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Men
had their work that was, in the main, revolutionarily new, and all-absorbing,
often requiring long hours at work, trips to headquarters and to contractors'
works, and, of course, it was secret. Even if we wanted to talk about
our work and associates at home, it was difficult because of the unusual
nature of what we were doing. Then there was the shared camaraderie of
war service that isolated the men from their women. In other men's reminiscences
I was in the cockpit of a Lancaster bomber over Germany; trying to establish
radio communication in the desert; in Changi jail in Singapore - or wherever
the world-wide conflict had taken me and my colleagues. The women were
isolated - intellectually as well as physically. They went 'home' (i.e.
back to mother) to have babies or at every opportunity; they pushed prams
in the teeth of the winds that rushed in from the Irish Sea; they had
the 'hierarchical' coffee morning! Everyone's grades, and hence salary,
were known, and houses were allocated by size of family and by grade.
Thus, when I reached the grade of Principal, we moved into an 'A' type
house, i.e. four bedrooms plus garage. These were the ladies who found
their way to the newly opened psychiatric wing of the now-being-constructed
hospital and the newly appointed consultant MC, who, in turn, sent some
for a second opinion to BW. With the best will in the world, how could
these specialists really understand the home life, social background of
many of their patients? Of the three psychiatrists whom I saw, not one
had been in the armed forces; none had been in industry or saw many people
outside their profession other than patients. Thus it was that LW and
BW, on the basis of forty and ten minutes contact with me, respectively,
presumed to analyse, categorise and prescribe.
As with
many of my colleagues at work, I had at first lived in a nearby hostel
for unmarried or unhoused staff. I lived there for four years and many
friendships were formed. We got to know each other's girl friends who
later became wives, and our children grew up in the influence of these
groupings. I still have a number of on-going friendships from those days,
ones that were formed nearly fifty years ago. Of some partnerships only
a widower or widow remains, and in a haphazard way our paths sometimes
cross, and we reminisce. On two separate occasions, I had virtually identical
conversations with two of the widows. Both of the husbands had been friends
of mine and aspects of the past were being discussed, and both widows
used exactly the same words - "I never really knew him". Now
this had been after thirty-five to forty years of marriage, and, in one
case, the upbringing of three children. "I never really knew him".
If this was the case after such a long period of shared life, how possibly
could a psychiatrist in one short interview do more than scratch deeper
than one micron into the surface of the individual before him?
My label of 'chronic anxiety neurosis' was applied to me when all else
had failed in the ongoing battle against my enteritis, not as the result
of thoughtful consultation and analysis, and the Librium prescription
was the medicine of last resort. My second GP (GP2) accepted the diagnosis
and continuing prescription seemingly without question. But where were
the cautions, the restrictions? With so many 'Home Doctor' programmes
available on CD in our computers, it is now so easy to access the information
that was presumably made available to medical practitioners with the launch
of new drugs. One does not have to be well qualified in medicine or psychiatry,
but only to be able to read - yes read. Thus benzodiazepine - for
the short-term relief of severe anxiety. But they have paradoxical
side effects - thus increased anxiety, and perceptual disorders,
which, coupled with the drowsiness and light-headedness,
were the likely cause of the apparently psychosomatic disorders that ultimately
led to my referral to MC. But this was after two years of prescription.
Where lies the responsibility to assess continuously the results of medication?
Should not MC have carried out an audit when I was first referred? He
classed me effectively as 'garrulous, giving a wealth of hypochondriac
detail', yet another of the paradoxical side effects is talkativeness!
My referral letter records the fact that I had been taking Librium for
two years - where was his awareness of the oft stated caution that withdrawal
should be very slow after such a long period of usage? He should
surely have been aware that abrupt withdrawal might produce confusion,
toxic psychosis, convulsions or a condition resembling delirium tremens.
As I have recorded elsewhere, my withdrawal was immediate, with
the consequences that I have noted. Yet no alarm bells seem to have rung
and caused him to review the medication - only puzzlement at the presumed
and never before recorded idiosyncratic reaction to the new drug that
he had prescribed. But, as his notes record, I was having problems also
with micturation and libido, standard and well recorded
side effects of benzodiazepine. Well?
