuition in a variety of subjects such as engineering, metal work, electricity, bookkeeping, and typing. Since the average duration of treatment of the hospital is only 6 to 8 weeks, the courses cannot be designed to give a real training in these subjects, but they do serve to bring out practical abilities which may be developed on return to the forces or civilian life. Here again, the instructors' reports prove most helpful to the doctors of the hospital. In each unit, the doctor organizes his patients into the necessary ARP squads. Thus, practical wartime needs give an added opportunity to foster a sense of social responsibility. This hospital was in fact bombed and damaged. On that occasion, the firefighting services worked efficiently and the patients showed notable discipline and self-control. Competitive games are organized between the units. The enthusiasm shown gives the doctor an index to the morale of his patients. This man was a prisoner of war in Germany. He escaped through Russia and Iraq. As a result of his severe experiences, he developed an anxiety state. He will soon be with his unit again. The doctor encourages attendance at educational lectures which are organized in collaboration with the army education corps. Hobbies, interests, and citizenship are the main items. Five lectures and two discussion groups are held weekly. Well now, accepting that distinction, which do you think is the more efficient method of government? Well, it depends what you want to get out of it. I mean if if if you wish to become uh to domineer the world, maybe the the totalitarian method is best. But if you wish to live peacefully amongst everyone else, maybe the democracy is the best. After a full day, the patients relax and are free to amuse themselves till lights out. The doctors make a point of joining in the weekly dances. The band is formed from the nursing staff, Royal Army Medical Corps personnel, and the patients. All these various activities, organized as a general background to special treatment, are operated by civilian doctors. In the case of service personnel, the backing of military authority is naturally required. So, a resident military registrar advises or deals with such matters as discipline, pay, and allowances. Social workers act as a link between the hospital and the home, the patient and his family. We have two main functions. The first is to hear the mother or the wife account of the patient's early history and all the subsequent factors in his life which may contribute towards his present illness. This information, we hope, will assist the doctors in diagnosis and treatment. The second is to relieve the anxieties of both patient and relatives as they interact on each other to prevent full use being made of the hospital treatment. Through various societies and organizations, we can arrange for social workers to visit families throughout the British Isles. We find that the relatives are often very glad of this personal contact and of an opportunity to discuss the wide range of problems which do arise in cases of neuroses. Let's try my distance. Now, I've been to see your wife. I went yesterday and as you say, she is worried about where she's going to have the baby. Well, we talked the matter over and I think we have three possibilities, really. She could, of course, have it at home, but as you suggest, that's not very satisfactory because she won't get so much attention and she could, of course, go into hospital here. But, she could, you know, be evacuated under the government scheme and have her baby in the country and then come here when she's better. And we talked that over fairly fully and she seemed to think it was quite a good idea and she'd like that. And I wonder what you think about it. Oh, myself, I think it's a very good idea. Mhm. that's the main thing if your wife is agreeable. I was thinking only cost of the thing, you see. Mhm. That's what worried me mostly, the cost of the thing. Yes, quite. Well, she's getting her army allowance now, isn't she? Yes. Well, she'll go on drawing that, you see, wherever she goes. And so far as the the journey and so on goes, she that does come under the government scheme and it's quite free. You won't have to pay anything for it. And really, you know, the government wants to encourage people, you see, to have their babies in the country because it seems a better arrangement. For service cases, there are three possibilities. Firstly, they can return to their unit fit for full duty. Secondly, they can be retained in the forces but with selected posting. This scheme of transfer and special training within the forces has been developed in cooperation with the military authorities. It has been freely used and has had a marked effect on the hospital morale. It enables potentialities discovered and developed in the hospital to be fully utilized. And as it's evident from the follow-up, it has fully justified itself. Subsequent recurrence of neuroses has been less frequent. The next case is Private This chap is in an infantry regiment, hasn't done at all well. He couldn't understand the mechanism of the rifle and small arms and he broke down and came into hospital here with mild hysterical symptoms. Here, he's improved. We find he's very low grade intelligence, quite bright, in fact, with the matrices. And really, that's the trouble. He's a big, physically fit man and capable of a job of work. I think yes. Well, he should go to the Pioneer Corps. That's what we were thinking. Yes. And we'd like him to go to an unarmed company, I expect. An unarmed company, yes. He'd