IELTS Academic Reading Practice Test 399

York in the late eighteenth century was home to a prosperous community of Quakers, members of the Society of Friends. Among them was William Tuke, born in 1732, who made his living as a tea and coffee merchant and who had never studied medicine. In middle age he became increasingly troubled by the treatment of people with mental illness.

Those who could not be looked after at home were confined in private madhouses or in the county asylum, institutions whose main purpose was to remove them from public view. Restraint was routine, and in some establishments, including Bethlem Hospital in London until 1770, visitors were encouraged to stare at the patients as a form of entertainment. As dissenters, Quakers were excluded from the universities and from most public offices, and their energies went instead into business, philanthropy and the running of their own meetings.

The crisis came in 1790, when a Quaker woman named Hannah Mills died in the York Lunatic Asylum, an institution founded in the 1770s. Members of the Society of Friends had long been uneasy about conditions there. A patient who entered the asylum could expect to be cut off from visitors and letters, and the death of Hannah Mills convinced many in the community that the place was not merely grim but dangerous. Complaints were made to the asylum's governors, but they produced no change.

Tuke proposed that the Quakers build a hospital of their own, one in which kindness rather than confinement would be the organising principle. Some members of the Society hesitated over the cost, but subscriptions were raised and land was bought on Lamel Hill, a short distance from the city centre. The Retreat opened in 1796. It was a modest building, intended for a few dozen patients, with gardens in which they could walk and work, and it was deliberately planned to look like a large house rather than an institution. Tuke and his supporters were convinced that a very large establishment could not provide individual care.

Everything about the design was intended to avoid the appearance of a prison. There were no bars on the windows and patients were not locked in their rooms. The house was run as far as possible like a large family: there were shared meals, a garden, and work in the kitchen and laundry. Patients wore their own clothes rather than an institutional uniform. Tuke believed that the surroundings were themselves part of the treatment, and that a person who was treated as a reasonable being would behave more reasonably.

Restraint was not abolished altogether, but it was used rarely, only as a last resort, for short periods and under the supervision of staff. The guiding principle, which became known as moral treatment, was that patients should be treated with respect and encouraged to govern their own behaviour. Religious reading and reflection, quiet conversation and regular occupation were all part of the regime. The staff, who were called attendants rather than keepers, were expected to be patient and even-tempered, and to know each patient as an individual.

The work was continued by Tuke's son Henry and by his grandson Samuel, whose Description of the Retreat appeared in 1813. The book was careful and factual, giving detailed accounts of individual cases, a description of the building and statistics on recovery. It was widely read, and it made the Retreat known far beyond Yorkshire. Samuel Tuke was also a shrewd publicist: the account presented moral treatment as a coherent method rather than a collection of kindly impulses, and it gave readers a vocabulary with which to argue for reform.

Meanwhile the reputation of the York Lunatic Asylum had collapsed. In 1813 a local campaign, supported by the Tuke family, forced the asylum's affairs into public view, and a committee of inquiry was appointed. Its findings were sensational: patients had been neglected, beaten and, in some cases, left in chains for years. The contrast with the Retreat a mile away was impossible to ignore, and the scandal did more than any treatise to convince the public that the treatment of the insane was a matter for urgent reform.

The idea of moral treatment travelled. In Paris in the 1790s the physician Philippe Pinel was famously depicted removing the chains from patients at the Bicêtre hospital, and his writings and Tuke's were read by the same reforming generation. Quaker communities in the United States founded institutions modelled on the Retreat, and visitors came from Europe and North America to see it for themselves. By the middle of the nineteenth century the principle that an asylum should be a therapeutic place rather than a place of confinement had become orthodox.

Yet the approach had limits its founders did not fully acknowledge. The Retreat was small, generously funded and, in its early years, admitted mainly patients who could pay. Its staff knew every patient by name and had time to give them. As public asylums grew into vast institutions holding hundreds or thousands of people, moral treatment became impossible to sustain, and the words survived long after the practice had gone. The Retreat itself still operates as a mental health facility in York, and its early records remain one of the most detailed sources available to historians of psychiatry.

