How Alastair MacLeod is discovering a new theory about mental health
Leaving problems of the mentally ill to others while he pioneers a clinic for the mentally well, this Montreal psychiatrist is finding that the majority of people are not only quite fit but are highly capable of staying that way
ALASTAIR MACLEOD, a boyish but greying optimist who does most of his hopeful thinking as the assistant director of McGill University’s Mental Hygiene Institute in Montreal, is a psychiatrist who habitually speaks about mental matters in plain terms everybody can understand. This is a double turn of luck. Although mental illness is the leading medical catchword of the moment, it affects only a relatively small number of people; mental health, its almost unknown opposite, affects everybody. Plain-spoken Alastair MacLeod is one of the few psychiatrists anywhere who have discovered something new and meaningful to say about mental health.
Five years ago, when MacLeod reversed the usual psychiatric field by setting aside the study of mental disease to go after some of the facts about mental wellbeing, there were a few guesses but no knowledge about questions as simple and vital as these:
What is mental health and how do you measure it? Nobody knew.
How do you help a healthy mind grow healthier? Nobody knew.
We all worry about our problems, but at what point does worry start to undermine a healthy mind? Nobody knew.
Can psychiatrists work out a system of routine check-ups that will catch a mental skid and stop it before it leads to disease and hospitalization? Nobody had ever tried.
MacLeod and many other psychiatrists believe these are the most far-reaching questions psychiatry can tackle. Starting from scratch in 1954, he worked out an original system for getting at some of the answers. He minted the term "well-being clinic” to describe his system, and through his Montreal well-being clinic MacLeod has now screened the mental fitness of five hundred "ordinary, morc-or-less healthy” people — businessmen and students, women worrying about their husbands and girls afraid they’ll never find a husband to worry about, middle-aged people worried about retirement and youngsters worried about breaking away from home.
Neither MacLeod nor anybody else yet knows all the answers about mental health,
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“A well-being check-up can usually detect an emotional skid indicating a need for treatment”
but the well-being clinic has led MacLeod to some surprising and hopeful new conclusions. For most people, these are the important points:
+ Fifty-six people out of a hundred (according to a scale based on MacLeod s five hundred case histories) are "essentially healthy." In general terms, MacLeod says, this means that more than half of us have no serious cause for concern about mental health.
+ Thirty-four people in a hundred arc healthy enough, but they’re handicapped by problems they should be able to overcome. Very often, MacLeod says, a wellbeing clinic can show them the way to psychiatric, medical or social agencies that will help them snap back to full mental vigor.
* For both these healthy groups, a routine periodic check-up with a wellbeing clinic is a useful safeguard. I his is particularly true when people in the second group start slipping toward serious disease. A well-being check-up can usually detect the skid and pass them along to the right doctor for preventive treatment before their trouble is deep seated, painful to themselves and their families, and possibly incurable.
+ For many healthy people, a factfinding session that MacLeod calls a well-being interview seems to have much the same results on mental health that well-planned exercise has on physical health.
♦ The remaining ten people in a hundred are seriously maladjusted. I here is nothing a well-being clinic can do for them.
Although these findings and the wellbeing clinic itself are still experiments in an unknown field, many of MacLeod’s methods and results have already been widely accepted by psychiatrists. "No one before MacLeod ever managed to put mental health on a footing of regular preventive check-ups," says Dr. J. D. Griffin, the president of the Canadian Mental Health Association. "This has already done a lot of people a tremendous amount of good, and promises to do much more. As an example ot a community mental-health program, the well-being clinic is superb.”
In the United States, where concern over the questions MacLeod is working on is acute, a joint commission of many of America’s leading psychiatrists is midway in a national survey of mental health and illness that will be issued in twelve book-length reports. I he stall director of this commission. Dr Jack R Ewalt. who is also mental-health commissioner for Massachusetts, observed that "the greatest compliment he could pay" MacLeod's radical new approach was to admit he was borrowing the system to set up a well-being clinic in Boston.
A well-being clinic, as MacLeod (who invented it) uses the term, is an inexact phrase to describe a loose group of experts that should include a psychiatrist, several graduate psychiatric social workers and usually a medical doctor. Sometimes, depending on the most common problems among the people he is trying to help, MacLeod adds a handful of other experts in the social accomplish-
ments he believes help bolster mental health. So far MacLeod’s Montreal wellbeing clinic has been run on a shoestring with part-time specialists and no money at all.
MacLeod, the clinic psychiatrist, is an assistant professor in McGill’s department of psychiatry as well as the assistant director of the psychiatry department’s Mental Hygiene Institute. The well-being clinic is an experiment he is running as part of his job, and the clinic's only real estate is a corner of MacLeod's desk in a back-room office in the institute’s greystone row-house on Pine Avenue, the highest thoroughfare on the city-side slope of Mount Royal.
