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Tuesday, June 30, 2015

The Making of a Child Psychiatrist (2)

I was not particularly aware of it at the time, but I must have been both a bright and a confident child.  In primary school this was seen as a problem, and led to several punishments. As an example, in third year (aged 7 in 1951), our teacher left the classroom for several minutes to get supplies or perhaps go to the toilet. The class gradually became more and more noisy, and I (self-proclaimed leader) stood and tried to get everyone to quieten down. When this did not work, I climbed onto my desk (presumably to give myself authority) and shouted to everyone to be quiet. At that moment the teacher returned, and it appeared that I was the one making all the noise. I was taken to the headmaster for a reprimand and subsequently, laying across his lap and having my short trousers pulled up, I was spanked several times on the upper thigh in front of the whole school. Maybe I was hurt (I may well have cried) or mortified. I cannot remember whether I told my mother, but I am fairly certain that it was never discussed between her and the headmaster. Home was home, and school was school. It left some sort of a mark on my thigh (and maybe on my psyche), but it did not stop me; I continued to be somewhat bumptious with an apparent disdain for authority.
I can remember two later occasions when I was punished with a slipper for being part of some ruckus in the playground. There was also an occasion when I was 10 when I got the cane on the palm of my hand a couple of times. It must have been school based behaviour, but I cannot remember what. Being noisy and bumptious probably. Despite all of that, I was in a competitive high achieving small group in the senior class, and always seemed to do well without much effort. Ultimately I passed the Eleven Plus examination, and was offered a place at Chatham House Grammar School in Ramsgate.
I suspect the confidence came from being an only child up till the age of 7. My father was in the RAF, was rescued off the beaches at Dunkirk in 1940, survived the war, and decided to continue his service career post war. Ten months after I was born in 1944, he was posted to Egypt, and did not return until I was 4 years old – an immense shock to my system (but more of that later). So I had my mother to myself. After her mother Louie (née Barrett) died in 1945, she had moved from Feltham, Middlesex to Kent, and we took up residence in the top two stories over a photographer’s shop (affectionately known as Charlie Pearce’s), in Cuthbert Road. This backed onto the railway and the local station, and began an early interest in trains. The narrow stairwell was lined with brown linoleum, and I can remember the smell to this day, as well as the sound climbing those stairs.
There was a baker at the end of the block. The smell was always enticing, and the visits enthralling; I can remember the oven, and the heat, and over the years developed a special relationship with the baker and his family – which always led to extra small rolls. Coming home from there one day, I have a visual memory (from about the age of three) of an older gentleman who stopped my mother for a brief social chat. On parting, he patted me on the head, made a friendly comment, and then waved from a few yards away. I poked my tongue out, and was soundly told off by my mother.
Again, I can see an emerging attitude of refusal to accept older male authority. And I can see that in my career. It has always taken me a time to get used to males in authority, and I am sure I have been at times resistant, at times difficult, and at times rude. I am sure psychoanalysis would say I suffered from an ‘Oedipus Complex’, wishing to own my mother, and wanting to kill my father for being in the way. I am sure I did not have such wishes at the time of his return, but I know there were times later in early adolescence when I was angry enough to have such thoughts. Of course to have such thoughts invariably leads to self-doubt and depression. I can certainly remember these from time to time, but have always thought of them in retrospect as my ‘4% Syndrome’.
Let me explain. At the end of my first year at Chatham House, I had topped the class. The maths teacher, a Mr. Jacobson (‘Jake’ to the boys) called me into his room and explained that not only had I been good at Maths, but also he had given out marks for good behaviour during the year and in total I had scored 104%. He explained with his slight speech impediment: “Of course the headmaster, even as an English scholar, will know there is no such quantity as 104%. So I have decided to reduce your mark down to 96%. You will still be top of the class. You will still get the prize for mathematics for 1st year. I hope that is OK?” So, what do you say at 12. “Yes Mr. Jacobson. Thank you Mr. Jacobson.”
All the way home on the bus from school, I had a pleasant sense of achievement. I smiled rather frequently to myself. When I arrived home, I raced through the house and found my father: “Dad, dad, dad, I got 96% for Maths...” to which he responded: “What happened to the other 4%?” Well what can you say? It is rather lame at that point to try and explain the whole conversation and context. I was crestfallen.
Of course this is what can be called a ‘screen memory’ – the archetypal memory which draws on all those prior occasions when I was not quite good enough, had not achieved enough. Again this is very Oedipal. However, I am convinced that it led to my constant need for achievement over the years, my never being satisfied with my own achievement, and my sometimes deep despair when I believed I had ‘failed’.

