LISTENING TO THE SILENCES

Looking back at the events covered by the next two years, much of what I did, felt and suffered can now be understood and many things fall into place. First, there was the growing addiction. My very first act on waking was to pop a pill. If I didn't get my noon 'fix' on time I started to get the shakes. It was while I was doing this one day at work that I received my one piece of cautionary advice. It came from a former G.P. who had given up medical practice to found a firm which made endoscopes; he was visiting to supervise the installation of one of his industrial size 'scopes. When he saw the pill going in, he advised me instead to unwind at home each evening with a glass of sherry. Kind man that he was, on his next visit he handed me a brown wrapped bottle - " Special varnish" he said, "Don't open it here in daylight". I still think of rich, dark port wine as 'special varnish'. How I wish that I had been able to take his advice, but by now I believed that I had a C.A.N. How else could I explain the shakes that were cured by my next 'fix'? How else to account for the drowsiness that was besetting me in my office, the 'numbness' which enveloped my midriff and radiated outwards, the confusion or slowness in understanding the developments in computing, which specialist members of my department were engaged with? How else could I explain to myself the frequent malaises that had all the hallmarks of 'flu without the temperature?

Life at work was getting difficult, particularly the drowsiness - but how can you explain to your next senior something that you didn't understand yourself, and which he didn't confront directly? (The problems contained in that one sentence, and all the other examples that emerge of the inability to address or articulate a difficulty or problem, of the impossibility of admitting or communicating to one's partner, friends, colleagues, medical advisers, more than an inkling of the gut-wrenching, mind-warping fears and fantasies which emerge, are topics to which I must return somewhere in the discourse if I am to draw meaningful conclusions and offer advice to others on ways to cope or support; but how difficult it is!).

In the main, I was still doing a good job; no catastrophes, and many innovations at which I was particularly good. I remember, too, delivering a lecture to the Engineering Society on the subject of computers in general, and the ones in particular that we were then incorporating into the plant - the last major, positive event at work for some time to come. Such changes as were happening to my life and demeanour were yet acceptable and bearable compared with what was to come as 1963 was settling into autumn.

The G.P. who had made the original diagnosis and prescription had moved back to his beloved Scotland, and to his replacement I remember saying "You have inherited my chronic anxiety neurosis" - me still accepting what I had been told, and he having no reason to question it. Socially we got on very well and his wife and mine became firm friends. However, his professional visits to the home began to cause him some concern and in time, he expressed the view that what I was experiencing was psychosomatic. He advised that I should see a psychiatrist and arranged for me to do so. After the encounter with Librium, the meeting with the psychiatrist has become another of my life's great 'I wish it hadn't happened ' moments.

From this point on, I have copies of all my medical notes for the next thirty years - both those of the consultant and those of the local practice. The reason why I acquired them is revealed much later in my saga. Reading the notes - not an easy experience to cope with - it is revealing to see oneself as a 'he', a third person, almost a specimen with a label. To me, as an engineer, the most glaring difference between my profession and that of the psychiatrist, is the latter's lack of certainty, of objectivity. I was used to dealing with a reality - my whole purpose in my work was measurement - the complete delineation of the state of being of a piece of plant or an operation as it was then, at that moment. I had seen my devices - the nerves of the plant - put in place (nearly 50 years on, I have the personal and professional satisfaction of knowing that many of them, those completely inaccessible inside the nuclear reactors, are still there, still functioning). Their characteristics were known, for we had calibrated them; they told the operator exactly what was going on in the remote reaches of his plant; if anything broke down outside the reactor I had to know exactly why it had failed, and could only replace it with apparatus that had been thoroughly tested and calibrated.

My Consultant (MC) appeared to be thorough, no question of that. We talked, he arranged tests, e.g. was hypoglycaemia a possibility? But to the outsider, there appear to be no certainties in psychiatry, only opinions and educated guesses based upon the personal experience and training of the one particular practitioner; possibly even the 'school' of psychiatry to which he subscribes; no precise measurements or standards. Labels are put on 'bottles' of symptoms - but the contents of the bottles seem to change at the whim of one school of research or another. Take for instance Alzheimer's disease. I can read the standard, original definition of a 'pre-senile dementia', which, when originally identified and defined by Alzheimer himself, applied essentially to persons under the age of 55. Yet in a recent paper describing research into the prevalence of Alzheimer's disease amongst professional footballers, the author states that the condition is rarely experienced in persons under the age of 60!

