Ann Westmore | Obituary: Eric Cunningham Dax (1908–2008); A Tribute | Health and History, 10.1

Obituary

Eric Cunningham Dax (1908–2008); A Tribute

Eric Cunningham Dax, who died on 29 January just a few months short of reaching his ton, had more in common with Don Bradman than a love of cricket and year of birth.	1
Both men were outstanding in their chosen fields, impressive as administrators, turned their hand to writing for lay audiences during their careers, and were complex and highly driven individuals.	2
To those old enough to remember Dr. Dax or Cunningham Dax, as he was usually called, head of Victoria's Mental Hygiene Authority from 1952 to 1968, he had a larger-than-life persona and the influence to match. Tough, tenacious and politically savvy, he was tall, preposterously perpendicular, impeccably dressed, arrestingly courteous and spoke with the rounded diction of a Shakespearean actor.	3
He lived a life in two halves, the first spent in England and the second in Australia. Born at Eastwood, near Nottingham, he was the older of two children. His mother, Alice Mills, a close friend of D. H. Lawrence, established a nursing federation and social services for miners' wives while his father, Henry, one of a long line of apothecaries, held duel qualifications in pharmacy and optometry. Dax broke with family tradition and did his medical training at London University, graduating with honours in 1933. He studied psychiatry at St. Mary's Medical School, London, and gained clinical, pathological and research experience at Barnwood House, a private mental hospital in Gloucester, in the psychiatric units of the London County Council General Hospitals at Lewisham and Dulwich, and at Leavesden Hospital. His real strength, administration, was recognised in 1939 when he was appointed Deputy Superintendent of the 2000-bed Netherne Hospital, Surrey, home to many patients said to have chronic and incurable mental diseases. Two years later he was appointed Superintendent and, with characteristic gusto, set about transforming it.	4
He considered himself fortunate to graduate in medicine and enter psychiatry 'at a time which exactly coincided with a series of remarkable discoveries which have revolutionised the care of the mentally ill throughout the world.' New therapies that impressed him included convulsion-inducing treatments using the chemicals, Metrazol and Cardiazol, and electric currents (electroconvulsive therapy or ECT); insulin coma therapy; and leucotomy (lobotomy). Under Dax, patients at Netherne with the most severe and disabling forms of mental illness such as schizophrenia and entrenched depression for whom little else made a difference, were exposed to these and other treatments such as art therapy and psychotherapy, along with opportunities to take part in industrial rehabilitation activities.	5
In 1951, Dax and his wife of 16 years, Kathleen ('Katie'), a nurse, read an advertisement for the position of inaugural Chairman of Victoria's Mental Hygiene Authority (later the Mental Health Authority—MHA). His decision to apply for the job coincided with his growing unease about the impact on psychiatry of England's National Health Scheme (NHS), introduced in 1945. His application was one of seventeen all told, and one of eight lodged in London. When Australian journalist, Rohan Rivett, arrived at the Dax home to tell him he had been selected, he was flabbergasted. Some months had passed since he applied, and he and his wife had completely forgotten about it!	6
By the time he arrived in Victoria with his family at the end of 1951, he had read a 1950 report on the mental health system written by Professor Alexander Kennedy of Durham University and had corresponded with him. As well as problems of overcrowding, under-staffing, poor morale and 'archaic' facilities, Kennedy told him about undercurrents in the Victorian mental health scene not detailed in the report. He warned that 'one's attitude and actions out there are interpreted on a sectarian basis' and reported that 'the only people who had received any promotion were all Catholics and that many people who were anxious to criticise the Mental Health Service were not doing so because of religious loyalties.' Retrospectively Dax did not think these comments clouded his relationship with one of his most able Superintendents, Dr. John Cade, an active Catholic who pioneered lithium therapy (initially used to counter manic excitement). But they probably didn't help, especially in the highly charged atmosphere of the early– to mid–1950s when sectarian tensions split the Victorian ALP and its union powerbase.	7
His more immediate concerns were to scrub the smell and dirt from over 150 wards throughout Victoria's mental hospitals and training centres, and curb the excesses of some of his medical officers whose enthusiasm for new drug therapies he viewed with some alarm. Working through journalists such as Bill Tipping of The Herald as well as other interest groups, he battled under-funding and political apathy, gaining unprecedented government support for upgrading the amenity of institutions and broadening the services and treatments available to patients.	8
