‘The eye is not just an organ of vision, a human camera, but is one of the most basic organs through which an individual relates to the world’
Alexis Brook (1920 to 2007) was a consultant psychiatrist and psychotherapist at the Tavistock clinic in London[1] and was chairman of the professional committee[2] leading the Tavistock Clinicw. He had a deep interest in helping fellow professionals and brought an outward facing orientation to the Tavistock Clinic. He initiated new areas of work in the community, taking a psychoanalytic understanding out of the consulting room and into clinical settings in primary care and hospital clinics[3]. Throughout his career he developed an extraordinary range of links with and introduced psychotherapeutic practices to professional disciplines, including: ophthalmology, general practice, coloproctology and gastroenterology, psychoanalysis and psychiatry, occupational health and nursing[4].
He was born in Chiswick, south-west London, on 24 January 1920[5]. He was the son of Russian parents who had fled their home country for political reasons[6],[7] in 1908[8] (after the failed revolution of 1905 the Tsar attempted to save his regime by offering reforms, but by 1907 the country was again descending into political violence). His father was an engineer and his mother a chemist[9]. They moved to England in 1914[10].
Alexis went to St Paul’s School, a preeminent independent school, and then went on to Cambridge to study medicine[11]. He received his clinical training at the Middlesex hospital and qualified in 1943[12]. In 1944 he was called up[13] and served with the Royal Army Medical Corps (RAMC) from 1944 to 1947 in India, Burma, and French Indo-China (now Vietnam)[14],[15],[16].
As a medical officer in Burma he had to submit the figures for his battalion’s general sickness rates and as they rose he became anxious that he would get in trouble for not providing adequate medical care[17],[18]. He was surprised when he found that the person in trouble was the battalion commander, who had to explain why his leadership had caused such low morale[19],[20].
Viscount Slim, who at that time was commander-in-chief in Burma, recognised that if morale was high fewer soldiers fell ill and that these figures were indices of morale[21]. This approach to organisational health was introduced to the army by JR Rees, medical director of the Tavistock clinic, who was psychiatric adviser to the army during World War 2[22],[23]. For Alexis this insight was the start of a lifelong interest in the interaction between psyche and soma. It was also an important factor in determining his choice of psychiatry as a career[24].
Alexis was demobbed in 1947[25]. He then trained in psychiatry at the Maudsley[26],[27] and Bethlem Hospitals, obtaining his DPM in 1953[28]. He then spent 3 years at Napsbury Hospital [29],[30] before moving to the Cassel Hospital in 1956[31], where he consolidated his specialisation in psychoanalytic psychotherapy[32],[33]. He was there for 15 years, first as Senior Hospital Medical Officer, then as a consultant[34].
At that time Tom Main was the charismatic[35] director of the Cassel[36]. Tom Main had been an important figure in the RAMC under JR Rees. He was a key figure in what was known as the ‘invisible college’ (a group of psychoanalysts, psychotherapists and psychiatrists loosely organised around a core of Tavistock Clinic staff that JR Rees had assembled in the RAMC). Tom Main had spearheaded JR Rees’s initiatives in training and morale. To understand the stresses that trainee soldiers experienced he even went so far as to get his wings with the Paras. Tom Main was meant to be in charge of forward psychiatry for the Army after D-day and the Normandy invasion, but he had a poor relationship with Montgomery, became marginalised and was redeployed. Tom Main ended the war at Northfield, heading the second Northfield experiment after Bion and Rickman were removed during the first experiment. Tom Main’s experiences at Northfield led directly to his work establishing and developing the idea of the therapeutic community at the Cassel after the war.
For Tom Main the hospital was ‘a social system based not on the medical model of a healthy knowledgeable staff and sick obedient patients, but on the joint recognition of each individuals’ capacity for and limitations for performing tasks and with participation by all in allowing that these be carried out’[37]. This was the atmosphere in which Alexis Brook worked and trained at the Cassel.
