Still voices 2

1980

A chance meeting in a damp autumn street. A friend and his closer friend cycled on the pathway I walked and stopped to pass the time. These were two worldly wise people. I knew them out of the mainstream of my usual social life. They were employed. or one was. The other, a failed degree student clung to his mate like glue. I mistakenly took this for affection. In retrospect. Affectation of friendship was more likely.
They had a new man demeanour. Both cooked or aspired to cook and knew all the names of the great dishes of the world and their secrets. I was to join them for a dinner of Coronation Chicken and Souffle that evening. I was the audience.
Bob, the hanger on left to sign on. I remember thinking that even this was a sign of nonchalant ambivalence about the future. His friend, Steve and I walked on for a bit, talking about this and that. The Vietnam war mostly I think. Steve had read books about the effects of war on younger men and was keen to regale me with his knowledge. It turned out that he had recently been posted to the local Psychiatric hospital on placement from his course. He was to be a nurse. Whilst there, he had discussed trauma and felt that his destiny lay somewhere between the management of fractures and the glamour of new therapies. I was impressed. The temptation was of course to find a way to steer the conversation back onto firmer ground for me. To regale him back with quotes and anecdotes from what I knew of madness through the plays and poetry that had suffused my childhood.
I needn’t have worried about that. It became quickly clear that this new knowledge he was keen to share was too fragile to support a discussion. He filled the gaps in his understanding by finding his footing on the solid shores of nursing tasks. he quickly outlined how a therapy designed to help a trauma victim or the like could be assumed by most and delivered via a manual in stages. In a blatant backhanded compliment he suggested that I visit him at work. He would introduce me to the school of nursing and I could look at options for employment whilst there.

Still voices

Summing up thirty years in psychiatry.

Hanging on to the safety rails of salary and pension as community psychiatry careened from model to model, buffeted by the winds of political change has been a job in itself. Not a job I am proud of and one that proved at odds with the reason I sat in that precarious position for so long.

There were very few days of  safety. Lamentably many days of sadness, anxiety and frustration. Weeks and months at a time characterised by the worry that someone might choose to further destabilise the near catastrophe of the journey by indignation and complaint. Hours of thought blocking resentment at the blindness of a huge concern, unwilling to allow that research might support experience and permit the simplest progress. Minutes at a time when personal safety was compromised by public fury, stimulants or alcohol. Seconds when the blank looks of colleagues signal failure to accept that dogma cannot offer therapy. That communicating hope is a skill best learned as a child and developed through learning, not manualised in adulthood and offered as an alternative to creativity. The child in us all is ever ready to learn. This is the most valuable lesson of all.

The ability to deliver and participate in therapy is a rare skill. The ability to negotiate an alternative to therapy when the organisation suggests that it be used in any case, demands courage and a belief in the process of assessment. For as long as I can remember, psychiatry has been guilty of over treating members of the public rather than allowing proper periods of 'watchful waiting'. Largely, it must be said because it has never been clear who will be watching and who will wait. The identified patient is often the last to acknowledge that assistance may be useful. Families, feeling abandoned for real or fancied reasons are in no mood to wait or watch any longer. These are the desperate, in need of a lifebelt that will provide immediate safety, not a lifeline that they need to work their way towards. These are the puzzled, frightened folk, often living in social exclusion or refusing access to inclusion by dint of cultural mores, family influence or poverty.

The last few years of my career were spent in community provision, in General Practitioner's offices and in Mental Health team offices local to assessed need. My job has been typically varied at the senior end of a nursing team where management was not necessarily the next logical step. Moving from Primary Care in doctor's surgeries to Secondary Care and vice versa is relatively common and often provides the most effective saving grace for a practitioner. Retraining and garnering new skills (learning appropriate protocols) happens by default. There are 'easing in' periods and useful elements of each other's disciplines are portable across the perceived divide. Those of the team who have gathered enough moss to feel at ease in this variety of milieux are usually close to retirement age. Usually becoming more and more valuable. Usually in supervisory roles and usually tired of the whole thing.

It has been nearly a year now. My retirement has given me the opportunity to record my thoughts and feelings about the work, but not the inclination. It has taken longer than I thought to allow the wheels to spin down. My memories are not so weighted towards recently departed events but rather, the whole of the thirty years is gradually becoming a more meaningful account. More easily accessible and with less heat.

I have found the causes of modern institutional eccentricity more readily understandable as the relatively primitive meets what has undoubtedly become enlightened thinking further on. That there are such marked differences in such a short time has proved frequently alarming. I can feel the good that has come of our parts in this transition and now, nine months on, no longer need to vent my anger at the system. Rather, in celebration of those of us in therapy, this may serve to throw a small but significant part of British mental health care into relief. There..

..here goes..