Commentary on ‘In the Beginning’ by Felix Post Claire Hilton

INTRODUCTION

Felix Post was probably the first dedicated old-age psychiatrist anywhere in the world. ‘In the Beginning’ is his autobiographical account of the earliest days of old-age psychiatry in Britain. Such accounts are valuable primary sources for understanding the development of the specialty. We are now reaching a point in time when our earliest pioneers like Felix Post (1913–2001) and Martin Roth (1917–2006) have died. It is important that we remember the contributions of our teachers from the past who have set the foundations for our specialty, just as Phillipe Pinel, Emil Kraepelin, Sigmund Freud and many others are celebrated for their contributions to the mental well-being of mainly younger people.

This short chapter by Felix Post has been described as ‘pure Felix’. It characteristically reveals his humility and modesty, and his praise of others, attributing little achievement to himself. A brief biographical note and commentary are therefore warranted to set it in context.

‘IN THE BEGINNING’ BY THE LATE FELIX POST

In 1943, after a year’s early training as one of the war-time refugees of the Maudsley Hospital, Professor Aubrey Lewis passed me on to Professor D.K. Henderson and the Royal Edinburgh Hospital for Nervous and Mental Diseases, where I initially worked in the private department. During one of his rounds, Henderson said to me: ‘Post, do you see all these old people here? Why don’t you write ‘em up?’ This I obediently did, and my article appeared in the Journal of Mental Scienceⁱ. The article started by demonstrating that the admission rate of patients over 60 to the Royal Edinburgh Hospital had risen between 1901 and 1941 more steeply than the proportion of this age group in the Scottish population. Interestingly, at this early date, I had found no difficulties in the differential diagnosis of my colleagues’ and my own patients. There were 22 senile, arteriosclerotic and presenile dementia patients, 20 manic-depressive patients, 25 patients suffering from involutional or senile melancholia and 51 patients with schizophrenia. Assuming that the functional psychoses were the concern of general psychiatry, the rest of the paper dealt with the dementias and with an attempt to link the type associated with delusions and hallucinations to earlier personality characteristics. I noted that a high proportion of dementia admissions had been precipitated by terminal confusional states, and that of 111 patients admitted over the preceding four years with organic psychoses, only 23 were still occupying beds. I made the false prediction that in the future the main burden of the hospital services would be represented by the chronicity and survival of melancholic and paranoid patients. I did not anticipate that electroconvulsive therapy (ECT) and antidepressive drugs, while producing lasting recoveries in only 25% of cases, would make at least temporary discharge from inpatient care possible in most cases.

Aubrey Lewis was more farsighted. He had published, with a psychiatric social workerⁱⁱ a paper describing the psychiatric and social features of the patients in the Tooting Bec Hospital for Senile Dementia, London, UK, and in 1946 predicted, in the Journal of Mental Scienceⁱⁱⁱ that ageing and senility would become a major problem of psychiatry.

After army service, I consulted Lewis about possible positions and he recommended me for the post of assistant physician at the Maudsley Hospital. I flattered myself that in me Lewis had seen a future brilliant psychiatrist, but was soon to be disillusioned. Even before the Bethlem Royal and Maudsley Hospitals were united in 1948, Lewis had conceived the idea of using some of the Bethlem beds to establish a unit for patients over the age of 60. After a heated discussion with the Bethlem matron, Lewis obtained agreement for the admission of senile patients to a hospital which, like the Maudsley, had previously admitted only patients thought to be recoverable. Uncovering his batteries, he asked me to take on the development of this Geriatric Unit. Once again, I obeyed (to say without enthusiasm would be an understatement) and, right up to my retirement, I continued also to run a unit and outpatient clinic for younger adults.

A report in the Bethlem Maudsley Gazette^iv

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