Pre-registration house jobs were supposed to comprise twelve months working under close supervision whilst a decision was made whether the doctor should be allowed to work as an autonomous medical practitioner. In practice, it was unheard of that anyone should fail to move from provisional to full registration. My house jobs were due to end on 31st July 1981 and I needed to think very carefully about which psychiatric training scheme to apply for. The decision felt momentous . These rotations consisted of six to eight posts, each lasting six months. The posts were based in a particular hospital or group of hospitals. The most prestigious of these was the rotation based at the Maudsley and Bethlem Hospitals in South London. The least prestigious training schemes were those rotations based in large rural mental hospitals with no affiliation to an academic institution.
There were geographical considerations to take into account. My wife and I were not ready to leave London. We had money in our pockets for the first time in our lives, and we were enjoying unrestricted access to the unsurpassed range of cultural activities that London offered. We went to gigs, films and exhibitions several times each week. As South East Londoners, we did not seriously consider living or working North of the River. Many of my father’s family lived Over The Water and I knew Tottenham and Edmonton well. I considered North London to be a dark, sooty, depressing place, with minimal open space and little evidence of civilisation.
There were four psychiatric training rotations available in South London: Guy’s, Thomas’s, the Maudsley and St George’s. In order to make a choice, I consulted Kingsley Norton, who I first made friends with when I was a medical student and he was a very young trainee psychiatrist. Kingsley went onto become the medical director of the Henderson Hospital in Sutton and a renowned authority on therapeutic communities. His advice was that I should not even consider working at St Thomas’s. The department of psychological medicine there had been dominated for many years by William Sargent, a dogmatic and controversial biological psychiatrist. Sargant was often in the papers and on the television, and it was unfortunate that some of the treatments that he so stridently advocated had, in the fullness of time, been shown to be ineffective and sometimes dangerous. Sargent had retired, but his legacy persisted. A few years later, he sent his autobiography to every psychiatrist in the country, because he thought it would be improving for them.
According to Kingsley, Guy’s was respectable and offered a good training, but the training at St George’s was much richer in terms of psychotherapy. If I intended to become an academic, I should think hard about the Maudsley. It seemed pretty obvious that I should apply to St George’s. At that stage, I had no interest in being a researcher, but as far as George’s was concerned, there was the lingering worry over my serial embarrassments over the care of the boy with the irritable hip a few weeks earlier. However, my lack of ambition, combined with the Maudsley’s reputation as a competitive and stressful place to work, and I did not fancy it. In any case, I doubted that the Maudsley would have me, as my undergraduate career had been academically undistinguished.
Candidates for the St George’s psychiatric training scheme were encouraged to meet with the postgraduate clinical tutor, Loïc Hemsi. The ostensible purpose was to learn about the scheme, but informal discussion also gave Loïc an opportunity to weigh up the candidate. Some psychiatric trainees at St George’s found Loïc daunting, but I liked him from the start. I worked with him later on and he became a friend and a seminal influence. Loïc was a Jewish Arab, short in stature but large in personality. He grew up in Cairo. He was a polymath, an extraordinary linguist, music lover and pioneer of old age psychiatry. His conversation would range from Proust to Mahler to cybernetics, always punctuated by snippets of gossip. Working with him was my earliest exposure to the potential of community psychiatry. He was a creature of the left, and I learned an enormous amount from him. He was my doctoral supervisor when he died suddenly of a heart attack at a meeting at the Royal Society of Medicine at aged 54, surrounded by useless senior psychiatrists just after I was appointed to my first consultant post
At our first encounter, Loïc was friendly and warm. In an open white shirt without a tie, he described the training scheme and he told me what they were looking for in prospective trainees. He was encouraging but warned me that competition for these jobs was fierce. He later told me that I should have mentioned that to him I had come second for the undergraduate prize for psychiatry, but I did not even think of it. I would have been too proud to have mentioned coming second at anything.
Three posts were available. I applied and was duly short-listed for the St George’s SHO/Registrar psychiatric training scheme. The arrangements for the interviews were unusual. All of the candidates were told to arrive at the same time, and were left sitting around a table whilst each in turn was called. In my memory, the room was windowless, but my recollection may have been affected by the uneasy atmosphere. My memory of that day has become conflated with the film Twelve Angry Men, except that the film had a happy outcome. Chris Simpson, Simon Gowers and I were friends, having been medical students at St George’s together. The rest were strangers to us and to each other. Simon, Chris and I bantered with a false bonhomie, which others present later complained was a deliberate ploy to wind up everyone else. It was not. We were, I think, just trying to control our own anxiety and, being young, we were insensitive to our impact on everyone else. Or at least, I was. At the start, we were advised to wait after we had been seen, as the result would be announced at the end of the afternoon.
