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Volume 1, Number 1, 2001



Volume 10, Number 1



"Always be kind. Always be nice. You never know what troubles another person has."

- Stepmother of a little girl who committed suicide

A colleague shot himself some months ago. He was a child psychiatrist at a mental health clinic, and rumours from the kitchen said he was a refugee from a collapsed marriage and from the United States army, where he had been a high-ranking officer. He was past his half-century, a stocky man with an army shave of iron hair and the manner of a man of Mars, with a hobnailed tread and vaguely military dress: a sort of flak jacket, all pleats and pouches, belt a jingle with useful things, and everything topped off by a beret, its rim flat against his ear. His colour was high, but it hardly lent his eye a terrible aspect - nor let it pry through the portage of his head like the brass cannon: his eyes were shy and wounded. He had the depressive's sweet humility, but his bearing could be so brisk and brusque I feared I had offended him.

Like W.S. Gilbert's modern major-general, he was a brilliant man who knew everything about a range of things from trains, tobacco, pocket watches and different sorts of corn to such a treasure trove of psychiatric information and arcana that he seemed like an encyclopedia in combat boots. I often asked if I could borrow his head for the weekend to help stock up and refurbish my own mental furniture and was rewarded by the gruff bark of his laugh, so sweet because so rare.

I do not know what battles he had to fight. We all fight life on several fronts but our deadliest enemy is always ourselves - a sort of fifth column in the mind. Psychiatrists also are their patients' mercenaries in valiant sorties against psychosis and in long sieges against their demons. Wars are depleting. At times the work can seem achingly dull, as one hopelessly rustles the papers, or so extravagantly tragic that some histories almost make one laugh from sheer shock. One is aware of colleagues' derision about the glacial slowness of change during psychotherapy and, in the bleak watches of the night, one braves a bombardment of self-doubt: did a patient improve because of a dazzling interpretation or because he found a new girlfriend? No wonder Napoleon demanded of his marshals a two-o'clock-in-the-morning courage. Few of us have it, especially when Big Bertha opens up: Is this the way I want to spend my life? Is this it? Do I really do any good? and so on. Often a patient and the psychiatrist are unaware of what awaits them in psychotherapy. It is a bit like joining a laughing, singing crowd at a recruiting office when war is declared only to find oneself, 6 months later, without a leg, in a tangle of barbed wire. Many adult psychiatrists can protect themselves from the pain and horror of their subject by "medicalizing" it: poring over that drab slab of the DSMIII becoming "excited" by brain-imaging techniques, histamine receptors and the limbic lobe and by yet another trumpeted psychotropic with a name as long as your arm and no better than its brothers.

Surely it is far harder for child psychiatrists to numb their sympathy. How poignant it must be to reach out to a wounded child and be met by cynicism and rebuff, and how maddening to stand by, powerless, as parents slowly murder the soul of their child or children. Psychiatrists must have to suppress so much anger at the apparent opacity of some parents to themselves and at their cruelty and neglect; at the same time, the physician cannot forget that parents are children too - the victims of other victims - and, despite their behaviour, deserving of affection and respect.

What about allies and comrades? Aye, there's the rub. At a clinic a doctor is never really part of the "team." This is partly due to transference -the unconscious transfer of attitudes, fantasies, feelings and so on from important people in one's childhood to a person in the present. I believe that most people caring for the mentally ill have serious unresolved problems with their parents. So the doctor, as a parent figure, can expect to be the recipient of bucketsful of hostility expressed openly or in disguise. I think a common camouflage for transference toward a male doctor is a condescending feminism or an angry concern with rape and child abuse; at such times a man usually feels vaguely suspect and blameworthy. Or free speech may be suppressed. I remember complimenting a new occupational-therapy student on her pretty dress and watching her expression as she struggled with her natural grace and pleasure and a need to toe the party line and pretend that the remark was a prelude to the violation of her person. Again, drearier still, the staff may advocate half-crazed therapists and philosophies a la Shirley MacLaine. My fear that I had somehow offended my colleague was a transference from my own father, a dyspeptic major in the Royal Artillery with a damson face and ever ready with an unnecessary rebuke or a barked command. Although I have more silver in the hair than in the pocket, I am often 9 years old inside, which made me withdraw from my colleague when I could have moved toward him.

Hostility is also driven by envy of the doctor's superior salary and status and the veriest tyro believes he or she knows more about life and human nature than a psychiatrist. Hostility can become open and poisonous; one senior nurse rejoiced in rhetorical questions. "Why are psychiatrists so stoopid?" she would ask. "Don't you think all doctors are assholes?" When she treated our colleague with her customary insolence, I watched him slowly and silently light his pipe. I dare say this proud man had learnt tolerance from playing with his little patients with whom he loved to frolic on the carpet.