The human brain is divided into two halves, or hemispheres, which look almost identical but are not interchangeable. For much of the nineteenth century, neurologists wrote of a dominant hemisphere, usually the left, and a silent partner that contributed little of importance. That picture has since been replaced by a more interesting one. The two sides specialise in different tasks, and the value of the division of labour lies in how the results are combined. What makes the combination possible is a thick band of nerve fibres running between the hemispheres.

The band is the corpus callosum, which contains roughly two hundred million nerve fibres. Its task is to carry messages in both directions, so that what one hemisphere learns is rapidly available to the other. Because it lies deep in the brain and is hard to study in a living person, much of what is known about it comes from medicine rather than from laboratory experiments. In the middle of the twentieth century, surgeons began to cut it, or parts of it, in a small number of patients whose epilepsy could not be controlled by drugs, on the reasoning that a seizure spreading from one hemisphere to the other might be stopped by a physical barrier.

Language is the most strongly lateralised of human functions. In more than nine out of ten right-handed people, and in the majority of left-handers, the areas that produce and understand speech lie in the left hemisphere. The first evidence came from patients who lost the ability to speak after a stroke. In 1861 the French physician Paul Broca described a patient who could understand almost everything said to him but could utter only a single syllable; after the man's death, Broca found damage in a particular part of the left frontal lobe. A few years later, in 1874, the German neurologist Carl Wernicke linked a different kind of language failure, in which speech is fluent but meaningless, to the left temporal lobe.

The right hemisphere is not silent. It takes the leading part in visuospatial attention, in recognising faces and in appreciating the tone and emotional colouring of a voice, an aspect of language known as prosody. Damage to the right side can leave a patient unable to attend to the left half of space, so that a person shaves only one side of the face or reads only the right-hand half of a page; it can also make someone unable to tell whether a remark was friendly or sarcastic. Such difficulties are easy to miss in conversation and hard to live with.

The split-brain patients made the division of labour visible. In the 1960s the American psychologist Roger Sperry and his colleague Michael Gazzaniga devised a way of showing an image to one hemisphere only, because the visual pathways cross over. When a picture of an object was sent to the left hemisphere, the patient named it easily. When the same picture went to the right hemisphere, the patient insisted that nothing had been shown, yet the left hand could pick the object out from a set without hesitation. The two sides, it seemed, could hold different knowledge at the same moment.

In an intact brain the exchange is continuous, and most activities recruit both sides. Reading aloud, for example, involves recognising the printed word, connecting it to sound and producing speech, and although the language areas are on the left, the right contributes to the visual and attentional work that surrounds them. Imaging studies show both hemispheres active in nearly every task, though to different degrees. Dividing the work may have advantages of its own: if the two sides process different aspects of the same input simultaneously, the brain can analyse a scene in parallel rather than in sequence.

Why the brain should be lateralised at all, and why language in particular ended up on the left, remain open questions. One proposal is that concentrating a demanding skill in one place avoids unnecessary duplication, and that the benefits of speed and efficiency outweigh the risk of losing everything to a single injury. Another is that the arrangement is a by-product of other pressures. The difficulty is that the brain leaves no fossil record of its internal wiring, and comparisons with other species offer only indirect evidence; even handedness, which ought to provide clues, is only partly understood.

Whatever the explanation, the pattern is not fixed at birth. A small number of children with devastating epilepsy have one hemisphere removed, and many of them go on to develop language and attend ordinary schools, particularly if the operation is performed early. This does not show that the hemispheres are interchangeable; the remaining side takes over the work with effort, and some abilities, especially those involving fine spatial judgement, are usually weaker afterwards. But it does show that the lateralisation observed in adults is the end point of a long process of development rather than a blueprint fixed in advance.

None of this supports the popular notion that people are left-brained or right-brained. The labels survive in quizzes and in advertising, where the logical, analytical left and the creative, intuitive right are used to explain personalities, career choices and learning styles. The research offers no support for such claims: both hemispheres are engaged in almost every activity, and how a person thinks or behaves cannot be predicted from the relative activity of the two sides. What the two sides do, and how they combine their efforts, is a far more interesting question than which of them is supposed to be in charge.