When I became an in-patient in his ward, MC prescribed various barbiturates
to help me sleep. Now, there are cautions listed advising against using
the two types of drug together, which it would be tedious for me to include.
One side effect of barbiturates is the suppression of breathing,
yet when one day on the ward I commented that my breathing was very restricted,
I was told that as my lips had not yet turned blue I had no cause for
alarm - all very jocular, but not very perceptive. I later recorded numbness
of my scalp and part of my face, tinnitus. At one time, my vision
was disturbed - at times blurred, and, for a period, I lost peripheral
vision.
Remember, all this medication was gratuitous; I had never had the conditions
for which the drugs were compounded, although in all the literature, I
have not been able to find any comments relating to the effects of unnecessary
prescription. Remember also that benzodiazepine are classed as minor
tranquillisers; God help you if you get on the wrong side of the major
ones, the anti-psychotic drugs. I don't suppose that you will be
aware, though, your mind will probably have gone into orbit! In the wide
world of industry and agriculture, people have to be tested and licensed
and re-tested periodically to ensure that they are, and continue to be,
fit to handle noxious and potentially lethal or harmful substances. Surely
these drugs should be placed in a similar sort of legal 'containment',
and practitioners should be re-tested at periodic intervals?
You are
being very patient if you have read this far; I hope that you are not
finding it all too tedious. As we are yet in the Wonderland of Alice,
perhaps we have strayed into the Caucus race. "What on earth is the
Caucus race?" said Alice. "Why", said the Dodo, "the
best way to explain it is to do it" - no start, no finish, just keep
running in a circle until you feel like stopping, and everyone is a winner
- that is what it feels like to me at times as I revisit my past. The
people who have read this far tell me that they want to know the full
story, so you can blame them not me; I'm still running in my circle, how
about you?
The letter
written by MC to BW in which he asked for a second opinion gave no account
of the drug regime of the previous three years, but simply mentioned the
brief high dose of Librium within the sequence of E.C.T and insulin therapies
that he listed. My own reaction on first reading it was one of total surprise
and dismay at the absence of real fact and the sheer negativeness of his
narrative. He records, for instance, that I had failed my Higher School
Certificate (today's A-level). There were reasons, such as having to take
subjects that were not my first choice because of limitations in the availability
of staff, war service having claimed several, and other reasons, which
it would be tedious to relate. Why did he not say, for instance, that
I had been Head Boy, Head Prefect and School Captain, that I had for several
seasons played rugby with the First XV and had represented the School
at throwing the javelin, or that I had taken major roles in school plays
(Richard Burton was a contemporary and fellow thespian), or that I had
delivered the valedictory address to a long-serving, and now departing,
headmaster?
This disappointment, and the one of not attaining a commission, plus any
other of life's seeming catastrophes that he could include, were seized
upon by LW in the letter which he wrote for BW to sign, as examples of
my inability to cope with failures. How little he knew! Within a fortnight
of getting my exam results, I had volunteered for the Royal Navy, and
was accepted for a University Short Course with the hope of ultimately
being commissioned. In a further short time I was at Glasgow University
being trained in aspects of seamanship, signalling and sailing, and learning
the practice of coastal navigation, while academically I was studying
Natural Philosophy and Geography. Disappointed? Like hell! I was revelling
in it all. I cannot convey to you the joy in my life in at last being
in a boat and learning to sail under expert tuition, nor of being taught
the intricacies of knotting and cordage by a Chief Petty Officer who,
at seventy, had returned for service - someone who had actually
served in sail. My cup of happiness was very full. I passed with
distinction, fourth out of a course of about eighty. My academic subjects
were also passed well and there was the prospect of a return to Glasgow
on demob.
