It is now fifty years since I started working at the Brook Hospital in Woolwich, and more than forty years since I picked up my Springfield Hospital pager on my first day as a psychiatric trainee. I have done a lot of different things as a psychiatrist. Amongst them, I am most proud of what was achieved in Liverpool, working with a group of really talented people to establish a different sort of relationship between mental health services and the multi-cultural population that lived in the inner city area. Winsor House, which I was involved in setting up, is pictured.
I wrote the piece below a few years before I left Liverpool for North Wales, when I was 45. I submitted the article to be considered for publication in the Personal View section of the British Medical Journal. I never received an acknowledgement and I guess it got lost in transit. I forgot about it until I found a faded copy in an old box file recently. It mentions earlier versions of some of the ideas that I have explored in greater depth in this blog.
16/6/2001
An ordinary Friday. I’d forgotten that the Specialist Registrar from Accident and Emergency would be coming. He was a pleasant bloke, who had asked if he could be attached to our community psychiatric team for a while. I was pleased that he had recognised that this might be of benefit to him.
Over coffee it turned out that he’d approached me because a colleague had told him that I was the only sane psychiatrist he knew. I was distinctly disappointed. I’ve always embraced and celebrated the outcast status of the psychiatrist within medicine. If the standard of sanity is the personal conduct of, for example, some surgeons, then I’ll stand shoulder to shoulder with my patients any time. The mad psychiatrist motif goes all the way back to Dr Caligari’s Cabinet and beyond, and I think it reflects a primitive fear that mental illness is contagious; only those fearful of mental illness could think it taints those who treat it.
As it turned out, I had to leave the inpatient review halfway through the morning. There was a 35 year-old lady in the cells at the Crown Court who needed to be seen. My new colleague and I drove down there together. On the way, he asked me if I enjoyed my work (because most consultants seemed unhappy) and I found myself saying that after 20 years as a psychiatrist, I still love my job. OK, it’s stressful, but it’s never boring. I find it hard to sympathise with the incessant moaning of hospital doctors over their loss of status and the demands of managers. I’ve always felt that doctors are too unaccountable and now the profession is reaping the reward for failing to put its own house in order. I’ve generally found that managers want the same thing as me, better services, although, as with doctors, there’s a huge variability in managers’ ability and integrity.
When we got to the court, the lady had a chronic schizophrenic illness. She’d been homeless and out of contact with services for years. She’d kept her symptoms under control through heavy opiate use, and now that she was weaning herself off drugs, the voices and paranoid fears were returning. Everyone with this kind of lifestyle falls foul of the law, and she had plenty of previous. Charged with a very ordinary bag snatching, she faced five years to life under New Labour’s three-strikes-and-you’re-out legislation. The judge, or stipendiary magistrate, ignorant of the Mental Health Act, but keen to go to lunch, allowed me to admit her to hospital. Her barrister was very grateful. If I hadn’t come down personally, she said, her client could’ve gone to prison for years, cut off from any possibility of proper treatment. ‘Tough on crime, tough on the causes of crime’. Tony Blair’s historic second landslide seems to be built on populist nonsense which crushes the vulnerable in order to win votes from people who have little interest in how lives go wrong, and with no understanding of the causes of crime at all. I have rarely been so ashamed of being a Labour voter.
On the way back, we stopped off at a well-attended event organised for and by service users. One of my patients, Denise, was singing a few songs and she had asked me to go along, if I could find the time. The MC read the introduction that Denise had written. She described herself as a service user and student, she thanked her fellow students for their support, including her band, and then she thanked me, publicly. I’ve known Denise for a very long time. She’s suffered from a very destructive psychotic illness, and she’s been extremely ill at times. Recently, however, things have been a lot better and her involvement with the band reflects that. I’ve not done anything special, just stuck with her through bad times and good. Only a fool (I often say) would become a psychiatrist because they wanted to be popular, so I was very touched that Denise chose to thank me in that way.
It was her actual singing that gave me a massive visceral lift and brought tears to my eyes. Now I’m a musician myself, I hear every bum note and I know the difference between adequate and good. Denise sang in a rich contralto jazz-soul voice, with perfect control and with a beautiful balance of emotion and restraint. She sang a particularly exquisite version of one of my favourite songs, Bacharach and David’s Walk On By. It was as good a performance as I’ve ever heard in any venue.
Like all truly great blues, her singing seemed to carry in it the triumph of the human spirit over adversity. Her poise and sensitivity defied the consequences of a dreadful illness and its social stigma. New Labour want the mentally ill to be more thoroughly controlled, but good mental health isn’t about being controlled, it’s about liberation.
Just an ordinary Friday. I’ll stand shoulder to shoulder with my patients any time.
Rob Poole
Consultant Psychiatrist
Liverpool