Mind & Ecology: Who is the Real Patient?

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

 The 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 a doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang

In psychiatry, sometimes patients do not want any help. Often they positively refuse help and family members collude. At other times the “help” may not be all that good.

As a result many children grow up in very “unusual” environments. Yet we sometimes get very “unusual” outcomes as some individuals can turn such an experience into something ……well, something quite extraordinary.

Obsessional Compulsive Disorder (OCD) is one such condition that many families prefer to cope with secretly and often for many many years.

                                                                     Chapter 19 The Cockroach Catcher

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang

Recently, I visited The Museum Of Modern Art ( MOMA) in New York and saw something that reminded me of my patient’s mother.

Mr. Song Dong is the artist and his mother is called Ms. Zhao.

Here is a write up in The New York Times:

“Mr. Song was born in Beijing in 1966, on the very eve of the Cultural Revolution, a period of ideological danger and economic want. His mother came from a wealthy family that lost everything after one of its members was jailed as an anti-Communist spy. His father, trained as an engineer, spent seven years in forced labor after being accused of counterrevolutionary activity.

“When Mr. Song’s father died, in 2002, his mother was inconsolable. She continued to live in the jammed Beijing house, throwing nothing away and obsessively bringing more stuff into it, as if continuing to feather a nest for a now-absent family. And despite the threatened destruction of the surrounding area, she would make no move that entailed parting with her possessions.

“Finally, in 2005, Mr. Song proposed that they turn the accumulated junk into an art project. In this way, he argued, nothing would be discarded and lost; everything would be meaningfully recycled and preserved. His mother agreed to this and together, with the help of Ms. Yin and Mr. Song’s sister, Song Hui, they emptied the premises.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang

“Seen in the museum’s immaculate surroundings…….it is disturbing to imagine anyone growing up, as Mr. Song did, in so smothering a physical environment. Finally, it is deeply moving to see the span of one person’s life — his mother’s — summed up, monument style, in a work of art that is every bit as much about loss as it is about muchness.

“And five years after the piece was conceived……..mother agreed to collaborate with her son, empty her home and effectively let go of her past, she moved into the more manageable setting of a Beijing apartment near a park, where she died last winter after falling from a step ladder while trying to rescue a wounded bird in a tree.”

Life could be cruel.

Waste Not: Projects 90: Song Dong

June 24, 2009–September 7, 2009

The Donald B. and Catherine C. Marron Atrium

MOMA

From Wild Duck:


"Deprive the average human being of his life-lie, and you rob him of his happiness."

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Readers' views.

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Waste Not: OCD & MOMA

Monday, December 12, 2011

Chapter 29: Psychiatry and Religion

 

The following is extracted from The Cockroach Catcher: Chapter 29 The Power of Prayers.

According to old Chinese advice, it is wise never to discuss politics or religion even amongst best friends.  Religious belief can often blur judgement in the wisest of people. In psychiatry it is sometimes not easy. This is particularly true in cases of florid psychosis, which often presents with symptoms of hallucination, delusion and even vision.

         I remember my early days of psychiatry in a mental hospital in Hong Kong. Yes, it was the days of 2000-bed hospitals. Yes, it was the days of Medical Superintendents who had supreme power and all doctors of whatever rank and experience were Mental Health Officers with special authority to sign papers for compulsory admissions. The forensic unit was contained within the same complex.

         Those were the days when we encountered psychosis in the raw so to speak. All the colony’s really mad people were admitted to this one place set in the furthest corner of the colony. In our year seven of us decided without much discussion that we all wanted to go into psychiatry. That was over 10% and all had quite idealistic reasons. It was perhaps a bit of a disappointment to our parents that we did not pursue a more conventional specialty that might provide us with more status and financial reward. Then there was the fear of contamination that somehow one might become mad too. Recent day medical students are said to shy away from psychiatry for these same reasons.

         Education seems to have little effect on superstition.

         I can vividly remember the day when three coach loads of a particular church descended at the front entrance to our hospital. We had one of those grand gates which somehow were never locked. Those that needed to be locked up would have been detained in their individual hospital wards. The hospital had extensive grounds, and was the only non-high rise public hospital in Hong Kong. Wards were individual self-contained buildings spread like a horseshoe, and in all there were eighteen of them. The wards were given numbers without names but the numbers served the same purpose: 3 was for acute male, 11 for GPI[1]’s and so on and so forth.

         Only the maximum security wards were air-conditioned to satisfy prison standards.

