Understanding aggression (1960)

[Music] you're late the lecture started already I'm sorry we had a bit of upset in the ward I as quickly as I could all right going quietly see the origin of aggressiveness in human beings is extraordinarily complex but whether it's a primitive Instinct necessary for self-preservation or whether we think it comes as a well response to frustration one thing is certain aggression is a normal reaction in each of us part of the business of of growing up is to learn how to direct it into useful channels now we're going to look at a piece of film we'll show some scenes of young children before they have learned to control their aggressive urges what children want at this age they want with the whole of them they haven't learned yet that other people have needs and wishes just as urgent as theirs but because we humans are social animals we want to be liked by other people and to like them in return we want to work and play together our natural aggressiveness can give us drive and purpose for all sorts of activities and we can find Outlets that are socially acceptable but here in a mental hospital we often have patients who can't live peaceably with other people Psychopaths for example who haven't come to terms with their aggressive t es how can we help patients who are aggressive could we give some thought to this problem let's see if we can discover what lies behind any incidents in the wards equally important let's try to analyze our own reactions our personal relationships with the patients make a great difference to their behavior we can talk this over when we have our next discussion the more we can understand both our patients and ourselves the nearer we are to building well a calm and helpful atmosphere in which the patients can get better a truly Therapeutic Community thank you we've had a bit of an upset in the W this morning that's why I was late can I borrow your notes please oh you'll never be able to read this Scribble I'll copy it out and let you have it this evening all right okay same time same place see you then bye bye after I left the lecture I thought quite a bit about what Dr Daniel had been saying trying to relate it to the actions of some of our patients at the Villa there's a chap called Andrew Lewis for example he's an aggressive psychopath who's been sent to us by the courts we find him a difficult customer not only because of his occasional outbursts of violence but also because of his insolent Manner and his uncanny Knack of setting the staff one against the other talk about the patient problems of aggression Andrew's a past Master at making us feel aggressive among ourselves yeah how do you expect me to carry on my work party and get the shed painted when they tell half the patients they need come but I didn't tell half the patients Andrew Lewis told me he'd sprained his thumb so I told him he was to tell you and if you thought it was bad enough you'd let him off he told me you said I've got to let him off I'll give me a break sh don't usually interfere don't you this isn't the first time this has happened oh come off it mate surely you two know better than to let Andrew Lewis rattle you like this come on give me a hand with a l for the cricket match tomorrow all right Dr Daniel's lecture gave me food for thought too it was the very next day that something happened to precipitate an outburst from Susan Morris she can be very impulsive at times sometimes she starts on an expedition of her own that has some special meaning for her though it's difficult for us to see what this time she began to wander down the ward with stiff and awkward movements she seemed to be on the lookout all the time at one moment she had to steady herself on the table I was wondering whether to try and persuade her to join the others she doesn't like being interf with but she'll only get worse if we allow her to retreat into her fantasies too much just then Mrs Croft came up to show me her new glasses to please her I tried them on and said pretty powerful lenses aren't they everything looks about twice as clear Susan turned around and stared at me then it happened sister and another nurse were on the spot before she could hurt me it was over almost as quickly as it started Susan suddenly looked terribly small and lost as if she had just come back from another world a frightening World in which she'd been made to do things she didn't really want to do sister seemed to know exactly how to reassure her and bring her back to Everyday Life as for me I hadn't been hurt at all but I admit I was shaken this wasn't the first time Susan had gone for me why me I hadn't even been speaking to her after lunch we all turned out to watch a cricket match Susan was allowed to come too as she seemed to be back to her usual withdrawn self the match was one we'd look forward to patience versus staff we've got some good players on both sides this year Andrew Lewis told me how he'd got his blue at Cambridge and played at Lords well I took that with a grain of salt but I find there's something rather interesting about this young man although I know he doesn't cut much ice with Henry and the other male nurses I was glad to see Joan at the cricket match and so pleased to find Andrew making up to her beats me what she sees in him but there you are Andrew's stocking trade is his charm which he can lay on with a TR whenever it suits him the ward staff and I had some discussion as to whether Andrew Lewis was well enough to play he can be very violent at times but this is a sort of calculated risk we feel justified in taking after all the hospital is a sort of social laboratory in which patients should be able to test out different ways of Behaving sometimes they can only learn how to live more normally through trial and error so we try and create an atmosphere which is as near as possible to life in the outside world yet sufficiently controlled to be safe for experiments e [Applause] [Applause] come along old chap you're out Andrew had been so quiet for the past few weeks but it was disappointing to see him break out like this I decided to have him transferred back to his old Ward for the time being a violent Outburst of this kind is one of the most disruptive things that can happen in our community it brings out all sorts of emotions which often take the form of moral judgments Andrew Lewis again I knew there'd be trouble that what comes of all his freedom 5 to one what chance does he have oh well he'll soon settle down in the ward I phoned The Ward from the social Center to find out how Andrew was getting on the charge nurse told me he was still aggressive and didn't care what he'd done I ordered a sedative at the discretion of the charge nurse and told him I'd be along when the match was over our patient seemed to be a bit jumpy after the episode on the cricket field Joe Barkley felt he was being haunted again very restless Alec Chrome started his nervous tick he hasn't had it for months I could detect a ripple of tension among the patients at my end of the room too I thought Susan was going to become upset she had a current bun on her plate and began to stare at it it looked a bit like a face suddenly she started gouging the eyes out and giggling I diverted her attention with some chocolate biscuits which I know she likes and managed to get the bun away sister said she thought Susan would be all right at least till we got back to the ward and she was I went back to Andrew's Ward to see how he was getting on and was glad to learn that the sedative hadn't been necessary as charge nurse Waters was having a quiet session with him I didn't interrupt there had been quite a lot of interest among the staff about the two recent outbursts of