be useless in an unarmed company, I expect. We can arrange that. That's a simple disposal. Good. Thanks. Then, Poole. Poole is an odd sort of man. In civilian life, he was very badly adjusted in the personal sense, that is. He just couldn't mix, couldn't make friends, solitary nervous. On the other hand, he was a first class engraver. In the army, he was a signalman in the Royal Artillery. And as might have been expected, he broke down. He just couldn't make it. Came in here in consequence and here, he's improved. But, unless you can use him as an engraver, I don't think he's going to any good. I think he'll certainly break down. Must be engraving. Must be. Or nothing, yes. Nothing. Well, we have very little employment for engravers in the army and the few vacancies that do exist are full. So, I'm afraid we can't help. Yes, in that case, I'll brought brought him up then getting him before a military medical board and with a view to discharge. with a view to discharge. Yes. Good. McCleod. McCleod was a bricklayer in civilian life and he is in the signals. And he broke down in a mild sort of way, a little anxious. For that reason, he was sent in here. We know he's very high grade intelligence and has marked mechanical aptitudes. Uh this is the report of the engineering course, very good all round ability. Unusually good at drawing. And what we would like is for you to take him over trying to make him a fitter. Yes, we can send him on a course either for fitting, which is a high grade trade, or for one of the other mechanical trades and we can arrange that almost immediately. Good. Now, Morrison. He is a man of again, a very high intelligence. Actually, he's a first class man and dead keen on doing something in the army. He's a bank clerk in civilian life. Because of that, he was put into the Pay Corps. He was actually be fed up, became depressed and unable to make a do of things and he came Since he's been in here, his symptoms have cleared up and I think that if we could get him into a competent corps, put him really in the thick of it, he'd do jolly well. Yes. You think that he would the cure would be complete? I do. I don't think he'd break down. There's no chance of his breaking down. I'm certain there's not. Yeah. Well, we can arrange that. The Pay Corps, of course, has a number of high grade men and we're always aiming at removing those to competent arms and have periodical come outs. But, this man had better go at once. I think so. The quicker he's out of hospital, the better. Yes. Well, we'll send him to the infantry. Good. That's that, I think. I'm not a doctor, of course. And our main interest in this scheme from the army angle is our concern to use manpower as best we can. With these men, we understand from the doctors, are most likely to break down again if they return to their original units and we therefore dispose of them in the army in the sort of employment the medical recommendation dictates. Frankly, we've been surprised at the great practical success this scheme has achieved. Thirdly, there may be no alternative other than discharge from the forces. This does not mean, however, that those discharged may not become useful and efficient civilians. After treatment, every effort is made with the assistance of the Ministry of Labour and social workers to ensure that they obtain suitable employment. Uh come along, Mr. McLean. Thank you, sir. I see by the doctor's report that you've sufficiently recovered to be returned to civilian life. Yes. I'm from the Ministry of Labour, whose work it is to try and place you and all the patients that leave this hospital back again into useful civil occupation. Now, what were you before you joined up? I was a neon sign engineer. A neon sign engineer. Did you have anything to do with the blowing of the glass tubes? No, none at all. Did you have any experience in the factory on the bench? No. And what exactly did you do? If any of the signs broke down, I went out and repaired them. I've been in the Tank Corps and the National Fire Service. Yes, I have. Did you have any useful experience there? Uh in the Tank Corps as a driving mechanic. Well, I know neon sign work is finished until after the war. But, I think there's two courses open to you. One, we can send you straight back into civilian life as an unskilled man. Or you could go to one of our government training centers to be trained in engineering. How long does that training take? Well, that's usually from 12 weeks onward, according to where you get on. And then, when you are trained, we can return you into industry as a skilled craftsman. Possibly, we can teach you some tank work, too, while you're there. All right, then. I'll go into the training center. Right. Well, I'll make a report that you're a suitable person for training. All you need do is to go to your nearest employment exchange when you get home. And ask to see the training officer. My report will be there. And he'll he'll immediately set to work to get you into the government training center to be trained as an engineer. Thank you very much. Well, goodbye. Cheerio. Good luck. A follow-up is made at intervals to check their continued progress. Through the methods you have seen in this film, men and women are being sent out every day from this hospital and the others like it better fitted to take an active part in the national effort. Psychiatrists cannot work miracles. But with common sense allied to special knowledge and hard work results can be achieved in wartime which benefit not only the individual, but also the society in which he lives.