More to come...

Monday, June 29, 2015

The Making of a Child Psychiatrist (1)

The Making of a Child Psychiatrist (1)
Chapter One: Earliest Days
I have always been fascinated by people; how they get to be who they are and what makes them manage their lives in the way they do. From the age of 12 I went to a grammar school in Kent, and had to travel by bus from Westgate on Sea to Margate (about 3 miles), changing buses at Margate Harbour to get to Ramsgate (about 5 miles), the whole trip taking about an hour. Most people look out the window and admire the never changing view, or they bury themselves in a book. I watched people as they got on the bus and found their seat, settled into temporary relationships with the person next to them, or continued a conversation from earlier on with a loved one. I wondered who they were, and fantasised about their lives. Why were they laughing? What had made them angry that morning? What were they feeling when they reached up to a partner’s hair, tucking it under a woollen hat? Of course there were some young people travelling the same bus, but I was less interested in making relationships and friends than observing strangers. This has probably continued throughout my life, and although I believe I am a friendly caring person, and have good relationships with probably hundreds of people, I have not been able to make many close enduring friendships over the years. I am an observer.
Unlike many young people who often completed homework by the end of the journey, I could never bring myself to do that on the bus coming home. On occasion, I might have been reading an enthralling book, but as soon as someone got up to get off the bus, I would be distracted, look up to watch them manoeuvre, and my inner questions would begin. We might make eye contact, and I would smile, or nod, or answer a question; I was never shy. But it was not about making a relationship; it was about my questions.
From week to week, the same people would travel the same route, and I began to see change in them, or their relationships. Sometimes I might see a bandage or sticking plaster (bandaid), or note a lump or a bump. I can remember distinctly noticing a swelling in a middle aged and somewhat obese woman’s neck, and wondering why that had happened, and why she was a bit ‘dithery’ - slow and confused. In retrospect, this was my first awareness of a goitre, something that was to fascinate me about 10 years later during my medical training. I now know that I probably had a heightened unconscious awareness of the problem, given my mother had her goitre about a year earlier in my life. The details I was given about my mother were sparse, yet somehow they had prompted me to take note in another slightly older woman.
There was another strand in my life that began early. At about the age of 12, I had an ingrowing toenail which festered on despite baths and local treatment, and wearing sandals. I got taken to our general practitioner, a Dr. James Turtle, who lived in a big house with a surgery purpose built to one side. The driveway was circular and, parked in front of this mansion, was a large Jaguar car. You don’t know how impressed you are by such wealth, but I am sure I was. I was not overwhelmed though, and after Dr. James had had a look at my toe and its nail, he pronounced that it would only heal if the toenail was removed. My mother nodded; I don’t remember if she was anxious or not. So, Dr. James suggested I lie back in my school uniform and short trousers, while he went to work. I asked if I could watch, and with a slightly amused perturbed look he suggested I might faint. I denied this with confidence, not knowing what was to come. I watched in awe as he stuck local anaesthetic either side of the base of the toe (I now know this was a ‘ring block’), and we waited for it to take effect. When it was totally numb, he pushed a spatula down under the nail to the base, slid it from side to side and, deftly with a pair of forceps, removed my poor nail. I watched fascinated at the total lack of pain, and asked him where he had learned to do that? “At medical school;” he replied, “that’s where you get taught all the basics about becoming a doctor”. As I hobbled to our car, I said to my mother: “I am going to become a doctor”. I guess she would have smiled benignly, and I can’t remember either encouragement or denial. Was it the surgery, the fascinating knowledge, or the grand house and car? Whatever, the stage was set.
Within the next year of my thirteenth birthday, we gained a black and white television, a great square lump of furniture that sat grandly in the lounge at home. Every chance I got, I asked if it was OK to tune into medical programs. “Emergency Ward 10” (which ran from 1957-67), and was consumed twice a week.  “Dr. Kildare (from 1961-66)” in which his boss Dr. Leonard Gillespie told Kildare: "Our job is to keep people alive, not to tell them how to live", advice ignored through the series as they worked on physical and emotional problems. “Ben Casey” (from 1961-67) was another favourite about a young surgeon learning about neurosurgery. In have to say that I was lucky in that my mother was equally interested in the weekly diet, and it did not take much persuasion to switch on ‘the box’. Do these kinds of programs influence young minds? Or do you need to be fascinated by bodies and people in the first place? Or is the question of the chicken and egg academic variety?
More soon...