Those of us who had chosen to try for a seagoing commission joined, next,
a formal training establishment, where we learned more seamanship, gunnery
and so on, and were tested in our 'power of command' and our ingenuity
in trying to cross a crocodile infested river using only a length of rope
and two short planks. The hoped for commission did not materialise, which
disappointment is another which LW in his analysis said I had difficulty
in coming to terms with. Oh! Get a life! If he had probed further he would
have learned that, out of the whole group, less than 15% succeeded, and
he would have learned also the prime reason, namely that on D-Day, and
after, the anticipated losses of landing craft commanders had fortunately
not happened - and it was for such jobs that we were principally being
prepared, and were therefore not needed. We 'rejects' didn't sit around
moping, fat chance anyway, and at eighteen one is nothing if not resilient.
Within a very short time, several of us had chosen to be trained as Radar
Mechanics, and away we went into a fascinating new world, a world that
had only been created in the previous three years, and an entirely new
track, which fundamentally altered the course of my life.
In this short interview, LW had me dissected and sorted, or so he thought.
Oh, the arrogance of the man! Take this point: at sixteen I had had a
severe gastric upset which had resulted in a barium meal, abdominal X-ray
and the conclusion of our family doctor that "I had nearly had an
ulcer". LW's contempt was palpable - "You can't nearly
have an ulcer, it must have been dyspepsia" - end of story. What
sheer bloody arrogance! The family doctor had been a family doctor.
He had delivered me in our home and had tended all my growing-up illnesses,
as well as removing my adenoids. Which of these two men is most likely
to have been able to assess the causes of my gastric ailment? But this
is what one is up against, and the consequences, and not just for me,
are enormous. When you contemplate the 'armoury' that is at the disposal
of psychiatrists, you should quail, not only have they powers of incarceration
but they have, in the shape of drugs, prisons without bars and shackles
without chains. And yet, as my case shows, conclusions can be reached
and decisions and actions taken on the basis of the most cursory analysis
and arrogant self-belief.
There is so much in these two letters that could be subjected to my
analysis and comment, but no great purpose would be served; I think that
I have made a sufficiently valid point. I must also acknowledge, though,
that LW and BW had not been given a full picture in that details of the
drug regime and symptoms had not been included in the referral letter;
facts that might have alerted them and inspired a deeper examination.
On the other hand, to be sent for examination having been preceded by
a comment such as MC had made, namely that I 'presented a puzzling mixture
of anxiety and depression, with, at times, an ominous schizoid flavour'
does not allow one much scope to demonstrate that one is not actually
doolally.
I know that in concentrating upon my own experiences at the hands of three
individuals I am presenting an unfair picture of the whole profession.
There are undoubtedly many dedicated and competent psychiatrists in practice,
and I know that I would not like to do their work, and I acknowledge their
commitment and caring. I know, too, that it will be said that my own experiences
are unusual and a-typical. I sincerely hope that they are, but that being
said, there are elements that one learns are still being repeated in the
lives of other people, and will continue to be repeated as long as humans
have human failings both as patients and practitioners. Essentially, all
the latter really have to do, and yet it is most difficult, is to listen
with a mind which is not preformed, and to make judgments that are not
instant but which are open to further scrutiny, and which can be revisited,
revised and reversed, and do not result in the compounding of one symptom
by one drug, which creates another symptom or side effect, which has to
be treated by another drug, which creates another side effect which…
Do I exaggerate? I have a friend who was having problems sleeping. She
was given sleeping pills (designed for the short term - ha bloody
ha - relief of insomnia), which have the adverse effect of creating nausea
and vomiting; so now she has a gut problem and more medication. The pills
also interfere with the heart and circulation, so more medication, and
they cause anxiety, so she has an anxiolytic drug, which also can produce
depression, which requires an anti-depressant. No, I do not exaggerate
- this is real. But listen, yes, if they would only listen. I had a venerable
friend who was chuntering away one day when I called. He had painful arthritis
in his shoulder and had been to a consultant, but "…they don't
listen… they never listen, in spite of what you have to tell
them…and as for N (naming his GP) she tells you what you've
got and then you have to pretend to have it!"
