Doctor David Clark: Pioneer of the social model in psychiatry

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The Independent Online

Pressure to cut costs in hospitals, public worry about crimes committed by people with mental problems, war-induced mental illness in service men: these problems all faced Dr David Clark when he was appointed the youngest medical superintendent of a mental hospital, Fulbourn, Cambridge, in 1953.

A brave man, not frightened of authority, he was one of the major pioneers of the "social model" in psychiatry – open doors, work for all, and therapeutic communities (although he was himself an authoritarian figure). In addition, through his work for the World Health Organisation, he visited and advised on mental-health systems in other countries.

His verdict in angry retirement on the NHS was stern: "Authoritarian, bureaucratic organisation which the NHS has become... run by managers under constant pressure from central government to save money, cut costs and keep things under tight control... they have reverted to the kind of administrative behaviour that marked the worst of the asylum days."

A country walker all his life in Britain and abroad, Clark fought to preserve Fleam Dyke, ensuring that the right of way was preserved by a bridge over the A11, and was a keen bird-watcher. He was also vice president of the Euthanasia Society.

As a teenager Clark accepted the decision of his father, a scientist, that he should become a doctor. He graduated from Edinburgh University in 1943. Joining the parachute regiment as a medical officer he expected to die, but was influenced by two events in his military service: a period spent working in a psychiatric unit in an Army hospital; and seeing German concentration camps. The former made him determined to become a psychiatrist, the latter gave him a horror of people being locked up, which was to lead him to unlock wards as a psychiatrist.

He took his basic psychiatric training at the Royal Edinburgh Hospital, then moved to the leading English psychiatric hospital, the Maudsley. Looking for an appointment as a medical superintendent he found Fulbourn hospital, a seedy, demoralised and run-down place, overcrowded and understaffed, in a worse state even than most county asylums. The staff were looking for a new lead. "He was a godsend to me!" said the matron, Queenie Brock.

The first requirement was to get new blood into the nursing staff. Here an immediate solution came from an unusual source; an enterprising salesman persuaded the superintendent and matron to advertise for staff in French women's magazines. Some settled and trained as mental nurses, most stayed for a year, but the change lay in "having fresh, lively women in the place," Clark recorded enthusiastically.

Nurse-researcher Dr John Adams, in a yet-to-be-published history of Fulbourn hospital, notes that Clark's favoured mental-hospital model was the therapeutic community. The term had been coined by one psychiatrist, Tom Main, and developed by another, Maxwell Jones, who set up an industrial rehabilitation unit at Belmont hospital, Surrey, aimed at getting individuals with a poor employment record to return to work. The idea of the therapeutic community was that patients should participate democratically in their hospital experience.

Clark introduced the concept at Fulbourn with a young sister Ruby Mungovan, who became a leading advocate among nurses for the philosophy of the therapeutic community. "We had meetings every day, that's what you do in a therapeutic community," she said.

Always concerned with nurse education, Clark was given an opportunity to influence it at national level in 1965 when he was appointed to a Ministry of Health advisory body. When the Briggs report on nursing was published in 1973, Clark attacked it. "Psychiatry is not even in the index of this report" was his comment.

Psychiatrists tended to cling to the biological approach. "Quite a lot of doctors found it stressful and difficult and wanted to retreat back to sitting behind a desk and prescribing pills," Clark said in a TV programme in 1996. And it was not Clark but Martin Roth, who took the biological viewpoint, who was elected first professor of psychiatry at Cambridge in 1976. Professor Sir Martin Roth ensured that community meetings, the hallmark of social therapy, were "slowly deleted" at Fulbourn. A locked unit returned in 1994.

In 1967, as an adviser to the World Health Organisation on psychiatry, Clark was instrumental in transforming the Japanese mental-health system. Doubling a history of his hospital with an autobiography, Clark wrote of his achievements, frustrations and disappointment in The Story of a Mental Hospital: Fulbourn 1858-1983. He was also the author of Administrative Therapy (the original name for social or therapeutic therapy) (1964), Social Therapy in Psychiatry (1974) and a popular account of his war experience, written for his grandchildren, Descent into Conflict: A Doctor's War (1995).

David Hazell Clark, psychiatrist: born London 8 August, 1920; Medical Superintendent, Fulbourn Hospital, 1953-71, Senior Consultant Psychiatrist 1971-83; married 1947 Mary Rose Harris (marriage dissolved; one son, two daughters) 1983 Margaret Farrell (five stepsons); died Granchester, Cambridgeshire 29 March 2010.

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