In the late 50s I and a few school friends used to sit in the back yard of one friend's village hut, grinding away a black vinyl.
This
friend had a single record and so we got to know the music pretty well. He had a very old fashioned integrated
system, turntable, amplifier and speaker all housed in a neat upright
cabinet. The image came back to me of
him using his finger to clear the dust collected on the cartridge needle. It was strange that my friend who lived in a
hut should own an old gramophone player and one single record. But it turned out that his father was a
Traditional Chinese Medicine practitioner and managed to leave China early
enough to have his record player.
That was
how my classical music appreciation started, with two of my favourite pieces of
music. On one side of my friend's record
was Bruch's violin concerto and on the other Mendelssohn's. Years
later, I went to the Royal Festival Hall in London to
hear the violinist Chloe Hanslip perform the Mendelssohn. It was hard to suppress my emotions when I
saw her coming on stage and starting to play on her Guarneri del Gesu
1737. Of course she played exquisitely.
I have
talked about my radio making days in another episode. From radio, I moved on to assembling my own
pre-amplifier and amplifier, and finally my own record player from a kit as it
was the cheapest way to get good sound.
One of my uncles gave me my first vinyl: Brahms Symphony No.
1 with Karl Böhm conducting the Vienna Symphony Orchestra. Another village friend lent me his Beethoven's 3rd Symphony.
Moving to
England meant that my music playing equipment had to be left behind, but my
passion never dwindled. After saving
enough, I ended up getting one of the best vinyl players, the Linn Sondek
coupled with Exposure Pre and Power Amplifiers.
The music
world soon progressed to digital vinyl recordings, the precursor to CDs. Now everything is in the air so to speak,
with all the streaming going on.
Still I
treasure our old black vinyl days.
I am lost to the worldwith which I used to waste so much time,It has heard nothing from me for so longthat it may very well believe that I am dead! It is of no consequence to meWhether it thinks me dead;I cannot deny it,for I really am dead to the world. I am dead to the world's tumult,And I rest in a quiet realm!I live alone in my heaven,In my love and in my song.I did not know Mahler's music. No, not when I started at the Tavistock Clinic in 1973.
One day at
our referral meeting, a very interesting case turned up from none other than
the much revered paediatrician Dr. B at the Royal Free up the road from
us. In the early 70s referrals were
specific to the individual teams. I had
a suspicion that Dr. B liked to refer cases to my consultant as most of her
cases landed on our team. Dr. C's solid
history of working with the eminent Paediatrician, Donald Winnicott might have
something to do with it. Dr. B was a
very flamboyant character and I had met her at a couple of child protection
conferences where she spoke with great authority and commanded much esteem and
fear. I must admit I prefer her kind of
consultant that knows her specialty and shows great respect for similarly
capable colleagues.
Dr. C did
not routinely put patients on psychotherapy and very often managed patients and
their parents through good practical advice, and Dr. B was aware of this. To our surprise, with this case Dr. B
specifically asked if the 14-year old could have psychotherapy and preferably
with someone that knew a bit about music.
We all gasped but nobody made any comment.
I joined
the Tavistock Clinic, London's premiere psychoanalytic centre, not
knowing what to expect. In my nearly three years of training there, it had
never crossed my mind that one should use medication on children with
psychiatric problems, and I never once wrote a prescription. This is in stark contrast to practices in the
US.
My prime
years of child psychiatric training in a drug free environment were fantastic
in ways that I only realised years later.
I am what you would call a true organic free range Child Psychiatrist!
Miss Weiss
the Quaker social worker spoke up for me.
"Dr.
Zhang is very fond of music and he is forever carrying boxes of records
borrowed from the Swiss Cottage Library!"
It was
Miss Weiss who tipped me off about the extensive classical music collection at
the local library.
Well, that
settled it, and I got the fourteen-year old boy, my first adolescent. The small
kids I could cope with by playing with them. This new case would involve real
talking therapy. All eyes were on me and
I put on a brave face.