Married women become “Les Girls”
To handle the well-being interviews— the hour-long fact-finding sessions that are the heart of the clinic’s work with troubled and carefree people alike — MacLeod recruited the part-time, unpaid services of Mrs. Phyllis Poland. Mrs. Poland’s regular job is with the Allen Memorial Institute, McGill’s teaching hospital for psychiatric medicine, where she is in charge of the social-service department. In her turn, Mrs. Poland looked up seven experienced graduate psychiatric social workers, most of them married and all prevented by family circumstances from holding staff jobs with Montreal social agencies. The seven social workers became the well-being clinic’s part-time interviewers.
MacLeod. Mrs. Poland and the seven interviewers are the constant if sparetime core of the clinic’s staff. Only the interviewers are paid, not by the clinic but through an interview fee of five to ten dollars, depending largely on how’ well-heeled their clients are. In 1957, three years after they began handling well-being sessions for the clinic, the seven interviewers formed what they describe as the only group of family social counselors in private practice in Canada, under the name Counselors Associated. This has led Les Girls — as the counselors refer to themselves when they're
alone together — into doing much the same kind of work with people who come to them privately as they do with people who reach them through the wellbeing clinic.
Except for the interview charge, the clinic itself is free to anybody in Montreal who wants to seek it out. Oddly enough, though, it usually operates under a slight disguise. At the Montreal YWCA, where MacLeod first worked out the system in 1954, the clinic is part of a course designed by MacLeod and offered under the name Health and Charm, largely because more clinical titles seemed to dampen the members’ enthusiasm.
The Health and Charm course, which has grown from a membership of about forty women in 1954 to eighty in the year just ended, runs from fall to spring with sessions once a week in a YWCA meeting room. In successive weeks the girls hear a lecture by MacLeod on mental hygiene, another by a medical doctor on general hygiene, a talk on matrimony by a marriage counselor and others by diet and nutrition experts. All these instructors are part-time, unpaid members of the well-being clinic, as is Dr. Arthur Lismer, a well-known Canadian painter and teaching head of Montreal’s Museum of Fine Arts, who talks to the girls about art appreciation. So is Madame Jehane Benoit, a television hostess and expert on French cuisine, who shows them what it takes to entertain successfully. There are other sessions led by experts in dress, hair styling, make-up, interior decoration. budgeting and even a talk on public speaking by the Montreal director of the Dale Carnegie Institute.
The variety of instruction in the Health and Charm package is MacLeod’s answer to what he believes the girls in the Y course need most to balance their mental diet — more social activity. In the well-being clinic's second disguise, a course in the extension department of McGill University, the clinic’s own make-up is altered to fit the group of people it’s working with.
The McGill course is called Under-
standing Ourselves, and the membership is usually split almost evenly between men and women of all ages. They sit in on fifteen two-hour sessions during the winter in a McGill lecture hall. The sessions all start with a mental-health film, followed by a half-hour talk by MacLeod or another expert on how to make the mental machinery shown in the film work in everyday life. Then the meetings break up into a number of small discussion groups, each gathered around a mental-hygiene expert, and in giveand-take discussion participants try to reason out solutions to their problems.
Through the YWCA and McGill courses the well-being clinic is open to anybody who wants to attend and can penetrate its thin disguises, but MacLeod also runs the clinic for some closed groups. A couple of years ago the Bell Telephone Company in Montreal asked him to try an experiment in on-the-job mental health with a group of girls who seemed to take too many days off for reasons that were too vague. In this case the clinic did little more than pass each of the girls through a diagnostic interview with MacLeod and a later wellbeing interview, both in the company’s medical office. Their supervisors later reported that most of them showed improved work records within weeks.
The clinic also works with the Quebec Association of Protestant Teachers, by set ing up well-being interviews for teachers who feel uneasy about their mental tone. Last year all members of tiie graduating class in social work at McGill were given well-being interviews as part of their training. They promptly recommended that first-year sociology students take a routine interview when they begin the course, with follow-ups in their later terms.
In any of the well-being clinic’s disguises there is a single standard feature. With the exception of a few girls in the Y’s Health and Charm course who elect to skip it, everybody w'ho passes through the clinic takes a well-being interview'. Almost always the experience is markedly different from what they expect a well-being session with a psychiatric social worker to be.
To start the session the interviewer usually asks her "client." as she refers to him, whether there’s anything on his mind. If there is, they talk about it. If there isn’t, she suggests the client tell her something about himself.