A doctor's job is a lonely one. Two senior nurses told me that nurses have little sympathy for physicians in distress and cannot deal with it. Instead, most become rattled and demoralized. Of course, one's peers may be little better. I remember a young psychiatric resident's shock at listening to two professors of psychiatry discussing a doctor who was mentally ill; they had reservations about treating him because the prognosis was bad and their reputations might suffer. Their reputations, one for hubris and buffoonery and the other for a sort of malignant solipsism, remain untarnished to this day. I dare say they had never heard the ditty from the musical show 'Jamaica":

Napoleon's a pastry,
Bismarck is a herring,
Alexander's just crème de cacao with rum,
And Herbie Hoover is a vac-u-um.

So much for the bubble reputation. But I cannot cast a stone. As Mark Twain wrote: "The human race is a race of cowards; and I am not only marching in that procession but carrying a banner."1 I carry a large banner too. The young resident? She left psychiatry and now works happily in another specialty.

Badinage was toilsome for our colleague. Another psychiatrist at the clinic was a kindly older lady who relished military history. Together we warmed away the autumn chill with tales of flashing sabres as cavalry cantered against red squares, silent on their ridge at Waterloo. Or we thought sadly of Lord Raglan braving the ice and sleet in the Crimea, then slowly dying, dosed with opium and lead acetate. Our colleague rarely joined in although he certainly "knew at sight a Mauser rifle from a javelin." He belonged to a steely age of grim-jawed military efficiency far removed from the glories of the military tailor and the squalid romance of Victorian battles, laundered by sentimentality and time.

On two occasions, transferred withdrawal, hostility or moral cowardice made me passive. One was when my colleague advertised his distress at a party by drinking heavily, then, to fortify himself for the drive home, he paraded caffeine tablets in column along the arm of his chair and ate them one by one. A few pursed-lipped colleagues feigned a bogus outrage but less from sadistic virtue than from an excuse to take a swipe at a physician. I said and did nothing.

On another bad day at a retreat, a high-priced import from America told us all to choose a person with whom we felt uncomfortable and confide how we believed he or she experienced us. "Go on," he said, "after all, your clients have to do it with you every day." The older woman psychiatrist demurred with an expression Jane Austen might have worn if told a joke in doubtful taste. I saw my colleague glance at me but I flicked my eyes away and was buttonholed by a sweet-faced young nurse in Birkenstock sandals and granny glasses, who smelled of fresh-baked bread and summer savory. My colleague strode off muttering to fortify himself at the hotel bar.

I had lost an opportunity to understand him better and to be understood myself, perhaps to forge a bit of a friendship. I shall always regret it. And if I had been rebuffed -so what? I shall have many more rebuffs in my life. When another physician's practice and reputation collapsed in catastrophe out of the billows of schadenfreude and foam-flecked moralizing, one person said something sensible. "All he needed was someone to talk to."

Spike Milligan, the famous British humorist who wrote the Goon Show, suffered from depression all his life. Milligan could certainly be formidably tart and critical, but when depressed, he longed for someone to notice and to talk to him. He believed his psychiatrist had never suffered from severe depression, but a man like my colleague, with his demons' clawmarks plain to see, could have easily sympathized with Mr. Milligan and those similarly wounded.

Our colleague's suffering is unbearable to think about. What sick horror, hopelessness and self-loathing made him execute himself so savagely? At his memorial service a social worker told an anecdote to emphasize our colleague's autocratic style. One can only remember Longfellow: "If we could read the secret history of our enemies, we should find in each man's life sorrow and suffering enough to disarm all hostility."2 A senior psychiatrist broke down and wept when describing our colleague's goodness, suffering and compassion.

When I look down the ranks of my textbooks their little wisdom is summed up in the words of a neighbourhood pharmacist: "Be nice. Enjoy your life." Be nice. During the First World War, on the day before a battle, camps grew quieter and soldiers became kinder, more tender and more generous to each other before they went over the top. None of us has that long to live. As many of us step into the high summer and autumn of our careers, becoming dumpier, pudgier, more self-important and absurd, why not stretch out a helping hand to a stumbling colleague? The colleague we lost was not only a man of Mars but also a child of Saturn.

Daniel Day-Lewis wrote about the death of his father, Cecil Day-Lewis:

Since that bizarre, alienated, emotionless encounter with the great scythe, which left me reeling from my own indifference, my sense of loss has grown, soured, devoured, belched and finally purified into what it is now -the eternal certainty of grief ignorance and the mystery of love.3


  1. Ayers A: The Wit and Wisdom of Mark Twain, Penguin Bks, Toronto, 1987
  2. Roger J, McWilliams P: You Can't Afford the Luxury of a Negative Thought, Bantam, New York, 1991
  3. Day-Lewis D: Actor from the shadows. New Yorker, 1992; Oct. 12
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