Alex’s wider work in the community began while he was at the Cassel. He began by running Balint seminars for GPs[38]. He investigated 100 ordinary consultations and found that emotional problems played a part in 68[39]. Much of this research came about because, early on, Alexis took the unusual step of visiting the GP practices for half a day a week to sit in on surgeries[40]. During this work the GP was in charge and the visitor was a person to consult with, but not to be overruled by[41]. Alexis quickly became aware of the amount of chronic unhappiness and constriction of life that exists, caused by symptoms that are not acute, and would never give rise to referral to hospital psychiatric help, but may be responsible for major and ongoing difficulties for doctors who do not know how best to help[42]. This research led to the publication of a short paper ‘An experiment in general practitioner/psychiatrist co-operation’[43]. At that time the idea of psychiatrists working in the community was an innovation and Alexis was the pioneer[44].
In 1971 Alexis Brook became a consultant at the Tavistock Clinic[45],[46]. At that time the Tavistock Clinic three clear strands of work: its outpatient clinical work, its postgraduate training in psychotherapy, and community projects[47]. Initially he worked part-time at the Tavistock Clinic, combining this position with a senior lectureship at St Bartholomew’s hospital, as well as being a consultant in mental health to the London borough of Islington[48].
Working in the Adult Department, Alexis established a Community Unit, where for over five years he was able to place 3 or 4 part-time staff with local GP surgeries[49]. This led to Alexis producing a number of papers[50] where he argued that a psychological understanding of the patient’s emotional state helps the doctor to better understand the patient’s situation and to be able to treat the patient as a whole in a way that is better for both the patient and the doctor[51].
Not long after starting at the Tavistock Clinic he participated in a working party on health and safety at work for the Robens Committee,[52] which reported in 1972 with its recommendations being substantially enacted in the Health and Safety at Work Act 1974, which laid down the general principles for the management of health and safety at work.
Alexis had been involved in working with occupational health doctors in British industry since the 1960s, when, through his work in general practice, he noticed how often the patients he saw had developed their symptoms or broken down in relation to difficulties in their work situation[53]. He developed a particular interest in the study of the emotional environment within organisations and worked to identify the factors that contributed to high levels of stress in the individual[54]. This led to him producing a paper for the Journal of the Royal College of Physicians (Brook, 1969) and then organising an experimental course in psychiatry for industrial medical officers[55].
In the same way that he had worked with GPs, Alexis accepted an invitation to work with two occupational doctors in their departments. This in turn resulted in a paper given to the Society of Occupational Medicine (Erskine & Brook, 1976)[56] and then later a paper on ‘Coping with the stress of change’ (Brook, 1977), in which he quoted from both Isabel Menzies-Lyth and Wilfred Bion[57]. It also led to Alexis becoming the course organiser and principal lecturer of the mental health component of the MSc in occupational health at the London School of Hygiene and Tropical Medicine[58],[59].
Alexis became Chairman of the Professional Committee of the Tavistock Clinic, the equivalent of being Chief Executive, in 1979[60],[61] and held the position until 1985[62],[63]. This was a time when there was a high degree of concern about the future of the Clinic and its funding. Under his careful leadership both the Library and the Training Administration were acquired for the Clinic, and the post of Dean was created with Dickie Bird becoming the first Dean confirming its status as a training institution. Alexis Brook established the charity the Tavistock Foundation to generate funding for research and training, and he initiated the annual lecture[64].
Following his retirement from the Tavistock and NHS in 1985[65], Alexis took on another project, working at St Mark’s Hospital[66], developing psychotherapy for patients with gastroenterological disease (leading to the establishment of a three session psychotherapy post)[67]. This project was eventually so successful that the hospital now has a fulltime consultant psychotherapist, with an expanding department[68].
In 1992 Alexis Brook took up the work of William Inman[69], liaising between the Psychoanalytic Society and Queen Alexandra’s Hospital in Portsmouth, travelling down regularly to see patients in the eye department[70]. He joined forces with consultant ophthalmologist, Peter Fenton, and they constructed a study (Brook & Fenton, 1994) to look at patients with eye symptoms for which no organic basis could be found, or where emotional factors might have contributed to their development or a failure to respond to treatment[71]. After about 2 years Alexis decided that the work at Portsmouth could be complemented by further work in primary care, and he began to visit the Hackney practice, where Sotiris Zalidis is partner.
