Author: Sylvia Leith-Ross (1884 to 1980), first honorary secretary of Tavistock Clinic
IT WAS IN 1912 that I first met Dr. Crichton-Miller. He had then a consulting room in Park Street, Mayfair. As I remember it, it was a small room and rather dark. In those days, psychotherapy was still such a strange word in laymen’s ears that had the room been full of braziers and retorts, I would not have been surprised. Instead, there was a very tidy desk and a young, tall dark-haired Scot with alert eyes, who asked in abrupt phrases and an offhand manner, the most extraordinary questions.
‘Though nervous and bewildered, I recognised at once that here was someone worth listening to, even if it were with resentment or hostility; but neither of these attitudes could last for long with any honest patient, so clear was Dr. Crichton-Miller’s own sincerity.
When I knew him better, I often tried to think what motives enabled him to carry on day after day the exhausting task of dealing with neurotic cases. His attention never flagged; his patience never wore out; he never allowed his patient nor himself to give up hope. Later, when he moved to Harley Street, I noticed a small frame hanging on the wall, enclosing three lines: Guérir quelquefois— Soulager souvent— Consoler toujours.
It has seemed to me that those words summed up rightly Dr. Crichton-Miller’s whole attitude to his profession—in his case, vocation would be the better word. He could be dogmatic, even arrogant when defending the cause of psychological treatment or when convinced that he was right on any question of diagnosis, but he had no illusions as to the number of radical cures that psychotherapy could effect. On the other hand, it seemed to him intensely worth while to help patients to their feet even if sooner or later, they were to fall down again. At least for a time, their burdens had been lifted, they could take their normal place in the community and, oft-repeated phrase, they could “make their contribution to society’’.
And for those whose chains could not be loosened by any human effort, he had words of consolation which were never touched by sentimentality nor cloudy optimism but which gave the prisoner a sudden vision of new values and of unexpected freedoms.
It was at the Tavistock Clinic that I saw his methods most closely. The Clinic was his own conception dating from the last days of the 1914 war. His war service ended, he took up again his work as Medical Superintendent at Bowden House and as specialist in psychotherapeutic treatment in Harley Street. He quickly realised the number of civilian cases needing psychological help and the dearth of facilities. Service men were catered for in the military hospitals; the well-to-do could turn to the few specialists in England or to the larger number abroad. For the ordinary individual, especially for those whom we came to call ‘‘the educated poor” such as teachers, pastors, clerks, telephone girls, students, nurses, social workers, a class in which Dr. Crichton-Miller was specially interested, there was practically no provision.
His dream was to have a Clinic, run on the simplest lines, with the minimum of publicity and the maximum of work done. The staff would be voluntary, giving what time they could spare. [he patients would be charged a nominal fee of 5s. (if they could afford it) and would be seen by appointment only and always by the same doctor, exactly as at a private consulting room. The premises would have to be central and easy to reach from Harley Street; they would have to be open all and every day since the doctors would come at varying hours as fitted in with their own work: and, above all, they would have to be cheap for the dream, vivid in its conception, clear 1n its outlines, lacked even the flimsiest financial foundation.
I do not know whether Dr. Crichton-Miller tried to get any grant or subsidy towards the carrying out of his idea. All I remember is a drawing room meeting at the house of Lady Margaret Nicholson in Pont Street some time in 1919. Several doctors spoke. Dr. (later Sir) Farquhar Buzzard was one of them—and of course Dr. Crichton Miller. The meeting was a purely private one: one felt that perhaps loyalty, affection, respect for Dr. Crichton-Miller were the motives of the gathering rather than an enthusiastic conviction of the need for such a Clinic. In any case, if I remember rightly, the sum of £300 was promised and, in faith, Dr. Crichton-Miller carried on.
The finding of a house was not easy. It had to be fairly large and as there would be no funds for structural alterations it would need to have a number of small rooms to serve as consulting rooms. A stumbling block that had not been foreseen, was the difficulty of obtaining permission from landlord or estate agent to use any premises for such a Clinic. No sooner were “‘nerve cases’’ mentioned than they visualized a mob of demented patients howling on the doorstep and wrecking the amenities of the neighbourhood.