It is only in later years and being outside the maelstrom that I was then in, and fully in charge of my life and mind, that I can look back and be critical. But let me emphasise again, as I do through all that I write, that apart from those whose reasoning and lack of perception I condemn, and who will emerge later, I am not critical of the intent of any individual: I appreciate most deeply the care and concern which were lavished upon me by all the people whom I encountered. But I am a professional in my own right; my training and experience were on a par with most of the medical practitioners in their profession, and so I justify my own right to be critical of analysis and results. All this, of course, looking back with the benefit of the records in my possession, to let me see into the thought processes of those who were examining and analysing mine.

My perception of the lack of objectivity begins in the letter to GP2 sent after my first consultation. I was seen effectively as a 'garrulous, bespectacled, Welsh hypochondriac'. Welsh and bespectacled were irrelevancies that I couldn't alter, but who would not be a garrulous hypochondriac after two years on a continuous and substantial intake of Librium (which modern professional medical opinion now recognises as having been totally inappropriate and unnecessary!)? The fact that he rated me as of above average intelligence mollifies the personal affront to my self-image, which itself pales into insignificance before the recollection of what else appeared in the letter, and its immediate effect. After two years continuous use, at 10mg tds, my Librium was stopped forthwith and replaced by Tryptizol.

Oh Boy! Does anyone want to know what 'cold turkey' is like? My advice: don't try it! Recollect - I had been taking Librium in substantial dosage for over two years. Information readily available and unequivocal says that it is for short-term use. There is also full information about withdrawal after use - in my case after such dosage for so long my withdrawal might have taken over one year! Mine was overnight! The bizarre reactions and symptoms that I experienced are only partially recorded in my notes, but it was enough that when food was put in my mouth I lost contact with it, for I had no taste, no feeling down my throat. My stomach might not have existed for there was no sensation when I pressed that region, and I had no pressure sensation in my bladder. It was as if everything from my mouth to my fork no longer existed. The symptoms which I was experiencing were in fact so 'global' that in the correspondence between MC and GP2, they were referred to as '..this remarkable set of symptoms' and 'multi-various physical symptoms'. The possibility that they might be the effects of the instantaneous withdrawal from Librium was just not considered; everything I was experiencing was put down to a never-before-recorded idiosyncratic reaction to Tryptizol.

Time off work and a return to Librium produced a measure of stability. 'Stability'? Huh! Work was becoming a daily nightmare, if that isn't too paradoxical, while what was going on in the minds of my wife and daughter, I would not like to examine even after all this time.

If you don't succeed in flattening him at the first go, why, just have another. A couple of days on Stelazine - immediate disaster - then a second bash, this time with Melleril. Same result; bizarre symptoms; brief flirtation with Nardil; reduced to quivering jelly. Hospital? Yes please. Refuge. I could, with relief and without feeling guilty, put aside my responsibilities at home and work.

E.C.T.? If you say so. "Sign here" - as a voluntary patient. Bang! The next assault on my precious mind began.

Isn't it amazing how docile we are? Or maybe then we were more docile, accepting, than people are now. Perhaps people nowadays are better informed, or demand more information; also there are patients' support groups, and others active in attempts to outlaw E.C.T - it is, after all, a bizarre and dangerous 'treatment'. Whatever the analysis, there I was, good little Indian, ready to accept what the kind gentleman said because it would make me better. I am sure that you want to know all about it, for it is done in your hospitals, and by people who, indirectly, you employ.

Three times a week the Ward went into its well-rehearsed routine. You wake and get up as usual, but have no breakfast. Shortly, you have an injection of a belladonna (deadly nightshade) derivative whose purpose is to dry the mouth and prevent you choking on your saliva. Meanwhile the nurses are playing trains with the beds, pushing them end-to-end in the corridor outside the treatment room. Next, as your turn approaches, a second injection, this time of a curare derivative. Curare, as you probably know, is the poison that South American Indians put on their blow-darts; the object of its use in this situation being to cause complete muscle relaxation and minimise the risk of vertebral fractures (after all it is electro convulsive therapy) - no mention of the possibility of these when I gave my 'informed' consent!

Let me quote from The Oxford Companion to the Mind:

E.C.T: Applying a voltage with surface electrodes on the head
across the brain. This is done under anaesthesia or muscle
relaxant, as it produces convulsions which can be dangerous.
E.C.T is extensively used as a convenient and quick treatment for
depression, though there is no theoretical basis to justify it.
There is considerable criticism of its extensive use because it may
produce permanent brain damage, especially losses of memory
and intelligence, though the evidence is not entirely clear.

I want you to take particular note of the last sentence for reasons that will become pertinent later.