Main, Thomas Forrest (1911-1990)

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Thomas Forrest Main, a British physician, psychiatrist, and psychoanalyst, was born on February 25, 1911, in Johannesburg and died on May 25, 1990, in London. He graduated in medicine at Newcastle on Tyne in 1932 and was proud of his Geordie (Newcastle) background. He qualified for the MD in 1932, receive the MD in 1934, then turned to psychiatry (DPM, 1936), and at a very young age became a consultant psychiatrist.

Main, one of the new generation of psychiatrists selected by John R. Rees, had a brilliant war career. To understand the stresses of war, he made parachute drops and went to the front line in France. In the training of soldiers, he condemned artificial attempts to stimulate hatred of the enemy, and he investigated the maintenance and loss of morale. He worked in the Eighth Army in the desert and in the twenty-first army group before the invasion of France. It was said that he and Field Marshall Montgomery could not get along with each other.

As a lieutenant colonel, Main was a senior figure at the Northfield Military Hospital, where he was a colleague of Siegmund H. Foulkes and Harold Bridger. This was at the time of the second Northfield experiment, the first having been that of Wilfred R. Bion and John Rickman. Main's famous paper ("The Ailment," 1957) stated that the hospital as an institution should study its own processes, thereby enhancing its therapeutic powers and recognizing its antitherapeutic aspects.

After the war Main became director of the Cassel Hospital for Functional Nervous Disorders and was responsible for moving the hospital close to London. He had two motives for doing this: First, patients should not be isolated from family and society, and second, staff should be close to London to avail themselves of psychoanalytic training. He himself had analysis with Michael Balint, and his supervisors were the grandes dames of British psychoanalysis, Anna Freud and Melanie Klein.

The hospital treated a wide range of neuroses and personality disorders and, under Main, began to treat mothers who had become psychologically ill after childbirth. Main pioneered admission to the hospital of mothers with their babies, later with their older children, and eventually with husbands and the whole family.

Famous for his concept of the therapeutic community, a term that he originated, Main was especially skilled to hospital dynamics and psychosocial medicine. "The Ailment," reflected his observations on patients who engendered splitting and projective identification in the staff. Main was also a fine teacher and supervisor. Following Michael Balint's example, he led many Balint groups for family doctors and later developed Balint-group techniques for professionals treating sexual disorders. He founded and became the first president of the Institute for Psycho-Social Medicine.

A member of the British Psycho-Analytical Society, Main always maintained a psychoanalytic practice. Though he was not drawn to group-analytic psychotherapy, he appreciated the work of both Siegmund Foulkes and Wilfred Bion and wrote a classic paper on large-group dynamics. Another field that he explored was short-term psychotherapy, again collaborating with Michael Balint in a study eventually described by David Malan (1963).

Main, an important link between psychoanalysis and psychiatry, was active in the Royal College of Psychiatrists, of which he became vice-president. He was disappointed, however, that he did not become president, as he somewhat overoptimistically hoped and believed that he could help develop a psychodynamic psychiatry in Britain.

Fortunately, before his death his daughter Jennifer, herself a psychoanalyst, collected his papers in a book (1989). Main died from a carcinoma of the colon on May 25, 1990. His wife Molly, also a psychoanalyst and child psychiatrist, died in London in 1999. Two of their four children followed them into the field of psychiatry.

Malcolm Pines

See also: Great Britain; Tavistock Clinic.


Hayley, Thomas T. S. (1991). Thomas Forrest Main, 1911-1990. International Journal of Psycho-Analysis, 72, 719-722.

Main, Thomas F. (1957). The ailment. British Journal of Medical Psychology, 30 (3), 129-145.

. (1989). The ailment and other psycho-analytical essays. London: Free Association Books.

Malan, David H. (1963). A study of brief psychotherapy. London: Tavistock.