At last a house was discovered in Bloomsbury, number fifty one, Tavistock Square. It had been run as a ‘Victory Club” or Hostel after the war, failed to make good, and the lease was going cheap. It was a tall, rather gloomy house when, as Hon. Secretary, I moved into the top floor, some time in 1920. The stone staircase, discoloured wills and grimy paint were depressing but the windows looked on to the tall trees of the Square and the large, beautifully proportioned drawing room still had an exquisite grey and white “Chinese” wall paper. I had my own furniture and a little left over. Personal friends and Harley Street patients gave or lent oddments of many kinds. The house became human. Circulars were printed which could be sent to doctors and potential subscribers giving the names of the Committee and of the medical staff, and a short account of the aims and methods of the Clinic. No one wanted a high-sounding title, so we were simply called the ‘Tavistock Clinic for Functional Nerve Cases and quickly became ‘Tavie’ to all our friends. Through it all moved Dr. Crichton-Miller, never sparing himself in his efforts to awaken interest and to raise funds, always ready to advise and encourage.
The day Tavie was opened, he said: “My dream has come true” with that odd mixture of pride and humility in his voice that was often heard and, from that moment, he threw himself into the life of the Clinic with all the zest and courage, confidence and obstinacy, of which he was capable. It was all needed. At first, the Clinic hung fire. Few doctors sent patients and these were often nonplussed by the very lack of institutional atmosphere, of apparatus, of a bottle of medicine to take away with them. The staff, generous and devoted though it was, belonged to various schools of psychotherapy and had to be handled with tact and discretion. Funds were precarious. The general public was indifferent to the misery of “‘nerve cases’’ who needed only to be told to “pull themselves together’’, or prejudiced against ‘all this prying into other people’s lives’.
Then, gradually, the number of patients increased. They now came chiefly from amongst the “educated poor’’, the very people Dr. Crichton-Miller was most anxious to help. Soon there was a waiting list, yet, with a certain amount of juggling and the generous co-operation of the staff, It was seldom more than a few weeks before a patient could be seen. Consulting hours ranged from 9 a.m. to 10 p.m., according to what times the various doctors could spare. Many of the patients were working so the evening hours were the fullest and though the doctors came on to Tavie after a whole day’s work of their own, each Clinic patient got a full hour of their undivided attention. Dr. Crichton-Miller came at least one evening a week and I could get in touch with him at any time if a difficulty arose. Just as with his own patients, he insisted on a “‘bi-focal’’ view of each case, the organic as well as the functional, and it was generally through um that appointments for X-rays, dental examinations, etc., were made.
I have been asked about the administration of the Clinic. There was none. We had of course a Committee, men keenly interested but too busy to meet often and when they did, it was usually to defer to any suggestions Dr.Crichton-Miller might make. Only Dean Inge never the Gloomy Dean when together with Dr. Crichton-Miller would make a wry comment or set the Committee laughing with some witty jibe. We also had an Hon. Treasurer but apart from the payment of rent, I kept the accounts. They were starkly simple: there were no incomings except the patient fees, some subscriptions and donations, and later the lecture fees. The outgoings consisted of small sums for light, fuel, stationery, telephones and the wages of our one domestic help, Mrs. Banchini, rescued from a Paddington slum, indefatigable, shrewd, utterly devoted.
The members of the medical staff—the initial number was seven but it soon increased—were given complete freedom to use what method they thought best. Every week they met together to discuss their cases with each other and with Dr. Crichton-Muller and considering—or possibly because of—the simplicity of the organization, the absence of all self-seeking, the paucity of means, the results were deeply rewarding. It was pioneer work, an exploration. Some patients were cured; many were helped; only a few, too obtuse, too set in their ways, too suspicious or too fond of their neuroses, went away disappointed or angry.
I think the success of the Clinic during those first five years was due to Dr. Crichton- Miller’s original conception of it as a place where a patient could have a sense of privacy, of confidence. The mere fact that each one was seen by appointment and always by the same doctor, that there were no forms to fill, no awkward details to be given, was an immediate comfort to those who, overwrought, dreaded long hours in hospital waiting rooms surrounded by strange faces.