For most of the twentieth century, psychotherapy meant two people in a room. The arrangement was not accidental: the room provided privacy, a fixed hour and a physical separation from ordinary life that many clinicians regarded as part of the treatment. Since the 1990s, however, a growing share of psychological therapy has been delivered at a distance, first by telephone, then by video link, and now increasingly through typed messages on a screen. The change accelerated sharply during the pandemic, when many clinics closed their doors. The question is no longer whether remote therapy will form part of mental health care, but what it can and cannot do.

The strongest argument for remote work is access. A therapist who can be reached without a two-hour journey can serve people in rural areas, those with physical disabilities, parents who cannot arrange childcare, and patients for whom a crowded waiting room is itself an obstacle. In countries with severe shortages of trained clinicians, the hours saved by not travelling benefit both sides. Remote sessions also cost less to provide, since no consulting room is needed, and they make it easier for a patient to keep an appointment during a working day. For people who would otherwise receive nothing at all, this is not a small gain.

The evidence is strongest for structured, manualised treatments, particularly cognitive behavioural therapy, delivered online with some support from a clinician. A large number of randomised trials, and several systematic reviews of them, have compared internet-delivered CBT with face-to-face treatment or with waiting lists, and for common conditions such as depression and the anxiety disorders the outcomes look broadly similar. The picture is much less clear for complex difficulties, including severe personality disorders, psychosis and trauma affecting young children; these are precisely the cases in which subtle, moment-to-moment judgements matter most, and in which the research base is thin.

Critics once argued that a therapeutic relationship could not survive the loss of physical presence. The evidence on this point has been surprisingly reassuring: studies that measure the working alliance report that patients rate the bond with a remote therapist much as they do in person. But measurement may flatter. A typed exchange strips out tone, hesitation, posture and silence, and a message sent at midnight may be read by a therapist who is not there to notice how it feels. Some things are lost, even when they are hard to count.

The most serious worries concern risk. A clinician assessing a patient who mentions suicidal thoughts relies on more than words: on how the person looks, on the possibility of stepping in, on knowing who else is in the building. Working remotely, the therapist must ask directly about the patient's whereabouts and who is with them, and must have an address and a second contact number before the session begins. Domestic violence raises a different problem, since home may be the least private place the patient has. Services that have thought carefully about these questions build the answers into their procedures; those that have not may be dangerously unprepared.

Privacy cuts both ways. A video platform that records sessions, or a messaging service owned by a commercial company, creates risks that a consulting room does not. Meanwhile the assumption that everyone has a quiet room, a reliable connection and a device is false. Older patients, some disabled people and those in poorer households are less likely to be online at all. Telephone work, unglamorous as it is, often reaches people whom video cannot, and should not be treated as the poor relation of digital care.

There is also a commercial pressure that did not exist a generation ago. Hundreds of apps now offer what they describe as therapy, some of them with no clinician involved. A few have been tested in trials; many have not, and the companies that sell them have little incentive to publish results that disappoint. Regulators have begun to classify the most sophisticated products as medical devices, which is a sensible step, but an ordinary user is still poorly placed to tell a validated treatment from a well-designed interface.

My own view is that online therapy should be offered as one option among several, and that providing it is a matter of justice rather than convenience. A service that insists on face-to-face work when it cannot supply enough of it is not being rigorous; it is rationing care to those who can travel. But a service that quietly substitutes screens for people in order to reduce costs will do harm that its waiting-list figures never show. Remote work should be funded properly, evaluated honestly and withdrawn where it does not help.

That means triage rather than ideology. Some patients should be seen in person from the first session; others may do better with a mixture; many will do well entirely at a distance. The task is to decide which is which, and to make the decision with the patient rather than for the patient. A technology that widens access is worth having. A technology that becomes the only door is not therapy at all; it is a queue with a screen in front of it.