Aided by economic good times, he improved run-down facilities, and restored faith, hope and charity to demoralised mental hospital staff. He established Victoria's first coordinated network of community mental health clinics and encouraged the activities of mental hospital auxiliaries and non-government organisations—fulfilling a plan to progressively move the care of people with mental illnesses out of large institutions, provide first-rate community-based care, and involve Victorians in the process. He also established Australia's first mental health research institute, strongly focused on social, cultural and epidemiological studies and, in one of his more controversial stands, opposed Victoria's then burgeoning Scientology movement.	9
Senior staff applauded his dynamism but quaked at his occasional autocratic outbursts. Those who stood their ground rather than appeased him seemed to get on better in the long-term. Many were also sceptical about his pet projects, which included art therapy and leucotomy, two starkly different modalities that indicated his eclectic attitude to causes and treatments of mental illness.	10
He was not a fighter for patients' rights in the modern sense of the term, working in an era where psychiatrists made diagnoses and ordered treatments with little regard for recipients' views. But he challenged many ingrained community attitudes to the mentally ill and intellectually handicapped, stimulating wide-ranging public discussion. In so doing he exposed prejudices and promoted a more optimistic outlook about the prospects for improvement or recovery of former institutional 'inmates.' His attitude to staff was similarly top-down and some complained that he micro-managed, even to the extent of ordering the seating in one mental hospital cafeteria to be re-arranged in a more casual way.	11
The scope of his achievements gained him a national and international profile, attracting many visitors to Victoria, and involving him in consultancies within Australia and overseas, including several for the World Health Organisation. Acknowledged as a leader in psychiatry, he gave the Beattie Smith lectures in 1954, lobbied for the creation of Victoria's first chair in psychiatry at the University of Melbourne—established 1963—and presided over the Australian and New Zealand College of Psychiatrists the following year.	12
On turning sixty, he accepted a position as Co-ordinator in Community Health Services with the Tasmanian Mental Health Services Commission. It was a productive time, with Dax writing many reports, and acquiring an interest in the history of psychiatry, about which he later wrote a number of papers. On returning to Melbourne he developed the Cunningham Dax Collection, often spending two days a week sorting and classifying the thousands of art works created by people with mental illness and/or psychological trauma he had collected in Surrey and Victoria. He was also appointed a Senior Associate in Medical History at the University of Melbourne. In 1985 he was awarded an AO for services to psychiatry.	13
During the last dozen or so years of his life, I interviewed him on many occasions about the intertwining history of psychiatry and the mental health system in Victoria, often in his own home. Unlike Bradman, he did not become reclusive in his twilight years, nor wary of people who might attempt a dispassionate analysis of his legacy. Although sound in mind, he occasionally admitted to 'pin-pricks' when confronted with evidence of awkward incidents that had slipped his memory. He enjoyed mixing socially and was a frequent contributor at Medical History Society of Victoria meetings and ASMR conferences, which he attended regularly.	14
Dax expressed the hope soon after arriving in Victoria that 'mental hospitals in their present form' would disappear because of effective emotional and social re-education of patients, new treatments, and improved methods of rehabilitation. A revolution of sorts came to pass during the 1980s and 1990s when successive state governments closed all of Victoria's large mental hospitals. But the lack of adequate offset facilities, particularly hospitals for the acutely mentally ill and residential accommodation for those with intellectual deficiencies, greatly concerned him.	15
In 2005 he wrote to newspapers complaining about the dismantlement of the state's mental health system and calling for a judicial enquiry into the sale of public lands surrounding the Kew Cottages that would examine 'what has happened to the large amount of money obtained in this way.' Although an enquiry did not eventuate, the Upper House of the Victorian Parliament voted in 2007 to establish a Select Committee to enquire into the sale and development of public lands, particularly at Kew Cottages. It proved to be one of the last political achievements of an extraordinary change agent, a man who altered the course of mental health care in Australia during a formidable innings. ANN WESTMORE UNIVERSITY OF MELBOURNE	16

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