I told my
colleagues that from an early age, I sat in on my cousin's piano lessons, and I
listened to vinyls first played on my village friend's entry level integrated
gramophone system, and then on my own home built one. In high school I even ran the lunch-time
school music club, selecting classical music repertoire for introduction to new
devotees. I had never worked out why,
but at that time there might be the belief that even just listening was good
enough. China has now embraced music in
a big way, more so because Mao banned it for a number of years. It is now the world's largest piano producer
and piano playing is growing fast, with more than 40 million children estimated
to be learning the instrument.
"Who
is your favourite composer?"
"I
now pick up some unusual and less well-known works. Because older records are rather scratchy, at
Swiss Cottage Library I tend to go for
the brand new ones and often complete box sets.."
"Like
complete Mozart's Quintets?"
Nothing
seemed to escape the eyes of Miss Weiss, who was also an avid music lover. She lived virtually next door to the Royal
Festival Hall and
regularly went there for concerts.
"And
Peter Grimes, which of course is Dr. C's territory!"
I loved
the way the referral meeting turned into a cultural discussion. The significance of my early child
psychotherapy training has never been lost on me.
As
mentioned in another episode, Dr. C had a nice bungalow in Aldeburgh, the home of Benjamin Britten and Peter
Pears. The opera 'Peter Grimes' I had
never heard of until one day in Swiss Cottage Library when the librarian was
placing new records onto the shelves and enthusiastically recommended it to
me. A few years later Dr. C invited our
family to spend a week at Aldeburgh and we paid pilgrimage to The Maltings,
attending a Peter Pears recital. At the
seafront, we also met Imogen Holst, daughter of the composer. It took another thirty years before we first
saw a performance of Peter Grimes at the Royal Opera House.
Joshua,
the fourteen-year old boy referred to us, was said to be struggling with
everything and most seriously of all with his mother, and Dr. B thought he
would benefit from some fairly deep therapy.
By then, I
had seen quite a few children and on the whole conversant with the use of toys
and drawings as vehicles of communication.
For children who were a bit too old for the toys, I threw in Winnicott's
squiggle game[1]
now and again. Interestingly, most other junior doctors
were more at ease with the older adolescents and often came round to our case
presentations to hear about the management of younger kids. It was only when I became a consultant that I
realised that while I enjoyed working with the very young children, many of my
colleagues avoided them.
Now that I
had been thrown into the deep end, I had no idea what to do. I had learned from Winnicott's squiggle game
the importance of the therapist's quick response and spontaneity. Why should talking to the older child be any
different? This approach helped the
doctor to establish rapport very quickly especially with parents and served me
well all the way through to my Consultant days.
I learned from my gurus and teachers that we did not have to be held
back by rigidity.
At the
clinic, the team set-up was such that parents were seen by the lead social
worker Miss Weiss or her social worker trainee, and occasionally by Dr. C; the child was seen by the junior doctor and
only assessed by the psychologist if referred by the consultant.
As it
turned out, Joshua's father was a Surgeon at the Hospital where Dr. B worked,
and his mother taught piano at his school, one of the best known state school
in the area. The school had such a good
reputation that many of the professional class living in Hampstead sent their children
there. Do we still wonder why good areas
have good schools? It is only natural that good areas with intelligent pupils
attract good teachers. It goes on.
Joshua
first noticed the Mondrian on the wall.
"Did
some kid do that? Very neat!"
Perhaps he
was right. Picasso wanted to draw like a
kid too.
Then he
noticed the records I was about to return to the library: Mozart Quintets.
"Mozart's best. He
wrote these for himself!"
That was
how we started. Some might think I
plotted it by putting the records on my desk.
I wish I could have claimed to have planned it. Even to this day, I believe spontaneous
responses are best.
Joshua was
very knowledgeable as far as music was concerned. Yet I was not quite prepared for what he
bestowed on me as the sessions progressed.
