The Cockroach Catcher: Black Vinyl Days & Inverted Therapy: My first adolescent patient!

Tuesday, August 30, 2022

Black Vinyl Days & Inverted Therapy: My first adolescent patient!

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 world

with which I used to waste so much time,

It has heard nothing from me for so long

that it may very well believe that I am dead!

It is of no consequence to me

Whether 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.

Mahler

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.

[1] https://www.ncbi.nlm.nih.gov/pubmed/7005855