         In the middle of the horseshoe was the main medical block – the Medical Superintendent’s suite and the different staff rooms. Then there was the administration block where the kitchens were located. Laundry, refuse disposal etc. were a bit away from the main buildings, so was the Mortuary. Yes, there was a Mort. On call doctors carried out post mortems and very rarely would any outside pathologist be called in. There was much trust in doctors then. As there were dementia wards, people did die of natural causes especially when the weather changed.

         In a matter of a few weeks we learned a good deal. We learned a good deal about acute psychosis. We also learned a good deal about the other end of the spectrum, that of chronicity and dementia. We also became aware that suddenly we were no longer lowly medical students. Even though we were still junior we had certain status. Now someone cleaned our car every day for a small fee. The guards at the gate saluted you. The local restaurants knew there was a new group of doctors who would lunch regularly. Even the local shopkeepers gave us special treatment.

         Imagine the shock when three coach loads of church people descended upon this Institution to challenge one of its doctors.  The patient in question was a girl, and amongst other psychotic symptoms she had a vision. She was admitted the night before as she became unmanageable at home. She was sectioned and was now in the care of the team to which one of my good friends belonged. As luck would have it he was a devout Christian and managed to defuse the situation. Yes, she could be having a vision. Yes all necessary investigation would be carried out including that of the nervous system as she might have a brain tumour. Yes, please continue to pray for her. Yes, it could be the work of the devil.

         There was no brain tumour.

         There was no religious vision.

         The prayers worked.  She had a good doctor – my friend.  She was put on Stelazine[2].

         Some time in early February of 1978 I was called to do a Home Visit on a thirteen year old girl by Dr Pinkerton, a paediatric consultant. Dr Pinkerton had been the local Paed for years and was generally well regarded. She had, in my short time as consultant, referred a couple of cases, most notably that of a Tourette[3] syndrome and a boy with non-stoppable hiccups. Both cases put me in her A-list and I gathered that not many were on that list. Needless to say I realised too that her cases were never straightforward or simple.  Those she would have dealt with herself. The girl had upper arm stiffness on the left side and Dr Pinkerton could not find much else wrong with her, and so it crossed her mind that perhaps there was something psychiatrically wrong.  The girl was also carrying out some strange rituals around the house and Dr Pinkerton did wonder about psychosis or even catatonia[4].

         One of my two clinics was in this so called “new town”. Basically it was an idea conceived after the war in about 1949. The idea was that if people were moved out of the inner city their life would improve.  Because they often moved the same people from the same area to the exact same street in the new town the problems travelled with them. Old foes stayed in the same streets as warring neighbours. Yet generations of Local Councils continued to move people into newer housing estates, not understanding why they never managed to solve the problem.  I had visited a few of these new towns.

         The family I had to visit luckily did not have any enemies but they only moved three months ago and felt very isolated. They moved from a very tough neighbourhood in London not to get away from difficult neighbours. They moved because their daughter did not fit in. She was a timid shy adolescent who did not do normal South London teenage things and was becoming ostracised. She was not into drugs, smoking or drinking or even sex.  To her peers she was a weirdo.  After the move, father was able to find a job at the local airport and mother worked part time as a dinner lady at the local school. Feeling isolated, they went with a neighbour to a local church group and both parents had recently been converted.

         I was asked very early on by mother, although father did try to stop her, if this might be the work of the devil. She heard that the devil was always trying to do nasty things to anyone who had just become a Christian although she also heard that it could sometimes be God himself wanting to test her faith.

         Memories about my friend and the vision girl flooded back and I had not even had a chance to see what the problem was.

         I saw what mum meant. The girl was ignoring my presence. She was mumbling to herself and pacing around the room with a semi-fixed gaze. She held her left arm stiff in a half-raised position and was going round the room as if looking for bits of dirt on the wall and rubbing it.  It started about two days before when the parents came home from a church prayer meeting to find her non responsive. Since then she had had sips of water but hardly ate anything. Dr Pinkerton came out straight away to see her and called me in.

         There was really no significant medical or psychiatric history in the family. She was an only child with the history of the usual childhood ailments. She was average at school though the year before she was not performing well because of problems with other girls. Both parents were healthy although I noticed that mum was nursing a cold sore.

         I did wonder if catatonia was making a come back but the golden rule in psychiatry, as in General Medicine, is: if in doubt, observe.

         I told mother that it might be better if we got her into hospital for observation. After all they probably needed a break as they did not have any sleep properly since this started. The parents did try to take turns to catch some sleep but as father still had to go into work it was very exhausting.

         “But it would not be the mental hospital.”

         “No, it would be one of my beds in the paediatric ward, although it would not be the same hospital as Dr Pinkerton’s.”

