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Monday, August 31, 2015

Making of a Child Psychiatrist: (18) Back to School...

I had many reasons to admire this person who was two years older, and much more mature. Of course he was wiser, but there was a strange sense of humour attached to that. He claimed to have done all these naughty things in addition to smoking and drinking. So at some stage a story and photo appeared in the local newspaper related to a brassiere that had appeared on the flagpole above a convent. Fred claimed that he had climbed across a glass roof to do the dirty deed, and we all thought it was terribly funny. Did nuns wear brassieres in those days? I have no idea. Somewhat later he created a stuffed effigy of a person and hung it by the neck from a telegraph pole on a back road out of Ramsgate. Again it attracted a lot of press attention. And at the time, I thought it was terribly funny, not really considering the cost of the emergency services called out to take it down, or thinking there might have been traumatising implications for any one who had been touched by suicide. Such thoughts were to come many years later when I found myself on a career path of suicide prevention. At the time it was just one of Fred’s larks.
On another occasion, one that I actually witnessed, he had placed a wire under a dog’s leash and collar to make them retain their shape, and then walked down Westgate’s Station Road, pulling ‘the dog’ behind him, and talking to it as if it were there, telling it off for wanting to stop and sniff lamp posts. Passers by were befuddled. We struggled to keep our faces straight. There was a thought that some elderly person might approach Fred and say: “Excuse me young man, but I think your dog may have run away.” But it didn’t happen.
We plotted. There was an hysterical conversation over bridge one afternoon, with fellow conspirators, about what might happen if we put washing powder soap flakes in the town’s large open fountain down near the harbour. We had a discussion about fluorescein and the wonderful colours it might make in the fountain. I thought that was a marvellous idea, and tried it out in the well-stocked fish tank in the Biology Lab. It caused a very pretty effect with the late afternoon shining through the window behind it. Of course the next morning there were problems with several fish floating on the surface of the tank, and an irate biology master, Mr. Bob Bateman, who reprimanded me thoroughly, gave me a couple of detentions, and demanded I use one of them to clean out the fish tank ready to be restocked. How come Fred could get away with a Bra on a convent roof, and fake dead bodies on telegraph poles, and I could not get away with a few drops of fluorescein in a fish tank? Again, like the portable bus stop story from 2 years before, a reminder that I was unlikely to get away with anything slightly naughty in life.
Of course we discussed my progress with Freud, and Fred would look quietly all knowing when I dropped some naïve clue to my unconscious. We would then argue about whether his interpretations were accurate or not. I was younger brother, student of psychology, and an analysand rolled into one. And I was having fun beginning to understand bits about my self, from my dreams and from occasional slips of the tongue, or trying to recall past events about which I had been told but could not for the life of me recall.
Of course there was a different side to the relationship. Fred and his girlfriend Rosemary invited us to the odd party, and we invited them to the cinema and to my 16th birthday party, catered by my mother, and alcohol free (sort of). The idea was to invite a number of couples, and dance the night away in the front room of our semi-detached. Memory says there were about 7 or 8 couples, some from school, some from drama club. My new record player ran hot all evening, a dining room table covered in food was emptied, the carpet was mightily scuffed as we jived away, and I have a vivid memory of somewhat later when all the lights went out, with the rustlings and sotto voce moans. Of course it came to an end when my parents returned from wherever they had been. Lights went on, and red-faced snoggers had to straighten clothing and pretend it was all pure. Somewhere, I have three or four not very good black and white photographs taken with a flash. Or perhaps I just have a strong visual memory.
We repeated the party idea just before Christmas 1961, but this time at the hotel owned by Jan’s parents. It had been empty since the end of the season in September, and Drama Club had been meeting there regularly. Jan’s parents were away, but had given permission for the drama club to have fun. The dining room floor of the hotel was perfect for dancing. We organised some drinks and a light supper, and invited everyone we could think of – probably about 30 people – including Fred and Rosemary. Unfortunately, someone had told a friend who told another friend that there was going to be a teenage party in a hotel on the sea front. What was unfortunate, was that the friend lived in London, and had organised a coach to bring a load of slightly older young people to stay at the hotel, and party. They brought alcohol, and we are sure they brought Marijuana. We met the group at the front door, trying to be strong in our rejection, and using the excuse of a private party. We were overruled and overwhelmed, and this group of unknowns took over. What was left of the food and drink disappeared rapidly, and somewhere around 1am we managed to get the music off. Most of our friends all went home, but the strangers took over the 12 bedrooms upstairs (in various combinations), finding themselves bedding from various cupboards. We retreated to the family end of the hotel downstairs and had an uncomfortable night pondering how to get the hotel back into some sort of shape before Reg and Bobbie returned from London.
The unwanted guests got on the road early, and our morning clean-up began. It was frenetic, helped by a small group of our close friends who had stayed, in support. We were freaked at the state of the place. We stripped beds of soiled linen, tidied as much as we could, hoovered floors. The kitchen had been raided very early, and the fridges and every container had been emptied of anything resembling food. We actually had a laugh at this, given that Reg and Bobbie, at the end of the season, tended to just leave the place, and take a break before beginning to spring clean for the new season. So some of the biscuits and cake, for instance, would have been some months old. We never did really find out who the unwanted guests were, where they were from, and who had been kind enough to invite them. But it was an awakening of sorts to some of the world of the 60s we were to experience a bit later when we ourselves moved to London.
It was also part of an awakening to our own sexuality. I had had strong yearnings, and wanted very much to be close to Jan. I had thought this might be an opportunity. These older more experienced strangers clearly paired off, and were involved in activities about which we could only fantasise. They had ruined our somewhat naïve young person party, but they had also created problems which messed up the evening; particularly my tentative plans based in yearnings and fantasies. We were confronted by the reality of their activities, and forced to talk about the results, but it sent shock waves of disgust, mixed with wry amusement, through Jan and her sister and their close friends who were there.

