David Abrahamson MBE, FRCPI, FRCPsych- Contributions to Psychiatry

Journal of Psychiatry Reform vol 12, #2, January 22, 2025



                                                     Alan Eppel Editor

 

David Abrahamson was a contributing author to the Journal of Psychiatry Reform. He died in August of  this year after an outstanding career in Psychiatry.

David had graduated from Trinity College Dublin first as a veterinarian and then as a physician. In 1960 he became a senior registrar at the prestigious Maudsley Hospital in London. This was during the time when Aubrey Lewis was Chair of Psychiatry. David observed that there was a divide between the teaching hospitals and the mental hospitals. He felt that this was a two tier system with those in the mental hospitals being treated as “second class”. David noticed that there was too much distance between psychiatrists and their patients. This often diminished the essential humane nature of the treatment relationship. As a result he chose to work in a mental hospital after completing his training. He was appointed as a consultant psychiatrist at the Goodmayes Hospital in East London.

David took on an enormous clinical load with responsibility for two acute inpatient units, 300 long stay patients as well as conducting outpatient clinics. His outlook was humanistic and focused on the most seriously ill-psychiatric patients.  He was highly committed to the National Health Service (NHS) and refused to engage in any form of private practice.

QUESTIONING CONVENTIONAL WISDOM

David questioned the current view that schizophrenia was a progressively deteriorating condition. Manfred Bleuler had recently published a long term study contradicting Kraepelin’s view. Bleuler demonstrated that the course of schizophrenia, in most cases, was not progressive.

David undertook a detailed study of 490 long-term patients who had been hospitalized for 20 years or more at Goodmayes. Most of these patients did not show deterioration but rather reached a plateau. David was motivated by these findings to focus his clinical energies on psychiatric rehabilitation. He developed a program to move long stay patients into community housing.

The deinstitutionalization movement has largely failed. An effective approach to the movement of patients into the community was not properly developed and certainly was not properly funded. Over the ensuing two decades David developed a uniquely successful approach to de-institutionalization. This involved working with a rehabilitation team and collaborating closely with local housing authorities. He focused on the patient’s own wishes and preferences for a living environment. He identified that patients did form social networks within the mental hospital. The importance of maintaining social networks was essential to the successful transition to community housing.

 PRINCIPLES FOR SUCCESSFUL DEINSTITUTIONALIZATION

David identified the following principles for the successful transition from psychiatric hospital to community accommodation.

  • reevaluation of conventional views of long stay patients
  • predischarge preparation of patients: a critical step
  • the importance of patient choices
  • the heart of the matter: social networks

It was important to develop a range of accommodations to enable patients to exercise choice. Information must be provided to patients about options and preparation prior to discharge. ensure subsequent support and promote new social networks.

CRITIQUE OF RD LAING AND ANTI-PSYCHIATRY

Ronald D. Laing was  a psychiatrist from Glasgow. With the publication of  “The Divided Self”  in 1960 Laing became the leading figure and guru of the Anti-Psychiatry movement. Laing questioned the biological basis of schizophrenia and promoted  an existential, family and social conceptualization of  the problem.

Laing was also involved in alternative housing for seriously ill patients.  David reviewed the actual effects of Laing’s clinical innovations in housing long stay patients. He travelled to Scotland to review clinical records of Laing’s patients. David found discrepancies between what Laing had claimed and the actual outcomes.

  DAVID ABRAHAMSON’S LEGACY

David Abrahamson was a role model for trainees in psychiatry. He was a humanist who recognised that there is no essential difference between physicians and patients. Unlike many of his colleagues, who did not interact with patients outside of formal interviews and who maintained psychological distance by the wearing of white coats, David engaged with long stay patients even those who rarely spoke and were withdrawn into themselves. He possessed the essential characteristic of skepticism not accepting the received wisdom. Rather he searched for the evidence and acted accordingly. Abrahamson was a humanist dedicated to improving the life of long stay patients. Over the course of two decades he achieved remarkable success. He engaged with his patients and attended support group meetings and special events. He was awarded the MBE in 2002 for his contributions to Medicine.



References

Abrahamson, D. (1993). “Housing and deinstitutionalization”, in Weller, M.PJ. and Muijen, M. (Eds),

Dimensions of Community Mental Health Care, W.B. Saunders Company, London, pp. 208-32.

Abrahamson, D. (2011a), “R.D. Laing and Long stay patients: (discrepant accounts of the refractory ward and ‘Rurmpus Room’ at Gartnavel Royal Hospital”, International Journal of Psychotherapy 15 , pp. 21·32.

Abrahamson, D. (2011 b). “Long-term psychiatric patients-second class once again, The Health Summary,  18 No.9, pp. 7·9.

Abrahamson, D. and Brenner, D. (1982), Do long-stay patients want to leave hospital?”, Health Trends 14, pp. 95·7.

Abrahamson, D. and Ezekiel, A (1984), “The social networks of patients moving from hospital to the community”, paper presented at conference, Social Networks in Hospital and in the Community, The King’s Fund Centre, London.

Abrahamson, D. and Fellow-Smith, E. (1991), KA combined group and individual long-term out-patient clinic Psychiatric Bulletin.15, pp. 486-7.

Abrahamson, D., Swatton, J. and Wills, W. (1989), Do long-slay patients want to leave hospital? Health Trends, 21, pp. 16-21.