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‘Democratic Psychiatry’

A look at the life of psychiatrist Alec Jenner, 1927-2014

Andrew Russell

Professor Alec Jenner (1927-2014) managed the psychiatric services for the whole of the Trent region – a population of 6 million – from the late 1960s. Originally trained as a bio-chemist he carried out the first double-blind UK trials on Librium and Valium and pursued the idea of benzodiazepines and lithium alleviating the symptoms of his more distressed or depressed patients initially thinking a chemical cure was possible. Jenner took over as Professor of Psychiatry in Sheffield in 1967 from Erwin Stengel (1902-1973). Stengel came from Vienna, knew and followed Freud and specialised in research on suicide and Alzheimer’s Disease. Jenner observed ‘Wherever I went everyone thought I was ‘The Great Expert’ and the patients were riff-raff’ (Virden, Jenner, & Bigwood, 2008). It was Dorothy Rowe, a PhD student of Jenner in the late 1960s and early 70s who observed that under Stengel this is how things were (Rowe, 2007). Patients could not express their own thoughts or opinions in front of ‘The Psychiatrist’. Jenner came to talk with patients much to some staff’s initial concern and see that ‘all human beings need to feel special in some way’ and that allowing a patient freedoms improved their behaviour and their condition improved.

Image JennerIn his opinion huge improvements had already taken place in the 20th century. Catatonia had reduced, hysterical blindness, deafness or lameness lessened, schizophrenic cases were not as acute. He put this down to continuing better psychiatric care over the twentieth century. ‘No-one’ he said ‘is left to get as bad anymore – consequently anxiety and depression have become the more common forms of problems’ (Virden, Jenner, & Bigwood, 2008). He became very interested in the work of Franco Basaglia in Northern Italy that led to the opening of several large psychiatric hospitals there. Jenner saw what happened in Italy and looked at patient care in other countries especially Chile. He could see the ‘revolving door’ intake of patients was replacing the old sort of terminal hospitalisation and people were spending longer periods outside in society. He came to use the term ‘democratic psychiatry’ and in 1986 played a large part in setting up the journal Asylum: the magazine for democratic psychiatry. This publication gave room for writing by health professionals and people receiving mental health care. His idea was to create an alternative to the stuffy and elitist professional journals so as to offer an ‘open forum’ for anyone interested in debating mental health matters. This publication carries on this same work today and can be found online at www.asylumonline.net.

He worked hard within his domain to change the services to include the voice of the patient and to inspire many younger professional colleagues to be sceptical of the so-called ‘medical model’. As a psychiatrist himself this often put him in a difficult position. He still believed electro-convulsive therapy could be used in certain severe cases and although he lost all faith in outright biochemical cures still said that careful use of medications could help a person through crisis or if in a very distressed condition alleviate suffering. He faced much criticism; people either saw him as too radical or not radical enough. He was a complex mix of orthodox and more radical psychiatry.

Image Asylum JennerHe once said mental illness was having ‘a personality society doesn’t like’ and that diagnoses were ‘labels and language that always lets us down’. He saw too that mental illness had an unnecessary link with badness that is embedded in our history, culture and languages (Hudson, 2007). In 1993 he published a book with colleagues entitled Schizophrenia: a disease or some ways of being human? which re-evaluated schizophreneia as an ‘illness’ using his knowledge of psychiatry, bio-chemistry and genetics research. He was perhaps the most influential psychiatrist in the UK of his generation yet he never stopped believing that psychiatry, while necessary in society, must be constantly re-evaluating and changing itself; as ‘policeman of society’ psychiatry could be open to terrible abuse. During the 1970s he became involved with protesting Russian dissidents being locked up and treated as mentally ill by the state. This shocked him and he saw how psychiatry could be badly misused by the state.

Once, after e-mailing him questions about his work and articles he had written I phoned him to ask some questions. He was incredibly down-to-earth in his reply. ‘Ask me what you want … use my knowledge … I’m retired now I have the time’. I had just been diagnosed with a movement disorder, myoclonic dystonia, which is greatly improved by the use of benzodiazepines but felt unhappy about this. Again he was pragmatic ‘Are you coping? Do you have support’ I replied I was and had help from family, therapy and the Dystonia Society.

‘Does the medication help?’ I replied it had helped me to write, eat and sleep properly again – subduing many unwanted movements and the anxiety that comes with this. I was speaking to a man who had trialled benzodiazepines on himself and patients in Whitely Wood clinic in Sheffield in the early 1960s after he read that Hoffman La Roche had used them on animals in the U.S. (Kerry & Jenner 1962). Here was a man who helped create the tranquiliser boom that followed and created so many problems; his assessment on long term addiction questions in the 1980s was that the problems were as likely to be due to ‘addictive personalities’ and ‘neurotic’ or ‘pre-morbid’ diagnoses’ than benzodiazepine addiction and damage. I hoped he was right. ‘Any more questions, queries… ring again I’ll do my best to answer them’ said Jenner. At least I felt I was being treated as a person. I hope many of his patients felt the same.

Andrew Russell BA, MCILIP, AMA is the librarian for the Society of Analytical Psychology. He worked for 14 years at the V&A Museum as a Librarian and Curator and has some training in counselling and psychotherapy through the WPF.

References
Hudson, Gavin (2007) You can call me Alex if you like. In Your Voice: In Sheffield Mental Health. A Magazine for users, carers and professionals. 43,pp.6-7
Kerry, R.J. & Jenner, F.A. (1962) A double Blind Crossover Comparison of Diazepam (Valium, Ro 5-2807) with Chlordiazpoxide (Librium) in the treatment of neurotic anxiety. In Psychopharmacologica 3, pp.302-306
Rowe, D (2007) Why we behave as we do. In Personal Construct Theory and Practice 4, pp.50-52
Virden, P, Jenner, FA, & Bigwood, L (2008) Psychiatry: The alternative textbook pp.121-141. Asylum Books/Tiger Papers.