More later…

Sunday, August 30, 2015

Making of a Child Psychiatrist: (17) Back to school...

I am not sure where Fred had obtained it, but the book he lent me was Freud’s ‘Psychopathology of Everyday Life’ in a Pelican paperback edition, slightly dog-eared suggesting it had been well used. He made it clear that I was to give it back ‘on pain of death’; and I did… eventually.
The book is not easy to get into. Despite my voracious reading habits and my by now extensive vocabulary, many of the words were difficult to pronounce in mind, the concepts difficult to grasp, and the context (Vienna and Europe at the turn of the century) was foreign (if you will excuse the pun). But the ideas were fascinating, mind-boggling, and thought provoking. My current personal version of the book (bought about 5 years later) is now yellowed with age, dog-eared with several pages turned down, and like many others of my books, it has travelled around the world.
The first important idea it left with this then 16 year old, was that the mind had layers; you could think you were in total charge of your thoughts, but there was this underground river of old memories that could emerge to interrupt (or swamp) your thoughts during the day or at night. It made some sort of sense even then; in two ways. Over the years, I had had some weird dreams that only half made sense, and had troubled me for days. I supposed that in the past I had eventually dismissed them, but this book (and Freud’s ‘The Interpretation of Dreams’ which I was to read about 6 years later) suggested you could discover meaning by allowing the mind to wander, and noting bits of the journey. I began to keep a scribbled diary, on waking from a dream, trying to make sense of myself.
One of the pages still turned down in my own copy of the book relates to how we remember things. I have always had vivid dreams, and Freud points out that this is how most dreams are remembered. But in a brief few sentences, he also noted that many people remember visually (ie in pictures), while some remember as if replaying conversations (so-called ‘auditifs), and yet others remember through feelings or the body (so-called ‘moteurs’). We need to set aside a wider discussion of this for the time being, and that it may well have presaged the ideas I gained from a much later treasured training in ‘Neurolinguistic Programming’ (NLP).
I have always remembered in detailed pictures, and whenever I mentioned this, I had always been looked at a bit strangely. The book helped me to think I was ‘sort of normal’. From memory, my reading the book was not long after a time I was in a Drama Club play for which maybe I had not studied my lines with due diligence. On stage, and in front of an adjudicator, I dried up. In sudden panic, I found myself visualising my copy of the play, ‘saw’ the right page, mentally scanned down the lines, found my place and the missing lines, and began to speak. I am sure it was obvious to the audience, but I felt I had managed to cover my tracks. It was mentioned in adjudication, but not severely marked down. When I told a few people later about my embarrassing experience, and the way I had recovered, I got some very weird looks, a marked lack of response, and a rapid change in the conversation direction. I was left perplexed  - until I found this little gem in Freud’s book. So, I was OK; I was not as odd as I had come to believe. Nevertheless, I had the nouse to realise that my little report seemed to make people uncomfortable, so the episode was dropped.
My own thinking was that I wished I had been able to understand all this some years earlier. I recalled an embarrassing episode from when I was aged 11. I had entered a public singing competition at the Lido Theatre in Cliftonville. I had rehearsed a song (which one I have forgotten) with my mother playing the piano, and my parents came along to watch their choir boy with the golden voice, secure in their knowledge I might very well win the prize (I have also forgotten what that was). On stage, with a strange pianist, a jolly compere engaged in me in general chitchat to put me at my ease but, sadly, this had the opposite effect. When the music began, and I came to sing, I had forgotten half the words of a song I knew very well and had sung many times before. I was mortified, and even at that age, wished I could shrivel up and disappear through the stage. I suppose singing is somewhat more auditory than visual, and depends on practice to remember the sequence of words and how they fit with the music. I had not rehearsed enough, was a bit cocksure, and was thrown by the compere. Even to this day, while I can immerse myself in a wide range of music and songs, I have severe trouble remembering more than snatches of a song. Luckily, in general knowledge quizzes, I am usually surrounded by family members who remember every word of every song. Clearly, I was traumatised at age 11. Equally clearly, in retrospect, I could have written out the words on paper, and coloured them to help me remember. If only I had known some of the tricks. Another upshot, of course, was that I have avoided trying to sing competitively, or indeed in public, even though my treble voce matured into a rich tenor, and is now a strong (if elderly) baritone. The other result, was that in my father’s eyes (or perhaps in my perception of what I thought he could have thought), I had failed. The final (and longterm) implication has been that I work extremely hard at all of my public presentations to ensure I am clear, can remember what I am going to say, and have practised assiduously. I am also somewhat obsessive about ensuring that any equipment I am likely to use works well, or I am able fairly quickly to access a substitute bit of technology – all very ‘belt and braces’.
Now, I revel in being able to draw on this visual memory. In daily life when someone has lost an object, or can’t recall the origin of a picture or an object, I find it easy to get a context and pin it down. It pleases those close to me, but I know it irritates others. So be it. Professionally, I have been able to incorporate the visual into lectures, trying to literally ‘paint a picture’ for the audience of my understanding of an issue. More formally, I have actively used images in my Powerpoint presentations. A lot of my training program successes have come from using videotaped example. We will return to this later.
So Fred had begun this dialogue. We discussed the concepts in depth, and at some length, while playing bridge or just relaxing in the prefects’ room. The dialogue also went on in my mind with a heightened awareness of what I might be experiencing. I was hooked. Yes, I had this nebulous fantasy of becoming a doctor, but now it had subtly changed. My new direction was to become a neurosurgeon; someone who could understand the brain and how it functioned, and perhaps have the skills to help others when necessary.

