Aubrey Lewis and John Rawlings Rees

Papers of Aubrey Lewis College Archives IOP PP3/4/32/1This extract from an apparently cordial exchange of correspondence in 1943 between John Rawlings Rees (1890-1969) and Sir Aubrey Lewis (1900-75) concerning the clinical effectiveness of electroconvulsive therapy (ECT) masks a profound institutional rivalry between the Tavistock Clinic, of which Rees had been the director since 1932, and the Maudsley Hospital, of which Lewis had been the clinical director since 1936. The similarities between the two institutions might seem to us to be more obvious than their differences, as both seem to have been sceptical of pharmacological and surgical approaches to psychiatry.

However, the Tavistock Clinic was more favourable than the Maudsley to Freudian, psychodynamic therapy, towards which Edward Mapother, the first clinical director of the Maudsley, and Lewis were rather cool. Moreover, both organisations competed for the same scarce resources and in this the Maudsley was markedly more successful than the Tavistock.

At the time that Rees and Lewis were writing, electroconvulsive therapy was in its infancy for civilians, although a ‘Faradic current’ had controversially, been used to deal with some of the symptoms of ‘shell shock’ in the First World War. ECT has had a chequered history as a method of treatment. During its early years, it was thought to control schizophrenia through inducing epileptic fits. Psychiatrists rejected this theory many years ago. The correspondence shown here does not refer to it, but does indicate general uncertainty concerning its therapeutic use.

Rees, to his own surprise and to Lewis’s dismay, was appointed by the War Office in 1939 to take charge of Army psychiatry on the home front. He was determined to ensure humane treatment of soldiers. During the First World War he had seen soldiers executed for desertion who, in his opinion, had suffered nervous breakdowns. Despite their differences with Rees, Lewis and other Maudsley doctors made a significant contribution to military psychiatry in the Second World War. They were particularly instrumental in finding alternative occupations in the military for those conscripts who were unsuited to combat duties.

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