The Tavistock Clinic, or Tavi as it is colloquially known, was established in 1920 by Hugh Crichton-Miller, MD, FRCP, the founding Medical Director[1]. The first patient was a child, who was seen by Dr Hamilton Pearson[2] on 27 September 1920[3] and this is where we take the date of our founding from. The second patient was an adult[4]. After the first patient was seen Hugh Crichton-Miller said, “My dream has come true”[5].
The Tavi was originally organised into two parts: the Adult Department and the Children’s Department[6]. Its general orientation was psychodynamic, but beyond that it sought to ‘have no doctrine’[7].
From its founding the Tavistock Clinic had four aims:
- Understanding and treatment
- Research
- Prevention
- Teaching[8]
The Tavistock Clinic was founded directly after World War 1 as a result of the experiences of that war. Several of the early clinicians at the Tavi had personal experience of working in the Army, treating cases of neurosis and it is unlikely that anyone in Britain would have been untouched by the effects of World War 1. Consequently when Hugh Crichton-Miller sought support for his project he found it, with prominent society members donating money and Earls Beaty and Haig, two Commanders in Chief of the Services, taking up positions as Vice-Presidents on the Board[9].
The First World War had been a cataclysm of violence that destroyed a generation. Around 9.7 million military personnel and 10 million civilians died, with another 20 million casualties. It was closely followed by a Spanish influenza pandemic, which killed between 50 and 100 million people.
The war set in motion events that were to radically change the nature of society over the next 20 years. In 1917 the Russian Revolution overturned Russian society and sent shockwaves throughout Europe challenging the core values of how society was organised. Italy became a fascist state in 1922. The stock market crashed in 1929 creating a legacy of unemployment, soup kitchens, grinding poverty and despair known as the Great Depression, which lasted until 1939. In 1933 Hitler became Chancellor of Germany, reoccupying the Rhineland in 1936 and annexing Austria in 1938. The Gold Standard was abandoned by Britain in 1931 and the US in 1933, and money ceased to have a fixed value. In 1936 The Spanish Civil War began.
Such tumultuous events form the backdrop against which the Tavistock Clinic was founded and sought to establish itself.
All sources describe the Tavistock Clinic as being the ‘vision’ of Hugh Crichton-Miller[10]. This vision had its first public airing at a meeting in the drawing room of Lady Margaret Nicholson[11] in Pont Street, Chelsea[12] in December 1919[13]. Addresses were given by Rev L Ford, Lt-Col HGG Mackenzie and Hugh Crichton-Miller[14]. It was pointed out that the treatment of nervous disorders had greatly developed during World War 1; much had been done for ‘war neurotics’ but little was being done for civilian cases[15]. It was proposed to open an experimental clinic where medical men who had gained experience in the military might use that experience to help civilians[16]. Hugh Crichton-Miller persuaded a number of wealthy individuals to provide subscriptions to guarantee an income of £300 per annum for three years[17],[18]. A committee was elected and an honorary director – Hugh Crichton-Miller – appointed, thus the Tavistock project became a reality[19].
The search for suitable premises near to Harley Street proved more difficult, not only because there was a shortage of housing after World War 1, but also because landlords feared what the Clinic might be[20]. Eventually a house was found at 51 Tavistock Square, which the 11th Duke of Bedford had donated for the rehabilitation of World War 1 soldiers and had been a veteran’s hostel[21]. It had a number of small rooms and one large drawing room that could be used for meetings and lectures[22]. It became the Tavistock Square Clinic for Functional Nervous Disorders[23].
In the beginning the Tavi was the home of a small band of seven[24] doctors who Hugh Crichton-Miller led with enthusiasm. In addition to Hugh Crichton-Miller there was: Dr JA Hadfield [25],[26], Dr Mary Hemmingway[27],[28], Dr Neill Hobbhouse (Neurologist) [29],[30], Dr Leslie Tucker[31],[32], EA Hamilton Pearson[33],[34], and Dr JR Rees[35],[36]. These were mostly were loyal and eager disciples and some had been with Hugh Crichton-Miller at Bowden House. Mrs Leith-Ross (who served as Honorary Secretary of the Tavi for five years, before leaving to pursue a career in anthropology[37]) was also there from the start and provided much of the furniture for the new clinic. From the outset, the Tavistock Clinic had both an adult and a children’s department[38],[39]. The establishment of the Clinic ten years before the Mental Treatment Act of 1930 ushered in a new era of psychiatry[40]and seven years before the first child guidance clinic[41] was opened was groundbreaking innovative[42]. Part of the aim of the Tavistock Clinic was for these two part to be conceived as a unity where the child was the father of the man[43].