Some
therapists thought they were supposed to be a mirror to let the patient see
more clearly their own psyche. Others
were more assertive and felt compelled to make interpretations, not realising
that often one was limited by one's own psyche or understanding of it. Hence the need for some personal analysis to
deal with that aspect.
There is
of course a world of difference between reflection and interpretation. My personal feeling is that there needs to be
a balance between the two.
Psychotherapy
is thus quite far removed from medical history taking. In a serious medical episode, there is a need
to get a clear view of the events leading up to the episode. This enables appropriate investigations to be
carried out, and the right course of treatment determined.
Psychotherapy
affords us the luxury of a deeper understanding of the patient without having
to ask probing questions. It goes
without saying that with the more frequent therapy sessions, the therapist
gains a very profound insight of the patient without the need to go through an
intensive and compact history taking. We
also tend to remember these patients literally forever.
Joshua
hardly saw his father as he was busy with his patients. His mother would have been a concert pianist
but she had to make a choice and she chose bringing up Joshua and looking after
a rather nice house on the Heath. But
she had high hopes for Joshua, her only child.
Yes, to be something she could only dream of, a concert pianist.
Joshua had
been a good piano player but when he turned nine he told mother he would like
to learn the violin.
He picked
that up in no time and at sixteen was ready for his Grade 8 violin examination. He quit piano playing at Grade 5.
As I
progressed with Joshua, the very strange role I played became clear. I was his
mother that he could talk to, argue with and more importantly confide in. And perhaps also somebody with whom to
practise crossing swords with his parents.
It was easier for him, as I was not his mother and on the other hand I
was. But I was the one who could provide
some answer his mother would not give him.
One day I
had a complete set of Brahms Symphonies
on my desk, from the library of course, and he casually asked if Brahms was my
favourite composer or not.
Brahms 1st Symphony
was a present given to me by one of my uncles when I made my amplifier. He worked for Abbotts in Hong Kong and when I
got to medical school, he gave me my Littmann Stethoscope.
"I
love the First, especially the solo violin part in the last movement."
"Well,
you should listen to Mahler as he
composed solo singing parts to go with the orchestra, unlike Beethoven's Choral Symphony.
And my best Mahler is his Third Symphony, though everybody else I know
prefers the Second."
I had two
commuting friends that cared about music and they had not talked about Mahler once.
I tried
that day to secure any Mahler recording at
the library and could only find one: Das Lied von der Erde.
It was a
revelation to my commuting friends and they could not believe what they read on
the record sleeve: Chinese poems translated by a German!
At the
next session, Joshua was at his most enthused and energetic. He could not wait
to tell me more about Mahler.
"The
Third Symphony is all about nature and so positive and invigorating!"
I have to
say now that I have probably gained more from this one patient than I have from
any other. To have been introduced to Mahler at the time
when London was just waking up to it, and wake up it did!
Joshua and
I were able to talk about Mahler's struggles, the sadness brought by the death of
his daughter and the Rheumatic Heart Disease that eventually led to his death
One day he
was able to declare that his struggles were nothing compared to Mahler's.
It is
interesting that he never really talked about his own sadness as Mahler's overshadowed his and yet in true traditional
psychotherapy style he gained his own insight.
His time
with me or my time with him was coming to an end. Dr. C was highly intuitive and on the
recommendation of my psychotherapy supervisor helped me to terminate the
therapy. It was a credit to a state
funded system like the NHS that one did not need to hang on to therapy for
ensuring an adequate income stream. The
main risk attached to privately funded psychotherapy is the unnecessary
prolongation of therapy period, thus leading to the addiction of the patient to
the therapist or vice versa.
At the
last session, he told me he got distinction in Grade 8 Violin but he did not
want to be a violinist.
He wanted
to be a conductor.
In 2009,
Das Lied von der Erde was performed in Hong Kong. As I wrote this, I Googled and found that
Joshua was the conductor at a European opera house.
