Friday, May 12, 2017
Making of a Child Psychiatrist: (75) The General Practitioner (20); Blue Sky Dreaming
In early 1973, we found out that Jan was pregnant again, with the new baby due in late October. We were, of course, ecstatic and perhaps hoping for a girl. The pregnancy was going well, but Jan and I had not had a break for a long time and, although we were struggling a bit financially, we felt in need of a holiday. We just wanted to go somewhere and have some time together. Bobby and Reg said that they would be very happy to look after the boys for a time, even though they were still quite young with Jonathan a bit older than 5, and Roderick only just 3. We thought that they would be safe with grandparents with whom they had had a lot of contact, and would be unlikely to fret as long as they had each other.
I found a conference that looked quite interesting, and would allow us to defray the costs as professional expenses. Sounding plausible at the time, this was to be the beginning of a way of professional life – finding relevant conferences in exotic destinations around the world and wrapping a holiday around the event and/or a presentation. Part of the rationale was that I was enjoying my part time child psychiatry sessions but, within that, the most exciting aspect was working with families of the referred children, and beginning to have a language to describe what I thought I might be doing, and a range of techniques to use at appropriate moments. I was not a psychotherapist as such, had no idea what a whole conference on psychotherapy might be like, did not want to attend the whole thing anyway because I wanted to spend time with Jan, and assumed there may be some side events and visits for delegates that would make life fun for the two of us. The bonus was that neither of us knew anything about Norway, so sightseeing might be fun. Overall, the event was to be immensely influential in changing the direction of our lives.
The 9th International Congress of Psychotherapy, “What is Psychotherapy?” was held in Oslo, Norway June 25-30, 1973. When I had originally come across the conference in the psychiatric journal advertisement, the title had suggested it would be good starting point for a novice trying to do psychotherapy. In fact it ended up being an international window onto a plethora of approaches to working with people struggling with their mental health, and I was to be totally blown away. If I had thought I had begun to understand ways of helping recovery in my psychiatric registrar year at King’s, and rediscovering the joys of working towards understanding and change during my Canterbury days, this conference made me feel like a child in a sweet shop with only 6 pence to spend and an overwhelming choice of delights from which to choose. I had thought my early reading of my two books by Freud and Adler and later a textbook on psychiatry, might have given me a good grounding, but there was so much across the 6 days I just did not understand; the terminology was novel, the ideas complex, and some of it went way over my head.
One of the main Keynotes was an American called Thomas Szasz, from the United States. Of course, as with most of the speakers, I did not recognise his name and was not aware he was at the centre of a storm about the definition and management of mental health problems. His keynote got a mixed reception, and I had not realised that people actually heckled international speakers. There were others whose work eventually became part of my vocabulary and understanding. But generally speaking I was overwhelmed by the ideas, the numerous different forms of psychotherapy, the fact that people had actually written about working with couples, working with families, working with intergenerational families (ie including grandparents and perhaps others), and the arguments about it all.
We fell in with a bunch of happy and somewhat noisy Australians who were about our age. A couple of them presented and, dutifully, we went to hear them speak. Again, there was much I did not understand, but they seemed to know what they were talking about, and the arguments went on way past the end of sessions and back at the hotel. And they just accepted and began to include us in activities. At some stage we went on a fjord boat trip, a wonderfully peaceful event except that fiery and enthusiastic discussions erupted about the speakers the day before.
We had opted to go on a tour to an inpatient clinic doing therapy with families of children with problems. It was a single storey modern purpose built building of wood and glass set in beautiful surrounds; not like Lanthorne House at all. Outside it was chilly, of course, even though it was technically summer. Inside was cosy and warm as with most Norwegian buildings. The openness of families and staff members to talk about their experiences, the bilingual ability of even the children, and the enthusiasm for something vaguely called ‘family therapy’ was impressive. And it suggested possibilities for the future. What if I could become that skilled? What if I could become involved in such an innovative and effective clinical program?
The conference dinner was at the 13th century Akershus Castle near Oslo, and included an historical tour of the royal chambers, mausoleums, and the old prison area with guides who had the usual impeccable English. Like most castles, it was cold, dark and draughty with lots of steps going round and round in the towers. As I remember, we were both grateful to leave the tour a bit early and retire for pre-dinner drinks. I think by the time we got to the dinner, Jan had had enough of being away from home and of listening to people talk about therapy. She had taken several afternoons off to go shopping or to get a nap before dinner. Conferences (as we began to understand over the years) are often a trial of stamina, and while my excitement had buoyed me to attend as much as I possible could, I did have some appreciation of how pregnancy can affect stamina, even if I missed my constant companion.
On the journey home we discussed bits of the conference, and my overall excitement at the prospect of continuing on a steep learning curve in psychotherapy. Somehow our almost instant resonance with the Australian group seemed to be one more piece of the puzzle as to whether we should leave general practice and take up the offer of a job in Adelaide. We talked about what we might gain, but also all that we would lose by leaving family and friends, and the security that had been our place in the Birchington general practice. I was aware that Jan might have much more to lose than I. The excitement of a new job would take me over, but Jan’s would be the shoulders on which the responsibility might land for sustaining our family life and making a new home. There was a slight advantage in the fact we had spent three months in Adelaide 10 years before. And maybe there would be some support from family even though they were mainly in Sydney and Melbourne. Once home, and reunited with our two sons, we spent time talking through the possibilities with Reg and Bobby. They, of course, were very positive even if they had major reservations about their Jan living half way around the world. Ultimately the decision was made, and I wrote a formal letter to Jeff Gerard asking to take up his offer of a job from January 1975. We had about 17 months to get all the arrangements made.