The first seven were soon joined by many of the other early staff including: EA Bennet[44], Leonard Browne[45], Dr Gloyne (Pathologist)[46].[47], E Graham Howe[48], WA Potts (who became Head of the Children’s Department)[49], Alice Hutchinson[50], Dr Evelyn Saywell[51] and Dr David Yellowlees[52]. Staff had complete freedom to use whatever methods they thought best[53], and the general orientation was to ‘have no doctrine’[54].
From the very beginning Hugh Crichton-Miller laid down the principle that they were to be doctors first and psychiatrists second[55]. He wanted to integrate the biological, psychological and social sides of people, a unified approach to diagnosis and treatment[56] that stood between traditional psychiatry, medicine and psychoanalysis[57]. Hugh Crichton-Miller took a ‘quite open’ and independent view of psychoanalysis, drawing equally from Freud, Jung, Adler and French schools[58], differentiating the Tavistock from the ‘rigid orthodoxies’ of the early Freudians[59]. Hostilities caused by early demarcations of territory led Ernest Jones, the founder of the Psychoanalytical Society, to forbid psychoanalysts (members of the British Psycho-Analytic Society) from working at the Tavistock Clinic[60]. In return Hugh Crichton-Miller, JR Rees and JA Hadfield viewed the official Freudian group as a sectarian, inturned coterie[61].
At the same time the Hugh-Crichton-Miller was also at odds with Mapother and Potter-Phillips at the then leading teaching psychiatric hospitals, the Maudsley and Bethlem[62], who were critical of the Tavi as not all the staff at the Tavi had their DPMs or was a fully qualified psychiatrist[63]. So the Tavi was positioned by hostilities from orthodox psychiatry on one side and orthodox psychoanalysis on the other. It was later found that much of the quarrel with Mapother had at its root the territoriality and status around being a teaching institution.
From the earliest days the Tavistock Clinic regarded education as one of its most important activities[64]. Case conferences and staff meetings were organised for the staff[65]. Another aspect of the early Tavistock Clinic was the establishment of a library. This was originally run by Miss Selar, who was also a social worker at the clinic[66]. A substantial financial donation from a Miss Green was made to fund a library and this was created in 1927 to provide easy access to specialist books on psychology, psychoanalysis and psychotherapeutics for the staff and students[67].
Again, almost from the outset the Tavistock clinic started lectures, some of these were ‘popular’ lectures for parents and teachers[68], but there were also programmes of medical lectures primarily for GPs medical students[69]. Sometimes well-known speakers such as Alfred Adler were engaged to deliver both medical and popular lectures[70]. Initially these were held in the Chinese wallpapered drawing room[71], but audiences grew. Before long there were not enough chairs and people had to stand at the back, then there was not enough room and the audience overflowed onto the stairs[72]. Eventually they started hiring the large hall at the Mary Ward Settlement across the road[73].
In the financial year of 1928/29 there were more than 4,000 attendees at lectures at the Tavi[74]. As well as these many of the staff presented lectures to provincial or suburban groups[75].
Hugh Crichton-Miller with his soft Scottish accent was said to be a very good speaker[76], voicing his thoughts with an economy of words[77], and expressing the need for respect, patience and compassion for patients[78]. As well as the scientific point of view, he also touched on ethical and religious considerations[79].
By 1927 the medical staff included: PF Barton, EA Bennett, CM Bevan Brown, LF Browne, EA Clegg, H Crichton-Miller, JA Hadfield, MI Hemmingway-Rees, EG Howe, E Montgomery, G Nicolle, JR Rees, EN Saywell and J Young[80]. The Children’s Department included: CLC Burns, RG Gordon, EA Hamilton Pearson, AM Hutchinson and WA Potts (the honorary Director of the Children’s Department[81][82]) [83]. Clinical assistants included: IGH Wilson (pathologist), H Neame (hon Ophthalmologist), GT Hoyes (dental consultant), R Balmer (hon gynaecologist), W Morris (hon laryngologist), JH Woodroffe (hon radiographer)[84].