With an increasingly solid body of research Alexis began to write and speak about this work, generating an awareness that both eye professionals and GPs consistently turned a ‘blind eye’ to emotional problems in eye disorders[72]. He then organised a series of Balint-type seminars was for eye professionals in 1996 and followed this up with a one-day symposium called ‘The Mind’s Eye’ at Moorfields Hospital. Ninety-two people registered and Alexis gave the keynote paper[73]. A multidisciplinary seminar was held at the Tavistock in 1998, and in 2000 a second symposium wsa organised around the value of interdisciplinary work[74]. This led to Alexis cofounding the Eye and Mind Society and developing links with Moorfields Eye Hospital[75], which he remained involved with until in 2005 ill-health prevented him continuing with the work.
Alexis Brook died on 7 August 2007[76] aged 87[77]. He was survived by his wife Ruth, his brother Peter, two children from his first marriage, Rebecca and Tim, his two stepdaughters, Jane and Susie, and his grandchildren.
Author: Glenn Gossling 2020
Quotes
‘The eye is not just an organ of vision, a human camera, but is one of the most basic organs through which an individual relates to the world’[78]
‘After the mouth, the eye is the most important organ through which a baby and its mother make contact with each other’[79]
‘Until three hundred years ago, until Descartes, no one questioned the links between psyche and soma. Shakespeare understood perfectly that the eye functions as an eye of the mind, and can therefore express feelings that originate in it. In Othello, Desdemona says ‘Mine eyes do itch: doth that bode weeping?’’[80]
‘Giving insight means giving internal sight with the eyes of the mind.’[81]
Alexis Brook’s publications
Brook, S.J. Bleasdale, S.J. Dowlings, S.J. et al. (1966) Emotional Problems in General Practice: a survey of a sample of ordinary patients Journal of the College of General Practitioners 11:55184-194(March)
Brook, A. (1967) An Experiment in general practitioner/psychiatrist co-operation Journal of the College of General Practitioners 13:127-131
Brook, P.E. Strauss, P.E. (1971) Mental Health Social Workers in General Practice Practitioner 206:386-391
Brook, J. Temperley, J. (1976) The contribution of a psychotherapist to general practice Journal of the Royal College of General Practitioners 26:86-94(March) [Related→]
Brook, A. (1978) An aspect of community mental health: consultative work with general practice teams Health Trends 10:237-39
Brook, A. (1979) An aspect of the use of the psychodynamic model: whither psychiatry in general practice? Journal of the Royal Society of Medicine 72:6467-469(June) [Related→]
Brook, A. (1991) Bowel distress and emotional conflict Journal of the Royal Society of Medicine 84:39-42 [Related→]
Brook, J. Bingley, J. (1991) The contribution of psychotherapy to patients with disorders of the gut Health Trends 23:283-85
Brook, A. (1993) Functional bowel disorders and the stresses of adolescence Hospital Update :288-291(May)
Brook, A. (1994) Explaining variation in GP referrals: be honest about referrals British Medical Journal 308:6924340 (29 January)
Brook, A. (1995) Emotional Minefield Nursing Times 89:3
Brook, A. (1995) The Eye and I: Psychological Aspects of Disorders of the Eye Journal of the Balint Society 23:13-19 [→]
Brook, S. Blepharitis Zalidis, S. Blepharitis (1998) British Journal of General Practice 48:426923-924(January)
[1] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[2] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[3] A Elder, S Majid, J Stern, and guest editors, ‘Psychotherapy, medicine and the body: A Tribute to the work of Alexis Brook’, Psychoanalytic Psychotherapy, 23(4):289-291, 2009
[4] A Elder, S Majid, J Stern, and guest editors, ‘Psychotherapy, medicine and the body: A Tribute to the work of Alexis Brook’, Psychoanalytic Psychotherapy, 23(4):289-291, 2009
[5] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[6] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[7] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[8] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[9] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[10] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[11] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[12] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[13] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[14] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[15] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[16] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[17] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[18] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[19] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[20] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[21] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[22] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[23] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[24] Jennifer Johns, ‘Alexis Brook, the good doctor’, p293, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[25] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[26] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[27] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[28] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[29] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[30] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[31] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[32] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[33] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[34] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[35] Stanley Schneider, Haim Weinberg, The Large Group Re-visited: The Herd, Primal Horde, Crowds and Masses, p48, Jessica Kingsley, 2003
[36] Jennifer Johns, ‘Alexis Brook, the good doctor’, p292, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[37] Tom Main, ‘Some basic concepts in therapeutic community work.’ In E. Jansen (ed) The Therapeutic Community, p53, Croom Helm, 1980
[38] Jennifer Johns, ‘Alexis Brook, the good doctor’, p294, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[39] Alexis Brook, ‘An experiment in general practitioner/psychiatrist co-operation’, p127–131, Journal
of the College of General Practitioners, 13, 1967.