aggression so we arranged a special meeting to see what we could learn by pulling our knowledge and our experience but Susan gives you absolutely no warning one minute she was wandering down the ward and the next minute she was AC me and you didn't say anything to her no maybe something was going on in her dream world which made her aggressive and you just happened to be there could it be that you disturbed her world in some way could there be any connection between the glasses J was trying on and eyes in the C burn remember the eyes in those paintings of hers her paintings show clearly that she wants to escape from an allseeing eye which may be a symbol of her feelings of persecution somewhere in the picture you may find her crouching in a safe protected Corner she often tries to hide away in the ward I suppose that's part of it that walk of hers it looked as if she was waiting supposing in her dream world she was trying to find a safe place where no one would see her her voices urgently tell her there's danger in being seen everyone will know what she's [Music] doing s I'm watching you I see you all the time I see you [Music] Susan hide Susan Susan hide she's just about to find the safe secret place she wants when nurse Baker's voice comes to her from another world saying in effect I can see you very [Music] clearly but we don't know really we're only imagining Ah that's true enough but don't you think that imagination is one of the greatest gifts that we can bring to the understanding of our patients so we've got to be careful with Susan not to talk about eyes or seeing or watching it's going to be difficult isn't it I mean by the time you've got yourself sorted out with all of the patients you might as well take a vow of silence alt together that would be a terrible sentence for you myar now the way I see it is we can't hope to understand all their delusions no matter how hard we try but as long as we realize that it's nothing against us personally we can keep a calm relationship with our patients but you're bound to feel it personally at least I am it's no use pretending I don't I think I've got some idea now how this particular incident happened but you see she goes for me more than the rest why me do I get in her way accidentally or or what not necessarily would you admit to being a little uncertain of her well yes I am a bit I sometimes have to nerve myself to go up to her well do you think that might communicate itself to Susan in some way how do you mean well now you've got to remember that she's even more bewildered than you are she's lost maybe she panics when she senses your fears or maybe she wants to hurt you but if you can go on helping her in spite of these outbursts you must want to help her a great deal and that's what she desperately needs to know I think I see to me a schizophrenic patient like Susan isn't too difficult to understand you can make allowances when you get a chap like Andrew Lewis he seems to cause trouble for its own sake he's crafty it isn't as if he's psychotic he knows what he's doing he may not be psychotic but he's well quite as much a sick person as Susan Mr Waters you spend some time with him perhaps you could tell us a bit about his history yes I have managed to piece together quite a lot partly from talking with him and partly from what Dr Daniel has told me the main thing that comes out is that even when he was a baby no one really loved him or wanted him his father seems to have been a hard violent man and his mother a sick woman herself the father was actively hostile to the baby and his mother completely [Music] indifferent Andrew's early life was made up of UN happy incidents the mother rejecting the child and the father going for him when he was about five the father did a bunk Mrs Lewis sank further into apathy by now in this unloved little boy the ability to love had been stifled from now on he was growing up with an essential factor missing in his makeup he would lash out with rage and hatred especially at anyone in Authority he was destructive he lied he stole he had a deep and bitter grudge against the world in general when he was 12 he'd been sent to live with foster parents because his mother couldn't cope they were a very decent couple who wanted to make him a real home but already it was far too late for Andrew to return their love on the surface he could be as nice as pie when it suited him and then his resentment would burst out in apparently senseless destructive and cruelty he could no more help these outbursts than a lame man can help limping punishment meant nothing to him and he was incapable of learning from past experience in time his foster parents found they could no longer cope with [Music] him so this wretched boy grew up against a shifting background of people trying to help or reform him children's homes Child Guidance clinics Juvenile Courts the lot eventually he's sent to us for treatment the unhappiness of the child has been driven underground and on the surface we find the Spivy character who is often so difficult to understand when the Umpire told him to get along off the field it was Authority pushing him around again the same old pattern he met the situation in the way a small child might by lashing out I do believe he's so wared that he's incapable of behaving in any other way when he's frustrated well I know many people think he's a difficult cuss but I hope I've been able to give you enough information to get him a bit more sympathy I think we can probably help Andrew best at this point by examining our own feelings towards him you know I'm not certain we've got to the bottom of this business why de tag nurse first seron why not the Umpire the father figure how um how do you get on with him not terribly well I'm afraid may I ask you to a personal question I noticed at the match that Andrew was trying to make a hit with Joon and John didn't mind a bit would you say there was a bit of rivalry there well I didn't think that well he does rather it was just a thought you see we've got to remember that everything we do now every every single thing May react in some way on our patience well if there's been a bit of rivalry it would certainly make Andrew's defeated at the cricket match all the more humiliating for him but I'm not the only person that Andrew plays up he seems to create bad feeling between us all in the ward how do you react that well I'm learning to cope slowly I'm afraid but why does he get any satisfaction out of it divide and R that's his policy don't you think that uh because he at loggerheads with the world in general he wants us all in the same boat unconsciously of course but we mustn't let him upset us that will be fatal well can we turn it around the other way and show Andrew that you want him in our community we can only do that by making him feel we like him he'll never alter unless he really cares about what we think of him then bit by bit we can try and make him aware that his aggressive and antisocial actions are part of his illness and that is possible even with a psychopath it's a slow process needs infinite p patience and friendliness I think we have to admit we're still groping in the dark in our treatment of this illness it's a tremendous challenge to all of us so our discussion continued we were gradually coming to see that relationships in a community such as ours have to be based on acceptance an understanding that sick or injured patients with all their fears or aggressions are people very like ourselves in this atmosphere of acceptance their aggressive Drive can find new ways of expression in making things in useful chores and team activity and finally in preparing for a return to a full and normal life [Music] [Applause] [Music]