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.
Saturday, 15 October 2011
Tuesday, 27 September 2011
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..
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..
Saturday, 20 August 2011
Demons
I was visited by a Succubus this morning. Not the lame excuse for illicit guilt ridden sexual dalliances dreamed up by hemmed in Restoration virgins. Not the imagined demons of the dark hours conjured by pastors and priests. Not even the accumulated shards of fright I may have garnered over the years through nightly consumption of ever more finely crafted horror stories. This was a true Succubus of the soul.
Robbing me of my ability to move at all for an untold time. Severing communications between limbs and brain that we take for granted and incidentally casting a veil of immediate and tangibly petrifying fear. I was suddenly and for the first time in my life, granted access to the supernatural by this visitation. For an indeterminate period, I was scared of death, scared to live and terribly afraid of permanence. This last was paramount. The sudden irrational thought that sliced through the two sides of my consciousness leaving sharp barbed demands for attention was a questioning of my ability to cope with purgatory. That this fearfulness may rule my waking state with more and more puissance as sleep was to leave me. Any tiny rubs and strokes of hope eradicated, pushed aside by preternatural flaming terror. This was a visitation from hell.
The illusion soon revealed itself as such however. My singular impression of the potential for permanence began to dissipate as my waking self gained ground and rationality came within my grasp. Once more, the timescale here is hard to measure. Not now due to the emotional paralysis I was subject to but increasingly because I was coming to relish the prospect of exploring my experience. Time became at once a valuable cherished necessity and a gradually vanishing commodity. My waking self would soon slip quietly into it's customary service of our human timeline. My hypnogogic self clung to the awareness of time's gradually dominant state. I reluctantly allowed that any impressions I may be granted from this point would be guided by my own physical and emotional pilots. One to be dropped off at his billet on the Styx, the other to be piped on board by dawn.
Now less afraid and more intrigued, I was at liberty to test my paralysis and now aware of what the causes were, enjoy the lack of evidence for demons.
Arms, hands, legs, feet and face completely still I was made aware of the simple truth of propreoception. There was no doubt where I lay, in what position or direction. In common with the history of documentation of this condition, I was prone. I could now relate my awareness of the bedside clock with the rising sun and temperature in the room. One leg was uncovered and my right arm raised above my head. For the first time in this episode, I asked myself about duration. Becoming aware of the processes that I could consciously employ, I tried to move first one leg then the other. No luck. The effort needed was immense, merely to feel that some small change may be effected. All I seemed to be able to do was register that nerve and muscle fibres were at least acquainted. Full working relations had not yet been negotiated. My quarters were on strike.
Minutes now made good time. As my limbs began to thaw from the toes and fingers up, I realised how the enormity of this event had almost caused me to not merely suspend my scepticism but abandon all logic in my natural desperation to make sense of it. My imagination was the last recourse to something seeming akin to me whilst the awfulness took my sense of self by stealth.
It was during this presumably brief time that demons were available to me as reason and excuse for abandoned hope. Latterly, whilst aware of returning sensation, I was impressed by how much relief could be gathered up from the remains of this torture and formed into a countering force for good. How many such straws have been grasped over the years by those without the understanding to confound their superstition? At this time, I glimpsed the very subjective reality of faith in god. I saw the rationale behind beelzebub and understood the reason to abandon all my hope as I neared the gates of dispair.
Monday, 15 August 2011
A small planet..
I was suddenly taken by how this Bee and it's attending Hover Flies would experience the Alium. Miracles of tiny neurological engineering and balance control mean that they are the masters of the sphere but, how much further does their perception extend?
More of this and my own developing sense of wonder at our position later...
Thursday, 4 August 2011
Saturday, 30 July 2011
Wednesday, 13 July 2011
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