Friday, August 28, 2015

Making of a Child Psychiatrist: (16) Back to School

Sadly, holidays come to an end, and I had to return to school. In retrospect, it might have made sense to continue to study the French language and culture, but the choices had been made, so I settled into my three core topics Chemistry, Biology and Physics with some ongoing Maths and English. I was back into being a librarian and singing in the choir, and school drama and being part of Searle’s House activities. It was the autumn/winter term, so we were back into rugby. The routine set in. My tan, and the smell of garlic, began to fade.
To be truthful, the next two years at school are a bit of a blur, and it is hard to recall detail and sequence. I know I struggled with Physics all the way through, much to my father’s chagrin. I know he wanted to help, and I remember one particular incident where he tried repeatedly to get across the difference between a diode and a triode. Not only could I not make sense of what he was saying, I could not retain the information over time. He became frustrated, and obviously thought I was probably being difficult. He was probably right, and old resentments had marred my ability to be open to his explanations. Unfortunately, then and now I could not get it, and really could not care what the difference was anyway. The disease spread and, unfortunately, there was rather a lot about Physics I found tedious, boring and of no value.
This was nearly my undoing as far as University was concerned. At the end of the two years of being in the sixth form (June 1961, admittedly still only just 17), my results for Advanced Level were a B for Biology, a C for Chemistry, and a lowly E for Physics (a very bare pass). Not stellar, you may think, and the world agreed. I did not gain a place in London, Cambridge or St. Andrew’s. A decision was made for me to repeat 2nd year Sixth to improve my results.
I have always had a tendency to spread myself into a diversity of exciting activities, not focussed on the main game, and this continues to the present day. I would much rather be writing this book, remembering the past, visualizing episodes, and trying to synthesize the whole thing into a coherent narrative, than be writing the other book on the go at the moment. I am writing a book called (for the moment): “The Prevention of Suicide in Young People” which will bring together the thinking behind my 1999 Doctorate and all of the research which led up to it, and subsequently stemmed from it. I think it will be an important book. Given I have dedicated 30 years of my life to the subject, it had better be. But the current book is more fun!
So what were the distractions? Some we have begun to explore. They include ballroom dancing and my associated attempts to engage my life partner to be. Birchington Junior Drama Club was to underpin a lifetime of dabbling in theatre, and the excitement that comes from early rehearsal, later culminating in nights with an audience of the public out front, one night of which was formally adjudicated. But there were other distractions.
One distraction in first year sixth form related to my old problem with an ingrowing toenail. Probably compounded by poor attention to cutting the nail and keeping it in check and the grubbiness which comes from the limited hygiene of the time and my age and stage, there was recurrent infection. This at times limited my sports performance and, several other activities. And, of course, it was painful. Eventually, I was taken to a surgeon who believed the best way to solve the problem was to complete a Zadek’s operation. This was a removal of the sides of the nail, and the sides of the root of the nail, to stop the possibility of the nail curving into the soft skin on the side of the big toes, but also to stop regrowth.
