In an age when it has become more or less impossible to gear your intervention or non-intervention in the practice of Medicine, I remember this family fondly.
From The Cockroach Catcher: Chapter 19 Who Is The Real Patient? Part 1
T
|
he early seventies was a very exciting time in London as the first ever course in Family Therapy in the U.K.
©2006 Am Ang Zhang
Catherine
Catherine, aged fourteen, had not
attended school for some time and all
attempts by the school authority and educational psychologist failed to get her
back to school. This was a pity as Catherine was really university material.
She had eleven older brothers and
sisters. Two older sisters were married.
One of them had a little baby of ten months. The other had two children
at school. The youngest of the brothers attended a public school (i.e. an
English private school) on a scholarship, and with financial assistance from
the older siblings.
After an initial visit by the social
worker, the team decided to approach the case in a family therapy sort of way – big family therapy in every
sense of the word.
At that time, family therapy was a relatively new development and had
probably grown out of some group therapy principles. One of the first courses
was established at the Group Therapy Institute in London
Even the rather adventurous social
worker was feeling a bit dubious. “Do
you belong to the school that insists on everybody in the family
attending?” She asked, hoping I would be
a bit eclectic about it.
“Let’s try and get everybody at least
for the first session.”
“I will do my best,” she promised.
Good old Miss Kimble. She always got
things done.
As some of the family were working, the
session had to be organised for the evening.
There is so much mystique
attached to our kind of work that families often oblige without asking too many
questions, at least at the early stage.
One of the older unmarried sisters took
it upon herself to organise the meeting. The main one that caused some problem
was the oldest brother who was a long distance lorry driver going all over Europe . The
meeting needed to be on one of those nights when he was back from his delivery
tour. The brother at the public school had a cricket match and he was
apparently one of their best bowlers. One of the other brothers agreed to go to
the match and bring him to the meeting as soon as the match was over. The sister with the baby would have to bring
the little one but the older children would look after her at the meeting.
I told them that they could all join
in.
Luckily with so many children the
family had a reasonable sized council house and the family room was fairly
long. They moved the dining chairs
through to provide seating for everybody.
The scene was set. We just had to
deliver the goods.
“We have come this far. We just have to do it,” I told Miss Kimble. She probably had more faith in me than I had
in myself.
Father looked after the parks and
gardens for the council and had been with them since leaving school. Mother had
not worked outside of home since the first child was born. She used to work in
the Council Offices and that was where she met her husband.
All the unmarried children who had left
school had jobs except for the one who organised the meeting. She was in fact
the eldest sister. All hope was on the boy and Catherine, except now Catherine
was not going to school and had not been for nearly a year. Two of the sisters worked in an insurance
company, which was a very important local employer. Three boys worked for the
Parks and Gardens department. One girl was a life guard at the local public
Sports Complex that just opened and one boy looked after the gymnasium. The
parents had done well and you could see that it was a very close knit and
caring family.
Only the truck driver was absent. We
chatted and waited. The baby in the meantime was crawling in the middle with
the two older children fussing over her. Catherine sat close to mother and now
and again would hold her hand. I was not too sure who was comforting whom but
then family therapy was about observing the
family interactions.
Cricket boy was busy devouring a plate
of food mum left for him as he missed his school dinner.
Others were exchanging various gossips
about boyfriends and girlfriends.
I thought that this was fun but there
was also a lot to take in. The traditional approach would have allowed one to
be more focused but it would probably have taken a long time to get to where we
wanted to get to quickly.
When I heard air brakes, I knew that
big brother had arrived. Everybody else knew as well. Swiftly Catherine let go
of mum’s hand and went to the door. One
of the other sisters had the plate that had been kept warm in the oven set in a
tray complete with a big can of beer. I
declined the offer of beer as I was working.
Big brother was quite a big fellow but
was friendly enough as he shook hands with me. After a few bites and some gulps
of beer he turned to me and said:
“We are all here now. What is this about?”
“We are all here now. What is this about?”
To this challenge, I explained in a
very simple fashion why I wanted to see the whole family. I went on to use what
I had since described to my juniors as a journalistic approach to history
taking, as distinct from the traditional topic-by-topic approach. With the
journalistic mantra – Who? What? When? Where?
Why? How? – the patient or the family would just enter the conversation
barely aware that you were taking a history. To keep focused, you do need to
have clearly in your own mind the information you are seeking.
If you are not experienced, you can
follow a printed questionnaire and take three hours of history but you will
just end up with loads of seemingly unrelated information.
With my favoured journalistic approach
you follow leads. The whole session
becomes more integrated and it is easier for patients and families as you are
not likely to appear to be jumping from one thing to another. It also comes
across as more professional.
One thing led to another and my break
came when one of the boys let slip that he remembered mother going into
hospital after Catherine was born and big sister gave up a good job at the
insurance company to stay home to look after the rest of them.
Mother was in the local mental hospital
and had electrical shock treatment.
Mother started crying and big brother was rather
upset and asked me what relevance this had except to upset mum.
At this point, the little baby who had
been crawling around stopped in her track and crawled to Grandma and started
touching one of her slippers. She started crying too.
I have my own theory that even before
acquiring language, babies are able to retain emotional memory of early
experiences. Later on in life it becomes difficult to grasp the source of the
upset as there are no words to describe such emotional experiences. Traumas in
early life have diffused effects; those happening later on in life are more
focused and perhaps easier to deal with.
One famous psychiatrist once talked
about his own experience of his mother’s depression. He talked about having images of a wooden arm and it was through
years of psychoanalysis that he reconstructed the
whole image of his very depressed mother who had a rather catatonic posture in
the deepest depth of her depression. He could remember himself as a toddler running
into the house after play to be met with the wooden arm, sharply quietening
down and then backing off. It was a rather moving seminar he gave at one of the
conferences and a rare occasion when a British psychiatrist talked about
psychoanalysis.
Back with the big family – all went
rather quiet. A couple of the girls were sobbing. Catherine tried to comfort
mum who said she knew it was all her fault. The eldest brother thanked me for
making things clear for him.
All were relieved to hear that I would
not be forcing Catherine back to school and that mother would not be
prosecuted.
All agreed that Catherine would be
wasting her brains if she did not have some form of education and I explained
that I would be looking into alternatives.
Miss
Kimble told me later that I was lucky to have that break and that it was a good
job the baby was there.
It was uncanny that in my thirty plus
years of experience, over half of the children who had problems attending
school in a big way had mothers who
had serious puerperal (post-natal) depression. Was the school refusal (school phobia) a
clinical manifestation of genetically transmitted depression, or was it the
psychological effect of living with a depressed mother? I really do not know.
Catherine never managed to return to
“proper” school but with a fair bit of individual therapy we managed to get her
to attend a tutorial unit. This we achieved by getting mother to find some part
time work. Big sister too started working part time.
It was daunting for me to think that a
single family session brought about so much change, but then I was reminded
that the strength was with the family – we just tried to tap it.
Catherine had good exam results on the
limited subjects she could sit but was immediately offered a trainee post at
the insurance company.
Years later I bumped into one of the
older sisters at the Sports Centre. She
thanked me again for what I did for the family and told me that everybody was
fine.
I told her I was scared by the lot of
them especially her big brother. She told me I did all right. Catherine was his
favourite sister.
I cannot remember seeing another big
family since and with the disintegration of families it became increasingly
difficult to do that type of family work.
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