I am fast
approaching the point where I shall leave my medical records behind, although
MC will briefly tread the stage later in the saga. Before I finally quit
them, two further points from the notes, if you don't mind. One fills
me with dread at what finally might have happened to my mind, for I see
that after twenty-three E.C.T.s and the insulin jamboree, MC had been
considering further E.C.T! Fortunately, as he records, I firmly
rejected the idea. I speculate with horror that my poor innocent mind
might not have survived yet further assault.
The other
entry concerns a later time when I was divorced and living alone, but
in regular contact with my daughter and former wife. We had decided that
our daughter should move on from ponies to a small horse, and together
went to a recommended dealer who found for us a delightful little mare,
an Irish hunter of about fifteen hands and which had already been hunted
by a girl of roughly my daughter's age. We put her through all the tests
for steadiness and suitability that we could devise - from standing by
the roadside while lorries with flapping tarpaulins thundered by, to having
a car rev-up and its horn sounded under her nose, and a shot-gun being
fired behind a hedge. She, whom we called King's Courier, or KC for short,
came to stay with me, and my daughter would come from school at weekends
to ride. One Saturday it was raining, and she wore a police cape that
covered herself and the saddle, but, unfortunately, something that I hadn't
anticipated happened. The cape flapped in a breeze and startled KC, which
caused the cape to flap more and startled her further. The mare took off
on a road beside a river that was in full spate, soon came to a skew bridge,
leapt the parapet, and broke her neck as she hit the water. Fortunately,
my daughter was flung clear and I bless forever her keenness in swimming,
for, heavily clad though she was, she got to the bank and came and found
me.
MC comments
upon the episode in the next letter to my GP and goes on to write, "…I
think that Roy is more distressed at the loss of the horse than at what
might have befallen his daughter".
I was once
acquainted with two men, one at work and the other through the church.
The first had two sons and the elder went to university to study geology.
On the first weekend visit home, brand new geologist's hammer, family
trip to Wasdale, two boys dash up Yewbarrow, eldest jumps over a rock,
hammer in hand - never seen alive again. He wasn't found until next morning,
for he had immediately lost his footing and crashed down some way to his
death.
The second man also had a son, and the lad had reached the magic age that
allowed him to ride a motorbike. The longed for day arrived as did the
gleaming machine, bigger than youngsters are allowed today. They lived
just a short distance from the 'Irton Straight', where everyone of my
acquaintance who owned a bike used to go to test it after adjustment.
The lad must have dreamed so many times and lived it all in his mind,
as I had lived my sailing. The bike roared into action. He went around
the corner heading for the Irton Straight, and they never saw him alive
again.
I used to see both men frequently. I never ever saw them smile. Their
eyes showed that they were locked in a world of perpetual misery and possibly
self-condemnation. I looked briefly into that abyss and came away quickly.
You don't dwell on it; you don't think about it. If you do, even so briefly,
you don't share your thoughts with anyone - certainly not with a psychiatrist,
no matter how friendly he then appeared to be. Since reading what he wrote,
and remembering all that he had caused to happen to me, I have feelings
now that would cause me to use the language of the lower-deck. But what's
the point?
Come, let us move on....
But
where, oh where shall we go?
Let's send Alice to enquire, shall we?
Strange, where did that Cheshire cat appear from? Perhaps he knows...
" Alice, will you enquire directions for us, please?"
"Would you tell me, please," said Alice, " which way I
ought to go from here?"
"That depends," said the Cheshire Cat, "on where you want
to get to.
Over there…lives
a Hatter,…and over there…lives a March Hare.
Visit
either you like: they're both mad."
"But I don't want to go among mad people," Alice remarked.
"Oh, you can't help that," said the Cat: "we're all mad
here.
I'm mad,
you're mad."
"How do you know I'm mad?" said Alice.
"You must be," said the Cat, "or you wouldn't have come
here".
Which seems to be where we came in.
Perhaps we should emulate the
Cheshire
Cat
and
j
u s t d i s a p
p e a
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