Hugh Crichton-Miller had also assembled and impressive roster of Vice-Presidents which included various marquesses and two World War 1 Commanders in Chief: Earls Haig and Beatty, as well as academic support of William McDougal (who had just moved from Oxford to Harvard)[85].
The staff from the early days were collected from a number of sources. Many, such as Dr L Tucker[86], Dr JR Rees[87] (who became Deputy Director in 1926[88]) and Dr M Hemmingway[89], came from Hugh Crichton-Miller’s other clinic, Bowden House. They had mostly been taught by Hugh Crichton-Miller himself and were medical doctors and not psychiatrists. Others such as Dr JA Hadfield[90] and Dr Hamilton Pearson[91] were psychiatrists from the military. Then there were a number of GPs who had an interest in psychotherapy.
Hugh Crichton-Miller’s original vision was of a clinic where there was freedom from administrative and institutional bureaucracy[92], where each person was seen punctually by appointment and always by the same doctor, with no forms and no white coats[93]. Each patient was allotted a full hour appointment, probably based on the Freudian model[94]. Each patient had a thorough physical and dental examination[95]. By 1926 they had installed their own pathology laboratory, with their own bacteriologist, Dr Arthur Davies[96]. The kind of therapy given depended primarily on the needs of the case, but also the interests and training of the doctor[97]. For adults, this could be orthodox psychoanalysis, Jungian technique or analytic counselling with liberal doses of suggestion[98].
Although by the late 20s there were open hostilities between the Tavi, the Maudsley and the Psychoanalytic Institute, in the early days the Tavi received a lot of support from other institutions. Some 20 hospitals sent the Tavi patients and Queens Square (which was located close by) treated it almost as if it was one of its own departments referring all their neurotic patients to the Tavi[99]. The Tavi also got a lot of referrals from GPs and family doctors, this developed from the practice, established from the very beginning, of always writing to the doctor and keeping them in the picture[100]. This was done primarily because the Tavi saw itself as having a role in educating the wider medical profession.
The Children’s Department ran much as the early Child Guidance Clinics did[101], when they came into existence in 1928. As well as running a gamut of tests on the children, the Tavi developed play treatment and observation of play very early on[102]. The children’s psychiatrists also ‘volunteered’ as social workers for six hours a week to interview the parents and investigate the home and family conditions[103]. By taking this approach Hugh Crichton-Miller followed on from the psychology of Adler in ‘laying stress on the environment’[104], plotting out the ‘family style’[105], examining social and economic conditions[106]. It meant that from the outset the Tavistock Clinic established a multidisciplinary approach that straddled abstract disciplinary boundaries in order to investigate an untidy social reality that extended beyond the boundaries of a patient’s skin.
A key part of the work of the Tavistock Clinic was prevention. Hugh Crichton-Miller had seen how the intense horror and stress of modern mechanical war could break strong and healthy men with no history of neurosis, not just those who were predisposed. Similarly, the stresses and situations of the modern world could also wear people down. There was an emphasis on treating people without hospitalising them and in so doing not disrupt their ordinary social connections[107]. He was keen that his doctors maintained a keen awareness of human respect and concern for the deep anxieties and vulnerabilities of their patients. He was also keen to maintain what he called ‘binocular vision’ – attention to the body as well as the mind of the patient[108], a psychosomatic or ‘double-barrelled’ approach as his colleagues affectionately referred to it[109].