[40] Jennifer Johns, ‘Alexis Brook, the good doctor’, p295, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[41] Jennifer Johns, ‘Alexis Brook, the good doctor’, p295, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[42] Jennifer Johns, ‘Alexis Brook, the good doctor’, p295, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[43] Alexis Brook, ‘An experiment in general practitioner/psychiatrist co-operation’, p127–131, Journal
of the College of General Practitioners, 13, 1967
[44] Jennifer Johns, ‘Alexis Brook, the good doctor’, p295, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[45] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[46] Jennifer Johns, ‘Alexis Brook, the good doctor’, p296, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[47] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[48] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[49] Jennifer Johns, ‘Alexis Brook, the good doctor’, p296, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[50] The Journal of the Royal College of GPs (Brook & Temperley, 1976), Health Trends (Brook, 1978) and the Journal of the Royal Society of Medicine (Brook, 1979)
[51] Jennifer Johns, ‘Alexis Brook, the good doctor’, p296, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[52] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[53] Jennifer Johns, ‘Alexis Brook, the good doctor’, p296, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[54] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[55] Jennifer Johns, ‘Alexis Brook, the good doctor’, p296, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[56] Jennifer Johns, ‘Alexis Brook, the good doctor’, p297, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[57] Jennifer Johns, ‘Alexis Brook, the good doctor’, p297, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[58] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[59] Jennifer Johns, ‘Alexis Brook, the good doctor’, p297, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[60] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[61] Jennifer Johns, ‘Alexis Brook, the good doctor’, p297, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[62] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[63] Jennifer Johns, ‘Alexis Brook, the good doctor’, p297, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[64] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[65] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[66] Jennifer Johns, ‘Alexis Brook, the good doctor’, p298, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[67] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[68] Jennifer Johns, ‘Alexis Brook, the good doctor’, p298, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[69] Sotiris Zalidis, ‘Tears: Emotional or somatic?’, p321, Psychoanalytic Psychotherapy, Vol. 23, No. 4, December 2009
[70] Jennifer Johns, ‘Alexis Brook, the good doctor’, p299, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[71] Jennifer Johns, ‘Alexis Brook, the good doctor’, p299, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[72] Jennifer Johns, ‘Alexis Brook, the good doctor’, p300, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[73] Jennifer Johns, ‘Alexis Brook, the good doctor’, p300, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[74] Jennifer Johns, ‘Alexis Brook, the good doctor’, p300, Psychoanalytic Psychotherapy, 23:4, 292-302, 2009, DOI: 10.1080/02668730903368091
[75] Sotiris Zalidis, ‘Alexis Brook’, BMJ, 2007 Dec 1, 335(7630): 1161, doi: 10.1136/bmj.39392.703160.BE
[76] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[77] Isca Wittenberg, ‘Obituary Alexis Brook’, The Guardian, 27 September 2007
[78] Alexis Brook, ‘The Eye and I: Psychological Aspects of Common Eye Disorders‘, p124, Psychoanalytic Psychotherapy, 1998; v. 12 (2)
[79] Alexis Brook, ‘The Eye and I: Psychological Aspects of Common Eye Disorders‘, p124, Psychoanalytic Psychotherapy, 1998; v. 12 (2)
[80] Alexis Brook, ‘The Eye and I: Psychological Aspects of Common Eye Disorders‘, p124, Psychoanalytic Psychotherapy, 1998; v. 12 (2)
[81] Alexis Brook, ‘The Eye and I: Psychological Aspects of Common Eye Disorders‘, p124, Psychoanalytic Psychotherapy, 1998; v. 12 (2)