The operation was done under a general anaesthetic at Margate Hospital (which was sad because I had wanted to watch), and after an overnight stay, I was transferred to the Royal Seabathing Hospital in Garlinge. This had been developed in the early part of the century for sufferers of Tuberculosis, and the sleeping arrangements included my being in bed on a veranda with a cage over my foot and leg to keep the bedclothes from pressuring the toe. It was late autumn, and the hospital was literally on the cliffs facing the sea. So the night air was somewhat fresh, and provided good reason not to throw the covers off in the middle of the night. I convalesced for nearly a week, fascinated by the routines of the place, the process of cleansing and redressing my paltry wound, and the banter of the nursing staff. It confirmed something about my future, in a fuzzy kind of way. However, it did take me out of school, and gave me an excuse to be poorly and of course unable to study. It later curtailed some of my rugby training, and PE.
The most annoying restriction was that I could not comfortably get the boot of a hired roller skate onto my foot for several weeks. Jan and her sister and friends had begun to attend roller-skating on Saturday mornings at Dreamland Amusement Park. It was one more opportunity to gain a new skill and show off in front of the girls, but for several weeks I fretted at home after my convalescence.
In second year sixth form, I became house captain of Searle’s House and a prefect. This gave ample excuse for distraction. Prefects had a special area set aside for relaxation during recess and lunch breaks, if we were not on some school duty looking out for miscreants. Another prefect was a young man called Fred Stamp, who had come from the secondary modern system to complete his A levels, having shown considerable interest and ability in subjects not necessarily well taught at his original school. Though he lived in Ramsgate, he did not have that many friends and, perhaps both being loners, we hit it off. He was a couple of years older than I was, and had a long-term girlfriend called Rosemary. They and Jan and I were to become firm friends.
Because he was older, and over 18, he claimed to smoke a pipe outside of school hours, and this gave him an air of sophistication. In addition, he claimed to drink pints of beer – something I had not yet attempted, and again this turned my young head. But the real action was in school. Fred played Bridge. My family had always played card games at home, and I believe both my parents had played some social bridge. I had learned to play all sorts of simple games, but found myself on a rapid curve of learning at lunchtimes in the prefects’ room, with sessions sometimes lingering into the afternoon. We also played for a time after school, until we were thrown out by the cleaners, or had some other commitment elsewhere. I was hooked. We became good partners, using an Acol system, and I would have happily not bothered with lessons and just focused all my time on Bridge. I was later to play Bridge at Medical School, played for King’s College Hospital and then London University. Later in Adelaide, I played with 3 psychiatrist colleagues once a month for a total of 14 years, and also had an eminent psychiatrist colleague with whom I played (and won) for many years, in a highly competitive group deriving from his training group at University, when one of the members was not available.
In retrospect, I wonder just how much I could have attained professionally, without this (and other) distractions. All an academic discussion; you are who you are, and you do what you do. But in those early years struggling to get sufficiently good grades to get to University, bridge was one of the distractions that kept me from studying. On the other hand, it was an activity that gave me (and still has the capacity to give me) great joy.
And Fred had one other surprise in store for me during that year. Of course we discussed our respective possible careers. Another piece of the bonding was that Fred wanted to become a doctor, too. In particular, he had aspirations to become a psychiatrist, and had begun to read psychiatric texts. I was fascinated, and eventually he lent me a book that would quite literally shape the person I was to become.