It is difficult to give a picture of Tavie in those early days which would convey the austerity of the surroundings—a bare table and two chairs furnished the consulting rooms; the lack of equipment—a steel filing cabinet was the only item that had been bought; the often laughable expedients to which we were driven—when Dr. Crichton-Miller arrived in the evening, the four consulting rooms would be full, so the best-tempered doctor and patient would be turned out to sit on the floor of the still empty lecture room. Yet there was no doubt that good and unique work was being done. To many people to whom psychotherapy was an unknown or misunderstood word, came the revelation that it was a reasonable and respectable form of treatment like any other. Prejudice and suspicion broke down when met by the open friendliness of the Clinic staff und the practical comprehension of the patient’s needs and circumstances. Admittedly it was pioneer work but it was a valuable experience for all concerned and though more could have been done with more time, more money, more staff, perhaps there were compensations in that a close and happy co-operation was easier to maintain.
All the same, looking back, I wonder how such a loose and unorthodox organization could have held together even for the five years I was there. The answer of course is that, whether he was there or not, whether any individual doctor followed his methods or not, Dr. Crichton- Miller’s influence was constant, never constricting nor hampering but binding the members of the staff together by the sheer strength of his personality. With such an example of singlemindedness, others could but follow and if he could make such 4 sacrifice of time and labour on behalf of the Clinic, so must they.
Tavie was always active, often even gay in spite of the tragedies it dealt with but when Dr. Crichton-Miller came in, all its pulses beat faster. He never threw his weight about yet one had the immediate knowledge of the presence of authority. His sure quick movements, his immediate yet unhurried grasp of whatever problem was set before him, his freakish sense of humour, his anger over a mishandled case or sorrow over some hopeless one, brought into that bare building, when perchance interest or patience or confidence began to flag, a current of air and warmth and energy. Correct in a Harley Street consultant’s attire, he nevertheless carried with him a sense of hills and the spring of heather.
When the lectures started, Tavie entered its heroic period. Its name was almost famous; patients and voluntary physicians multiplied; there was a balance at the bank. Looking back, I wonder how, with all his other commitments, Dr. Crichton Miller had either time or zest to plan and deliver these lectures, even though their organization, the correspondence, the answering of endless enquiries, the distribution of tickets, was admirably and devotedly undertaken by Angela Trotter (now the Countess of Limerick) and Winifred Hollingsworth with the ever-constant help of Lorna Southwell at the other end of the Harley Street telephone.
Some of the lectures were for medical students, some for teachers and social workers. The first ones were held in the Chinese papered drawing room. When the audience overflowed on to the stairs and Mrs. Banchini and I could no longer perform the miracle of turning six chairs into sixty, we hired the big hall of the Mary Ward Settlement across the road. Even then there was hardly room. Dr. Crichton-Miller when at his best was the best lecturer ] have ever heard. He had an exceptionally attractive speaking voice and when lecturing, he had but to raise it a little and. every word came through, full and clear. He spoke with ease, yet not in facile clichés. Each sentence had been worked over so as to express the thought with the greatest economy of words. Whether you agreed with him or not, you had to listen and when he allowed what was sometimes his quite wicked wit to flash like lightning over some controversial subject, you had to laugh.
He could also, when moved himself, move the most unlikely audience. In a last lecture of a series for medical students, young men and women who mostly approached life from a purely scientific point of view, he touched upon the ethical side of medical work. He spoke of the respect, of the patience and compassion due to patients, even the most foolish; of the doctor’s own need for self-examination, of humility and suffering. His last quiet words were: “There: is only one way, and that is through the Manger and the Cross.” There was a silence I remember after all these years and then a long low indrawn breath as, dazed with a sudden vision, the students rose to their feet.
That was probably Dr. Crichton-Miller’s greatest gift: the power to present a vision.
From: Hugh Crichton-Miller 1877-1959 : a Personal Memoir By His Friend printed privately by the Friary Press. Dorchester 1961