         “Anything would do, Doctor. We leave it in your hands.”

         Even when we did not know what was going on, we had learned how to keep that from our patients. Was it cheating or was it just good doctoring? Patient’s confidence in you is as important as your medical knowledge. Perhaps that is why doctors are not doing so well nowadays.

         “You will sort her out, won’t you, doctor?”

         “Sure we shall. In hospital we can run a few tests including those on the brain just in case and then we can proceed with treatment.”

         “Have you seen cases like this before?”

         “Sure, not that many but we sure have.”

         What else could I have said? To be honest, I am only a junior consultant and I have never seen anything like this before, any further question?

         “I know you are good.  You have helped the boy with the swearing at our church. He now hardly swears.”

         My goodness. It is a small place.  I have been here only three months and people already know.

         All I knew was it would be easy enough if it was indeed the start of a psychotic illness and all would be all right though sad.

         I must first exclude rare but serious neurological conditions.

         I had no idea what was to hit me in the next twenty four hours.

         The hospital to which she was admitted was built during the war by Canadian soldiers. It was unusual for an English Hospital as all the wards were built of Red Cedar. All the wards were linked by covered walkways. Over time we all became very fond of it - a true cottage hospital. Everybody was friendly. Consultations were easy to arrange in such a place; I had used my two bed allocation regularly and had developed a good working relationship with the paediatric nursing staff. In fact the Tourette boy was one of the first admitted for observation and proved to be a great hit. Most had never heard of such cases and the few that had had never seen one. Then I had the boy who refused to eat what most others liked and I soon became the psychiatrist that brought interesting cases.

         They could not wait for my next case. Maybe not.

         Sister Clark used to be at University College Hospital in London where I had the good fortune of gaining some paediatric training. She moved here to look after her eighty eight year old mother. We knew we were in safe hands as there was nothing to replace a good Sister on any ward. They reminded us of important things to look out for and basically if we were not too pompous they would look after us. That way we tended not to miss a thing clinically.

         When I reached the ward after my day’s clinic, Sister took me to the nursing station. She said the girl was either pregnant or she had a full bladder. A quick examination revealed a soft mass up her umbilical level.

         How stupid of me. Remember: every female of child bearing age is pregnant until proved otherwise. Mother’s reassurance that she was not like the other girls fooled me. She must have found it difficult to tell her parents and therefore was in such a difficult psychiatric state. Faking mental illness would be one good way out.

         I thought: great!  At least I could deliver. Pregnancy test and OB consult and that would be it.

         But hang on. Would mother not notice her sickness if she was this big? Would she not have complained about other symptoms? Something was not fitting in. And she still looked pre-pubescent.

         Perhaps we should catheterise her. She had not been seen to use the toilet for hours although she was not drinking much. She was still going round in her room – we gave her the side room and a nurse – and we put on an input output chart so we knew. The new junior doctor’s car broke down so she was late in examining her.

         Bother, I forgot it was changeover time, when new doctors came in for their new six-month rotation.  This is one of the days of the year not to be ill.

         “Good work Sister. What do we do without you?”

         Sister did the catheterisation but only got about 150ml. The mass was still there.

         I phoned Ob-Gyn. The consultant had left for home, but I got her Senior Registrar.

         He came over. Yes, it was possible that she was pregnant but unlikely as there were no breast changes. He would hate to do an X-ray but that seemed justified in the case of an undiagnosed abdominal mass.

         My mind was racing now. Sometimes you do have to believe what you see. Sometimes you have to believe the parents. She was not one of those girls. She could not be pregnant. So now we had to go through the differential diagnosis for abdominal mass in a young girl of thirteen.

         Ovarian cyst was the obvious one.

         This big?

         Possible.

         No. It cannot be.

         The x-ray came back. The tell tale tooth was there and yes – a Teratoma[5], the distinctive type of tumour that can include teeth, hair, sometimes, even a jaw and tongue.  I guessed just a split second before the results came back. How annoying.

         Working diagnosis: Teratoma with possible toxic psychosis.

         Emergency operation was arranged. Yes, she would be fine a little while after the operation, I reassured the parents.

         The paediatric junior arrived and took some history and did a quick physical before she was prepared for the theatre. This petite doctor with a very babyish face told me that on her first day in her last job she had to do an emergency tracheotomy. This time she had been on call for the last three nights and the battery in her old Mini could not cope with the heavy frost so she had to wait for AA before coming. She was most apologetic for not having got in earlier.

         She asked if I had seen many toxic psychosis cases and I asked if she had come across any in her psychiatric placement. As with all good psychiatrists answering a question with another is in our blood and here it worked well.