More later…

Tuesday, August 25, 2015

Making of a Child Psychiatrist: (15) France 2

The Veyssieres kept chickens, and it was a new experience to have them follow you wherever you roamed in the garden. They always knew when it was feeding time, and gathered in a clucking mass shortly before. Oddly, they did not seem to be overly perturbed when Monsieur appeared with an axe, about once a week. Certainly, they scattered when he tried to catch one, but it seemed to be a game (with a rather unfortunate ending). I had never seen a chicken beheaded with one swift chop onto a large block of wood. Intrigued and revolted at the same time, I remember forcing myself to watch as the poor headless thing was released to run around in circles for a short while before falling over exsanguinated. The chicken was then hung up on a hook on the wall of the cool dark barn, just down two steps out the back door. The bikes were kept in this shed, so the evidence of death was there for me to see each day, until Madame decided it was time for a roast. I struggled. Not being a country boy, not understanding the basics of life really, I initially found it hard to approach the roast with relish. But..., welcome to the real world, pauvre petit Anglais!
To be truthful, there were few things that I could not eat. I am not sure whether Madame was being careful, or whether they just ate fairly simply, but there was only one time when I really had to decline – with very sincere apologies. Madame had organised a special treat – calf’s cheek – to be sautéed lightly. I just could not imagine myself eating this pure white fat, and had to ask for ‘un petit morseau de pain, et peutêtre votre confiture d’orange’ (ie bread and your (special) marmalade). She was crestfallen, I was embarrassed, but knew I would be even more so if I was to be sick.
Over the latter weeks, we attended a number of extended, and large, family events around the area, and because it was summer, and full of fête days, the food was in abundance, but with little that I felt I had to avoid. Mostly, I was a ravenous 15 year old, doing more exercise than I had ever done, beginning to become tanned, and beginning to sound very French – even if some words in an excited conversation escaped me. The grape harvest had led to new wines, presumably made on the property, or at least locally. So I began to develop a taste for the wines of Southern France (slightly watered down), much to the amusement of the Uncles and Aunts.
Summer also meant weekend fête days for towns, with a carnival atmosphere, roundabouts and sideshows. We toured from one to another. I am not sure where I had learned the basic skill (maybe at ‘Dreamland’, the amusement park in Margate), but I seemed to be quite good at shooting galleries, and often returned home with assorted dolls and French sweets. Jacques was better at cycling, but I seemed to a better shot. On occasion we went to these en famille, but mostly we cycled, often in a gang of cousins and cousins.
Because Jacques was that bit older and building towards a driving licence, and related to the fact that all his family members of the same age were riding motorized bicycles or Mopeds – called Mobylettes, Jacques (somewhat against his parents’ wishes) managed to gain access to one, and began to ride up and down our stretch of straight road. This was serious stuff. Sometimes I got to travel pillion with one of the cousins and, towards the end of my stay, I got to practice on this exquisite piece of machinery. Bliss. The feeling of power travelling at about 20Kms an hour was exhilarating, and I promised myself that at some stage in my life I would gain access to this mode of travel.