As he speaks, the client begins to realize he is talking to a good listener. The interviewer rarely says anything, and when she does it is usually to lead him into a new topic when an old one is played out. In about forty-five minutes most of the things the client had on his mind when the talk started have been brought out. turned over, and looked at openly. Often the client realizes he has been talking about things he has never discussed before.
For the final quarter-hour, the interviewer takes over. She asks her client to do a simple but usually unfamiliar thing — to put his own identity aside for a moment and look at himself through the eyes of several other people.
"Put yourself in your parents' place. Now, how do you rate yourself as their son (or daughter)? Have you treated them the way you’d want your own children to treat YOU - or where have youi fallen down?
"Now put yourself in your boss's place. Again, how do you rate yourself? "Now look at yourself from your
wife's (or husband's) point of view. Now from the viewpoint of your own children. "How do you look to your best man frieind? Your closest woman-friend? "One last question, from your own viewpoint this time. What are your goals? What do you really want from life?" MacLeod and his group say these questions size up a person's "roles and goals." They ask them simply to get information, to fill in the blanks in the profile they are drawing of their client's mental health. But when the clinic picked a hundred names at random from the file of previous clients and checked back with them by phone between six months and two years later. they heard some surprising stories.
The interviewers managed to reach fifty-five of the hundred. Twenty-three of them seemed to be feeling about the san-ne, mentally, as they had at the time of their first well-being sessions. Four appeared to be worse, for reasons the original interviewer had spotted. The clinic had advised further professional care for all four, but for one reason or ano4her the suggestion had been ignored. The' remaining twenty-eight all said they definitely believed the well-being inter view had done them good. The inter viewers, too, decided their mental tone seemed to be improved (in the tenuous new' science of positive mental health, the only readily available evidence that someone is "healthy" is his own feeling of well-being. There is. of course, always the chance that he's lying. but his in centive seems small.)
Rightly or wrongly, MacLeod has re ported to the American Psychiatric As sociation that his fact-finding interviews have "some unanticipated therapeutic effect." Why? "We can only assume that many people have never added up their strengths and weaknesses. haven't stop ped to decide where their lives are falling short of what they want, or why. When they weigh these things in a meaningful, self-revealing, face-to-face talk, they're often surprised to find they can do sometiling about them," MacLeod says, look ing slightly surprised himself. Although the clinic's work with the YWCA has unbalanced MacLeod's five hundred case histories in favor of women, he feels enough men have reach ed the clinic through the McGill exten sion course and the sessions for teachers and students to give him a fairly good cross-section of mental well-being prob lems in a city like Montreal. These are some of the main factors that work to undermine mental health, as MacLeod describes them:
1. Social malnutrition. This is the well-being clinic's colorful term for lone liness, A social diet too thin in friend ship, conversation and normal give-andtake with other people, MacLeod main tains, can be as harmful to mental health as near-starvation is to physical health. While this problem, reasonably enough, is most common among young single people, the clinic has found it to be fairly widespread, sometimes in unex pected places - among suburban wives anchored at home with small children; bachelors and spinsters of all ages; women facing the menopause and men facing retirement.
When the clinic decides a client is suffering from social malnutrition, it tries to put him in touch with people who share his interests: classes, lecture
groups and courses, social, recreation and sports clubs, service associations and volunteer organizations. The special sessions in the YWC'A Health and Charm course, with instruction in such widely varied subjects as make-up and art appreciation. are planned mainly for girls whose social diet is too thin because they're unsure of their own accomplishments.
2. Fear. Recent publicity campaigns to fix attention on the menace of mental illness may almost have been too suc-
cessful, MacLeod believes. “Like propaganda against cancer and other physical diseases before it. vivid propaganda against mental disease is making us all alarmed about an illness that only attacks a few of us.” One of the well-being clinic's most useful jobs, MacLeod says, has been to reassure people who were groundlessly worrying themselves into a mental decline.
3. Reluctance to make decisions. The
unease and tension that builds up when decisions — important and even trivial
— are left open too long seems to sap mental well-being much as a virus saps vigor. "Staying robust mentally is pretty much a matter of doing something about whatever is bothering you," MacLeod has decided. "When you’re worrying about a problem, you start to slip. When you move against it, you snap back.
“In psychiatric terms, we’re problemseeking animals. And when you look around at the problems we create for ourselves in any modern big city, the surprising thing we’ve found in our wellbeing experiment isn’t that ten people in
a hundred are seriously ill. It isn’t that we’ve screened out another thirty-four who can use some help, or even that a few of these might have skidded into serious disease if they hadn’t come to us for a check-up. The really astonishing thing is that everybody else seems to be handling his problems on his own and doing a first-rate job of it.”
Talking to MacLeod about mental well-being is a little like talking to an archbishop about piety. “Look!" he says with evangelical enthusiasm and belief. “There’s so much health around!” +