         Neither of us knew what was to hit us next.

         At 2 A.M. I had a call from her.

         “Your patient – I mean our patient could not be aroused after the operation. Yes they removed the teratoma, complete and intact. It is bigger than any specimen I have seen but she could not be aroused.  Any ideas?”

         “Call the paediatrician on call in the regional paediatric unit and I will be in.”

         What happened?  I asked myself as I drove to the hospital.

         What had we done? This was fast becoming a nightmare situation.

         What was I going to say to the parents?

         Something else was going on here, and I was not happy because I did not know what it was. I was supposed to know and I generally did. After all I was the consultant now.

         Thank goodness she could breathe without assistance. That was the first thing I noticed. I saw mother in the corner obviously in tears. She asked if her daughter would be all right. I cannot remember what I said but knowing myself I could not have said anything too discouraging. But then I knew I was in tricky territory and it was unlikely to be the territory of a child psychiatrist.

         A good doctor is one who is not afraid to ask for help but he must also know where to ask.

         “Get me Great Ormond Street.”

         “I already did.”

         She is going to be a good doctor.

         “Well, the Regional unit said that they had no beds so I thought I should ring up my classmate at GOS and she talked to her SR who said “send her in”.”

         Who needs consultants when juniors have that kind of network?  This girl will do well.

         “Everything has been set up. The ambulance will be here in about half an hour and if it is all right I would like to go with her.”

         “Yes, you do and thanks a lot.”

         I told mother that we were transferring her daughter to the best children’s hospital in England if not in the world and the doctor would stay with her in the ambulance. She would be fine.

         When I got into work later that day, my secretary asked how my patient was as she heard from her friend that the church was going to hold a 24-hour vigil for her.

         Trust my secretary. She knew someone from the same church and she always had the knack of extracting information first hand.

         “They say this may be the work of the devil as the doctors and surgeons all did the right things and removed this big tumour but the devil must have got to her.”

         I did have a vague fear that there might have been some anaesthetic accident but quickly told myself off for thinking along that line. I knew all the anaesthetists and such a thing could never have happened.

         I was back at the hospital to deal with an overdose case. The junior was there and we had a chat in Sister’s office.

         They had to ventilate her. That was the first thing she told me. I thanked her for going up there and she said it was scary but she felt important and the mother who was in the ambulance could not thank her enough.

         She was impressed with mother’s faith and trust in God.

         She said mother was near to tears. It was bad enough to have such a large Teratoma and then to have the patient unconscious with no one knowing what was going on was very frightening.

         “I have seen some deaths as a medical student but never since I was registered. I do not want this to be my first.”

         I knew the feeling well but what could I say? A doctor has to face it some time.

         “Do you believe there is God?” She asked

         “Do you really think I can answer that one?”

         “Well, you have more experience.”

         “To me it is like reading a good book. You would not know until the end.”

         “So you mean I am not going to know until then.”

         “Interpret whichever way you like. I remember Jung in his Memoir gave quite an account on the Holy Trinity.  There were seventeen bishops in Jung’s family including his own father. Jung had always been puzzled by deity and the bible and most of all by the concept of the Holy Trinity. I know many religious philosophers struggle with that too. By some accident he had access to his father’s inner library. He saw this folder clearly marked Holy Trinity. The relief was phenomenal. He could now have the answer. He hesitated before opening the folder.”

         “What did the folder contain?”

         “See, you want the last chapter. I wanted to know as well. The folder contained pieces of blank paper.”

         “That was it?”

         “That was it.”

         “Well. My view is this. We are here. We live. We help others to live and maybe we do not ask too many questions and we might or might not in the end know the answer.”

         “But do you think this girl is going to live though? I do not want this girl to be my first death. It would be so awful.”

         “Neither do I. I keep saying to myself that it is now over seventy two hours and she is still alive and I do know that some cases of viral encephalitis can be very dramatic in presentation and recovery.”

         “But which virus?”

         “The nearest I have is Herpes.”

         “Mother’s cold sore.”

         “You have noticed that too.”

         “I was with her for a long time.”

         We had our own prayer for her too. Let it be Herpes encephalitis and all would be well.

         I left the hospital feeling slightly strange. I just had a philosophical encounter with a young doctor. How strange it is that threats of death always get one thinking about these things.

         The girl remained unconscious although the word was that the EEG was more hopeful than was first thought.  GOS decided to transfer her next door to Queen Square - National Hospital for Nervous Diseases. A lumber puncture[6] was done and the initial findings were in keeping with viral encephalitis. They were now trying to grow the virus. They also wanted Queen Square to decide on assisted ventilation.