As well as the clinical work that was carried out in the Adult and Children’s Departments, teaching was very much part of the activities of the Tavistock Clinic from the outset. At that time the method of teaching was by case conferences, discussion of diagnosis and theory[110]. This method of joint discussion was also how supervision was managed. The whole staff would attend once a week and report what they were doing[111]. At these meetings Hugh Crichton-Miller would act as Chairman; JR Rees said: ‘It was not a leaderless group exactly, one cannot imagine that with H.C.M. there, but they were enormously inspiring.’[112]
Teaching and lecturing to other professional audiences also began almost as soon as the clinic opened[113]. In the autumn of 1920 Hugh Crichton-Miller gave ten lectures on elementary psychotherapy and JA Hadfield gave ten lectures on psychology and ethics[114]. In 1921 Potts lectured on mental deficiency, Hugh Crichton-Miller on elementary psychology and the new psychology, and Maurice Nicholl on analytical psychology (the Jungian system)[115]. During the first seven years 389 lectures were given, with an average attendance of seventy people per lecture[116]. Throughout the early years JA Hadfield influenced the teaching and theoretical orientation considerably[117]. Most of the early staff at the Tavi were trained by JA Hafield, James Glover[118] and Maurice Nicholl[119]. JA Hadfield in particular developed a ‘following’[120].
In general staff at the Tavi used discoveries and hypotheses from the schools derived from Freud, but with some dilution[121]. Overall it sought to position itself between organic medicine as practiced in 1920, the older world of the bedlam mental hospitals and orthodox psychoanalysis[122].
Staff at the Tavi were also busy with PR activities, lecturing to medical audiences in provincial cities, for example in 1922 Hugh Crichton-Miller addressed a student audience at Cambridge University, chaired by Dr Joseph Needham[123]. There was an early commitment to going out into the community[124].
From its earliest days the Tavistock Clinic found a certain currency with American institutions. Early on, contact was made with the ‘mental hygiene’ movement, which had been founded by Clifford Beers in 1908[125].
In the first seven years the staff team at the Tavi grew from seven to 19 members[126]. Attendances grew from 2,200 to 3,800 and patient numbers from 247 to 690.
From the outset Hugh Crichton-Miller had never considered the Tavi as a long-lasting venture. He originally conceived it as a ‘model’, which he expected would then be copied by teaching hospital psychiatric departments and out-patient centres[127]. The Tavi would then become superfluous, but this never really happened and the Tavi evolved into a highly idiosyncratic institution[128].
Author: Glenn Gossling 2019
[1] HV Dicks, 50 Years of the Tavistock Clinic, p1, Routledge, 1970
[2] HV Dicks, 50 Years of the Tavistock Clinic, p25, Routledge, 1970
[3] HV Dicks, 50 Years of the Tavistock Clinic, p14, Routledge, 1970
[4] HV Dicks, 50 Years of the Tavistock Clinic, p14, Routledge, 1970
[5] HV Dicks, 50 Years of the Tavistock Clinic, p14, Routledge, 1970
[6] HV Dicks, 50 Years of the Tavistock Clinic, p2, Routledge, 1970
[7] HV Dicks, 50 Years of the Tavistock Clinic, p2, Routledge, 1970
[8] HV Dicks, 50 Years of the Tavistock Clinic, p1, Routledge, 1970
[9] HV Dicks, 50 Years of the Tavistock Clinic, p16, Routledge, 1970
[10] HV Dicks, 50 Years of the Tavistock Clinic, p12, Routledge, 1970
[11] Tavistock Square Clinic for Functional Nervous Disorders, Report for the Years 1920 – 1927, p5
[12] HV Dicks, 50 Years of the Tavistock Clinic, p12, Routledge, 1970
[13] Tavistock Square Clinic for Functional Nervous Disorders, Report for the Years 1920 – 1927, p5
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[24] Hugh Crichton-Miller 1877 – 1959, A personal Memoir, p43, The Friary Press, 1961
[25] JR Rees, Reflections, p25, The United States Committee of the World Mental health Federation, 1966
[26] HV Dicks, 50 Years of the Tavistock Clinic, p14, Routledge, 1970
[27] JR Rees, Reflections, p25, The United States Committee of the World Mental health Federation, 1966
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[40] JR Rees, Reflections, p27, The United States Committee of the World Mental health Federation, 1966
[41] Emanuel Miller established the East London Child Guidance Clinic in 1927
[42] JR Rees, Reflections, p27, The United States Committee of the World Mental health Federation, 1966
[43] Doris Odium, The Tavistock Clinic and the Tavistock Institute of Human Relations, p1, unpublished MS
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[56] D Armstrong, ‘Madness and Coping’, Sociology of Health and Illness, 2, p293-313, 1980
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[104] H Crichton-Miller, Psycho-Analysis and its derivatives, p202 Home University Library, 1933
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