Haiku on Pace/ Goal/ Side/ Wind/ Fright & Warm


So close to my heart
You set rhythms to my days
Pacemaker lover

He took one more pace
Enfolding her in his arms
The audience gasped

Living mindfulness
Requiescat in pace
The mind gentles down


Mountain has a goal
Outlive these mindless creatures
Sitting stony faced

Goals are for sportsmen
Wishful thinking is the norm
Ordinary folk

They took turns with dice
A six would give him his goal
Her jade doorway key


The old side of beef
Gone out of fashion today
Too much fat and bone

Always on your side
Even when I know you're wrong
Love does some strange things


Joke to wind you up
Your impassive face suggests
My timing was wrong

The North wind doth blow
What will the robin do then
Why, play in the snow

Bad case of the wind
A public embarrassment
Just need to pop off

Fright & Warm

The fright of my life
A warm puddle on the floor
Oh dear, was that me?

Gave her such a fright
When she fell into the pond
Retrieved wet and warm

A fright night special
Warm blood dripping through ceiling
Calling the Bones team

Sunday, June 14, 2015

Haiku on Yesterday/ Hide/ Together/ Effort


Yesterday's small girl
A confidant young woman
Taking on the world

Dying to be loved
Yesterday's abused children
Today's statistics

When will I know all?
And the oracle answered
Yesterday, my dear


Hide your true feelings
And they may never return
In such purity

Playing hide and seek
The child crawled under the bed
To return next day

That man has such hide
Twisted manipulator
Thinks we'll vote for him


In the global war
Together we will conquer
Divided we fall

Clouds fuse together
Cumulonimbus piled high
Birds have gone quiet

Surprising moment
Thoughts concluding together
Pinky linking time


Why hurt one person?
With a little more effort
You can stir nations

A hard day's living
Waking up, breathing, eating
Such a big effort

Walking the forest
Unpicks jumbles in my mind
No effort at all

Sunday, June 7, 2015

Haiku on Light/ Recover/ Blend/ Penultimate and Others


The light shined on us
This Christmas celebration
Best of everything

Love light in your eyes
Everything comes down to this
Best of responses

A year of the best
Everything fell into place
Lighting the pathway


Never recover
Gather energy, adapt
Move on, different

Recover from food
And excessive alcohol
New Year's Eve beckons

Favourite armchair
Recovered in a new style
Never quite the same


No pure black or white
We're all genetic mix ups
Unique colour blend

Blueberries and ice
Yoghurt and coconut milk
Morning smoothie blend

You speak my dark thoughts
And wash them in laughing light
Unique blend of love


Counting down from 10
Penultimate second reached
Time stopped forever

Watching the mirror
Saw penultimate hair drop
Baldness one away

The latest laptop
Pen ultimate replacement
Thought transfer is next


Enjoy family
And your home environment
Travel brings dangers

Sloves gyred and gymbled
Dyslexic Jabberwocky
With small contraction

You solve one problem
And create another one
Someone's Law, maybe?