         There was now a candlelight vigil at the church and it was hoped that there would always be a lit candle until she came home. The story was in the local paper and radio. Faith was now on field test if not on trial. The doctors were not. They had done their best.

         On the 10^th day the ventilator came off, and she was able to breathe without support.

         They then started a vigil in the girl’s home.

         By the 23^rd day, as my optimism was about to give in, word came from the hospital that she became conscious. It became big news in the papers.

         When mother came home from London, she came to see my secretary to give her the details. She told my secretary that she always knew that her daughter would live.

         No virus was ever isolated and her diagnosis on discharge was that she had a variant of Encephalitis Lethargica[7].

         “Did you agree with the diagnosis?” The junior asked me when I saw her next.

         “Why should I be arguing with the best neurological centre in the world? It is harder to argue with a variant of Lethargica. However the next few months or years will be important. If she is well then Herpes fits in better and often it is an allergic type of reaction on first exposure. But if she is like those in Awakenings[8], then Encephalitis Lethargica.”

         I saw her at the local hospital rehab a couple of times. Initially there were a good deal of residual symptoms including awkward gait and dis-inhibition. She became better and was moved to a specialised centre and that was the last I heard of her.

         Ten years later mother came to see my secretary and left a photo. It was a photo of her daughter and her new baby. She had been working at the local bank since she left school, met a very nice man and now she had a baby. Mother thought I might remember them and perhaps I would be pleased with the outcome.

         I was very pleased for them too but I would hate for anyone to put faith or god to such a test too often.

---

[1] GPI - General paresis of the insane.  A now-rare neuropsychiatric disorder affecting the brain and central nervous system. A late complication of syphilis.

[2] Stelazine - trifluoperazine hydrochloride, an antipsychotic widely used for schizophrenia before the new generation of drugs came on the market.

[3] Tourette syndrome - Over 100 years ago, the French physician Georges Gilles de la Tourette wrote an article in which he described nine individuals who, since childhood, had suffered from involuntary movements and sounds and compulsive rituals or behaviours. In his honor, this constellation of symptoms was named Gilles de la Tourette's Syndrome. Today, we recognize that Tourette's is a spectrum disorder, with some people having a few tics and others having tics plus features of other conditions such as obsessions, compulsions, inattention, impulsivity, mood variability. Once thought to be a rare condition, Tourette's is a fairly common childhood-onset condition.

http://www.tourettesyndrome.net/tourette.htm

[4] Catatonia - Catatonia is a disturbance of motor behaviour that can have either a psychological or neurological cause. Its most well-known form involves a rigid, immobile position that is held by a person for a considerable length of time— often days, weeks, or longer. It can also refer to agitated, purposeless motor activity that is not stimulated by something in the environment. A less extreme form of catatonia involves very slow motor activity. Often, the physical posture of a catatonic individual is unusual and/or inappropriate, and the individual may hold a posture if placed in it by someone else.

http://www.minddisorders.com/Br-Del/Catatonia.html

[5] Teratoma – Teratomas are tumors comprising more than a single cell type derived from more than one germ layer. Usually, dermoid cysts contain representative tissues of the three embryonic germ cell layers: ectoderm, mesoderm and endoderm. Sebaceous material, hairs, cartilages, teeth, even thyroid tissue are frequently observed. A well-formed jaw and tongue has been reported. Teratomas of other organs have also been reported to contain teeth.

[6] lumbar puncture – A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. 

[7] Encephalitis Lethargica - a disease characterized by high fever, headache, double vision, delayed physical and mental response, and lethargy. In acute cases, patients may enter coma.

http://www.ninds.nih.gov/disorders/encephalitis_lethargica/encephalitis_lethargica.htm

[8] Awakenings –  Oliver Sacks’ remarkable account of a group of patients who contracted sleeping-sickness during the great epidemic just after World War I. Frozen in a decades-long sleep, these men and women were given up as hopeless until 1969, when Dr. Sacks gave them the then-new drug L-DOPA, which had an astonishing, explosive, "awakening" effect. This account inspired the 1990 film of the same name, starring Robert De Niro and Robin Williams.

http://www.oliversacks.com/awake.htm

Post Script:
“Ten years later mother came to see my secretary and left a photo. It was a photo of her daughter and her new baby. She had been working at the local bank since she left school, met a very nice man and now she had a baby. Mother thought I might remember them and perhaps I would be pleased with the outcome.

I was very pleased for them too but I would hate for anyone to put faith or god to such a test too often.”