A psychiatrist who revelled in controversy - Charles Mercier by Dr Claire Hilton

Charles Mercier was a British psychiatrist and former president of the RCPsych (then known as the Medico-Psychological Association). He consistently advocated for his patients and endeavoured to improve understanding of mental disorders. He was remembered for his ‘wide reading and mordant wit’ and that ‘he revelled in controversy’¹, but his bluntness sometimes risked antagonising colleagues.

For example, at a time when Freud’s work was becoming popular with the educated public but many psychiatrists were sceptical, he wrote: ‘I do not hold that there is only one cause of mental disease. If I did so hold, I should be little better than a psycho-analyst’.²

A century on from his death on 2 September 1919, it is worth reflecting on some of his messages which have an enduring quality and may provide inspiration, or timely reminders, for psychiatrists today. Don’t be put off by Mercier’s archaic, patronising and sexist Victorian language.

When you read the aphorisms below, substitute psychiatric disturbance for insanity; mental health service for asylum; team member for attendant; and so on. His writing reflects his humanity and concern for his patients.

These are some of my favourites:

1. In nothing is the treatment of insane persons so defective as in individuality. … They are dealt with far too much in the mass.³
2. The medical superintendent should remember that his first duty is the care and treatment of his patients. That is the object for which the asylum is founded and maintained, and unless this object is continually kept before his mind, he will be sure sooner or later to fall into one of the many pitfalls that beset his path.³
3. The first duty of an attendant, then, is to treat his patients with kindness and gentleness and humanity, both in deed and in word.⁴
4. [T]he guiding principle that the attendant should keep constantly in mind in dealing with patients is one that ought to be inscribed in letters of gold in every ward in the asylum, viz: The asylum exists for the benefit of the patients.⁴
5. Attendants are not to think that when patients are ‘lost’ – are completely demented – anything is good enough for them, and such patients often come off very badly. They should be as attentively served, and have as good food, as any other patients.⁴
6. [At night] the feet of sleepless patients should be felt, and, if cold, should be wrapped in a hot blanket. Noise of all kinds is to be avoided as much as possible. Night attendants should, therefore, wear noiseless slippers, and should be as quiet as possible in all their movements. … They must avoid flashing their lanterns in the faces of sleeping patients.⁴

So much has been achieved since Mercier’s time but there is much more to do, and some matters have hardly changed: Mercier’s comments on disturbing patients at night resonate with David Veale’s recent article in BJPsych Bulletin.⁵

Mercier put patients first and looked to the future, but he could never have dreamt that you’d be able to read his words in a blog and access his books electronically.

References 

1. GH Brown, Charles Arthur Mercier,  Munk’s Roll: Lives of the Fellows iv, 1826-1925, 463
2. Charles Mercier, Diet as a factor in the causation of mental disease, Journal of Mental Science 1916, 505-529
3. Charles Mercier,  Lunatic Asylums, their Organisation and Management London: Griffin 1894
4. Charles Mercier, The Attendant's Companion: A Manual of the Duties of Attendants in Lunatic Asylums London: J and A Churchill, 1898.
5. David Veale, Against the stream: Intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation. BJPsych Bulletin, 2019, 43, 174-176