From then on we travelled to the next two fête days in style. In those days no-one thought to wear crash helmets, so we reveled in that feeling of the wind through our hair and clothes. I am sure Madame et Monsieur were very anxious, and after my bicycle accident, they must have wondered just how much of me they were going to be able to send home to my parents. But no harm was done, unless you count the implantation of the thirst for motorized transport. As an act of homage, in the summer of 1966, Jan and I, just over one year married, drove our Vespa 150cc down D940 on our way to the Pyrenees and Barcelona. We stopped to look over the old place, and bring back memories. It conjured a time of sun and freedom and happiness.
Just a small coda. Monsieur Veyssierre drove me back to Paris, sitting importantly in the front seat of his Peugot 403. As I remember it we chatted amicably for most of the trip, with my now fluent of somewhat simple French. He put me on the train for the Channel Ferry back home. On board, I had been under instructions to purchase a bottle of spirits and a carton of cigarettes for my mother. Sitting on a seat on the deck with case and my loot, I realized that the whole transaction was done in French. The pale tubby English boy with a residual depression and halting French had been transformed over six weeks into a happy, confidant, deeply bronzed, slightly grubby (and very smelly, it turned out) copy of a French adolescent.
Clearly, my perhaps slightly romanticized memories of that summer in France have stayed with me for over 50 years. I have a fondness for French food and wine, for the language, for the subtlety of French films. I have in my head what I call my Treasure Chest of French. Many words and phrases have disappeared, and I am sure my second language is now a bit arcane and my accent faded, but each time we have been back I have been able almost immediately to recall words and phrases sufficient to manage a daily routine. We have taken opportunities to go back to France on many occasions over the years, introduced our children to French culture, and encouraged at least one of them to have a long term French pen friend. I have a deep respect for French people and their maintenance of their language and culture in a modern world, a European Economic Community whose Lingua Franca is English, and an online community whose language is American.
I think I grew up that summer. Without knowing it, my time became an existential adventure. We were, we did, we enjoyed; my soul became a little bit country French. The result was not only a lifting of my depression, but a building of a particular form of strength. Sadly, I am not sure that I missed my family very much. Yes, I thought about them, and I wrote a series of letters to my mother (at least one of which has survived to the present, helping me to regain some sense of that time). I guess I was ready to go back to school, and had grown a maturity that allowed me to take on the mantle of being in the sixth form. I was much clearer about what I wanted in life, and this was despite my rather strange brush with French Medicine. I believe I began a life journey to gain an acceptance of things foreign, and different cultural norms, which has contributed to my being able to accept interpersonal and cultural difference in my psychiatric work, and put my feet into the shoes of ‘the other’. People are. They come from where they come from. They have their own peculiar forms of baggage, based in their developmental, family and cultural background. I may be able to join with them successfully for a brief time. I may be able to help them find a new path.

I think there was a downside to my holiday in France. I had always been a bit isolated and singular, gaining friends in ones and twos, but not necessarily relishing large groups or needing too much of a social life. I think France reinforced my ability to be comfortable in being alone. It was not so much that it taught me I could survive anything life could throw at me; rather, I was there, it was a fascinating adventure, we had fun, and I thrived.