I was eventually called in for my interview. There were nine senior psychiatrists on the other side of a long board room table. One of them was smiling at me. It was the father of my former patient. He rapidly interjected that he had a conflict of interests as I had recently looked after his son “very nicely”. I thought he was being sarcastic, but he meant it. However, success as a psychiatrist (whether deserved or not) lay in the future. In retrospect, I did the worst interview I have ever done, and sure enough, I did not get the job. Neither did Chris. The only one of us that was successful was Simon, following his infuriating tradition of winning at everything, from space invaders to job interviews. It was a shame that he was such a nice person . As for me, I was niave about psychiatry and I was niave about myself.
I was immediately summoned to meet with Loïc. He was encouraging. He suggested I should apply again, filling in the time for six months, perhaps with another Egyptian psychiatrist, Mounir Ekdawi. He also suggested the Priory Hospital in Roehampton, which was never a possibility, given my life-long antagonism to private medicine. Mounir, I quickly learned, was a distinguished psychiatrist but was also a notable painter. The service he led at Netherne (home of the famous Wing and Brown ‘Three Hospitals’ experiment) was a national demonstration centre in psychiatric rehabilitation. If I had to fail to secure a training place at St George’s, at least I could work with someone interesting for six months.
One sunny morning, I drove to the Surrey hills, and followed the long corniche to Netherne Hospital. I duly was interviewed and was offered the job. I was pleased. I accepted on the spot and said I would start on Monday, this being Friday. As soon as I got home to Bromley, I was thrown into a panic. There was a telegram on the doormat, addressed to me. Telegrams have long been discontinued but they were the only way of communicating quickly, long before mobile phones. One of the successful candidates had dropped out. Would I like the job in her place? Starting almost immediately. In one morning, I had gone from having no job to having two, one of which I desperately wanted, but the other one I had already accepted. That weekend I struggled with my conflicting feelings about what to do. In the end, there was no alternative to explaining what had happened to Netherne and see what they said.
Netherne turned out to be relaxed. I hardly had the opportunity to get all the details out on the phone before the Clinical Tutor said that of course I must take up the opportunity at St George’s. A whole weekend had been wasted worrying. I hope I returned the favour to another generation of trainees later in my career.
I had nothing to do but to kill time for a bit, but there was the Royal Wedding. Younger readers will think I refer to Camilla or to William. Instead, on 29th July 1981, we endured the second great Royal event of my lifetime. The first had been the Queen’s Silver Jubilee in 1977, which was not quite so over the top, but still an orgy of deference. We held a party the night before in the hope we would oversleep and miss the wedding of Lady Diana Spencer and the then Prince Charles. It was a strange mixture of the couple being awkward, expensive pageantry and excessive obsequiousness from every one that commented.
We sat late into the night, on my balcony in Bromley, drinking and smoking, intending to sleep through the Wedding. In the event, we did not stay awake. After a walk in the early morning sun, we watched the initial coverage with much exhausted amusement as the early voice recognition software generated gobbledygook. Then we went swimming in a deserted swimming baths.
Finally, the fateful day arrived when I started work at Springfield Hospital, the start of an exceptionally long career in psychiatry that has taken me to all kinds of places, real and emotional, that I never knew existed. It was Tuesday 1st September 1981. I remember bright sunshine, but I may be wrong. Springfield was then a traditional Victorian Asylum, with a large resident population (“long-stay”) and a separate, much more transient population in the acute wards. Our recollection is mainly concerned with the long stay wards of old mental hospitals, quite rightly, because they housed people without hope, much as they had done since the late 19th Century. The acute wards were entirely different, mainly dormitories, light, modern and optimistic, with a lot of active psychotherapy and therapeutic communities.
I did not enter the hospital up the long, grand front drive to the main entrance, as I had done on arrival as a medical student. I came in back way, close to Tooting Bec tube station, the Glenburnie Gate as it was known. There was a Victorian porters’ lodge there, where I was to pick up my pager or bleep. The damned thing immediately went off. I called the number, and the student nurse who had called me had no idea that I was a complete novice. She was agitated. She was calling from one of the long stay wards, the location of which was a mystery to me. One of the residents, an inpatient since the late 1940s, had got up as usual, but instead of shaving had cut his throat and appeared to be dead. It was an awful scenario, but I did not have to witness it. The consultant arrived on the ward as she was explaining to me, and the call was cancelled. The lot of the chronically institutionalised has been a major preoccupation of mine ever since. I wondered if every day was going to be like this. It has never happened again, but my adult life as a psychiatrist had started.