The mind is fascinating and more fascinating in Child Psychiatry if you
can afford the time to try and understand it.
There is little doubt in my mind after spending 30 years trying to
think like a child (un-ashamedly borrowed from Picasso), I have come to
realised that our creator has provided our mind the facilities to heal and
recover. It is perhaps important that we should not jump in and use medication Willy
Nilly. Unfortunately nowadays they might be used for the personal
gain of the psychiatrist!
From The
Cockroach Catcher: Chapter 19 Who
Is The Real Patient? Part 2
he
early seventies was a very exciting time in London
as the first ever course in Family Therapy in the U.K. was just launched. Gregory Bateson just published Steps to an
Ecology of Mind,
which to this day still manages to be exciting for anyone interested in family
systems – a term coined to describe the interaction within a family or extended
family. Of course years before that, Ibsen neatly observed family interactions in Ghosts
and Wild Duck.
©2006 Am Ang Zhang
Both plays vividly captured family interaction that has hardly been bettered by
any other modern writings.
Wayne
Wayne must have been about
thirteen when he was referred to me. As with many similar cases he had not
attended school for
the better part of a year. I thought that this was another case of some degree
of maternal depression rubbing off on the boy.
Wayne’s father was a Sea Captain for years but for some
years now he preferred to stay with Wayne’s
grand parents. “Who could blame him?” Wayne
would remind me and himself. There was never a question of divorce and he did
not want to involve the psychiatrists either.
He preferred to just stay quiet about it.
Wayne had a very
impressive crop of hair very much like that of Art Garfunkel. He was also very
good looking, which immediately made him number one target for bullying. His
favourite subject was English. He liked poetry and Shakespeare best – further
cause for bullying. He enjoyed classical
music as his father had a vast collection of records. But he kept this secret
hobby to himself as the bullies already had too many reasons to pick on him. It was a rather sad
reflection of our society.
The
crisis came when his English teacher went on maternity leave. Before then, he
was teased as the teacher’s pet. His attendance at school was erratic at the
best of times and when she went on leave he stopped going entirely. Then when
he realised she was not coming back Wayne
decided that school was finished as far as he was concerned.
To
me Wayne had
managed to find a good excuse to relieve himself of some rather petty and
chronic bullying which could sometimes be worse than being severely beaten up.
I condone neither, but both kinds occur with serious regularity in our schools
although generally denied by school authorities. The side effect of this is that
it is often a relief for all concerned when a request is made that the child
should not attend school. It is when you start asking for other educational
provision that troubles generally begin.
Wayne, once you got to
know him, was the most pleasant boy you could wish to meet. He was not only
courteous and well spoken, but also very knowledgeable about his subjects of
poetry, Shakespeare and music. I do prefer to see more of the Wayne type than some other types I do not
care to mention. It might be unprofessional but I know a few of my colleagues
felt the same way too.
Some
patients kept us interested.
Despite
his age, Wayne
was always brought to the clinic by his mother. They both cycled in. The reason
was quite simple: Wayne
needed protection, not from anyone in the clinic but from the possibility of
bumping into someone on the journey to the clinic and back. When I realised this, we shifted the
appointments to school hours and Wayne
managed to turn up now and again without his mother.
His
mother was always well turned out, always soft spoken and always waited in the
waiting room through the whole session except when she saw our social worker.
But those appointments were spaced out as nothing much came out of them.
After
nine months, Wayne
finally opened up to me.
Mother
never threw away anything. Nothing at all!
Except
wet waste, which was a relief.
This
was a serious case of OCD (Obsessional Compulsive Disorder). It was still a
great shock to have the full extent of the things that were kept detailed to
you. Even a five bedroom house soon ran out of space.
Wayne
told me that as far as he knew, mother had always been reluctant to throw away
anything but it seemed to get out of control about five years ago when she
discovered that father kept a woman in a port in the Far East. She moved out of
the master bed-room and the rubbish moved in. Everything was neatly put in big
rubbish bags and properly tied up. Some were in apple or other supermarket
boxes. Even vacuum cleaner bags were kept.
Mother
did a good job of it so that there was no bad smell at all, Wayne would reassure me. Just no space.
All
these months, I had been thinking that the bullying was the cause of Wayne’s problem. Did I get
it wrong? All the time I spent trying to improve his self esteem, was it time
wasted? Was there something I could have done earlier? Why did he take nine
months?
Perhaps
he needed that time to find out if I was going to send his mother to an asylum.
Perhaps he needed all that time to trust me enough to talk about the
sickest person in the family. Perhaps he never had any plan but the secret just
came out.
Perhaps
these were all valid explanations, but what could we as a clinic do?
It
would be great if I were able to tell you that we carried out some wonderful
therapeutic intervention. Mother was able to get rid of her “collection” and Wayne went back to school
and eventually went to university and became a Professor in English or the
Classics or something like that.
It
would have been nice, but that would only have been a fairy tale.
We
tried to arrange a couple of mother/son meetings but we really got nowhere. Wayne made vague promises
in front of his mother that he would get back to school if this and that
happened but I think he knew that neither he nor his mother could really
initiate any change.
Could
a mother or son in such a relationship make a bold move to get the other going?
I fear not. It was a kind of symbiotic relationship that had gone too wrong for
too long. By making a move to get
“better”, one party would be putting enormous pressure on the other to do
likewise. Often either party would be afraid to become better in case the other
one might become even sicker. It was
just too risky to get better.
It is not
uncommon for young and enthusiastic juniors to be attempting the bolder
approach to force a change. I have come to realise and respect that many forms
of mental illness are a kind of defence and in the end the mind or the gene
that is the engine driving it knows best.
Similarly
with drug addicts, alcoholics and many with sexual deviancy and perversion, our
belief that they may change is perhaps misguided at the best of times and at
worst, dangerous to others in society.
I
was young then and a plan was soon hatched to somehow persuade mother that we
would arrange for her “luggage” to be cleared. She indicated that she would
find it difficult to watch. We managed to persuade her to go on a short break
in her favourite seaside resort so that she would be away.
To
our great surprise she agreed.
On
the day, we had a phone call from the car that we had arranged to pick her up.
“She
did not answer her door.”
Our
social worker rushed there. Wayne’s
mother refused to let her in but talked to her at the door. She had changed her
mind. She did not want to go ahead with the plan. By then the firm we engaged
to remove the rubbish had turned up too but she was adamant that she did not
want it done. After an hour of hard negotiation everybody left.
She
turned up for her next appointment to say that she could not sleep the night before thinking
about what we offered to do for her (or perhaps to her). She felt it was such
an imposition. She would need to dispose of those things herself when she was
ready. When she was ready! I have a great admiration for the English way of
understating things.
Wayne I never managed to
get back to school. He never sat any examinations.
On
the official school leaving day he asked me what he should do next. I told him
that perhaps on leaving my clinic that day he should go to the local Job Centre
to find a job.
To
my great surprise he did. He was immediately offered a job at the local Water
Works department as a receptionist/secretary. There they had problems keeping
any female secretaries and Wayne
fitted the bill. He had been typing since eleven and his English was good.
As
far as I know, he is still with them. I do not think mother ever threw her
things away.
Some
cases you remember because of good dramatic changes. Others you just remember.
From Wild Duck:
"Deprive the average human being of his life-lie, and you rob him of his happiness."
