Thursday, 30 August 2012

Reminiscences on the first Moon landing and what it meant for the people of Lancashire

The death of Neil Armstrong, the first person to set foot on the Moon, on August 25th 2012, brought to mind a flood of memories about that event and a little essay I wrote 39 years later for the Skeptical Adversaria, 2007 (4).  On this occasion I have given the essay a title.

Reminiscences on the first Moon landing and what it meant for the people of Lancashire

On a certain day, almost forty years ago, I was waiting to be served in a sweet shop in Rawtenstall, a mill town, as it was then described, in Lancashire.  The woman in front of me paid for her purchases and ended her conversation with the shopkeeper with the words ‘Scientists! It’ll rain, just you see!’

The date was July 16th 1969, and NASA was about to launch Apollo 11, the spaceship that would transport the first human beings to the Moon.  It seemed to me unreasonable, to say the least, that a spaceship taking off in Florida would cause rain to fall in Lancashire, over 5,000 miles away, on the same day.  But that was this lady’s main concern when it came to the Apollo Moon Mission.

At that time I was doing a vacation job in the local Parks and Cemeteries Department.  The Moon Mission was a regular topic of conversation amongst the workmen and we were all pretty much captivated.  Interestingly, many of these men had seen active service during the War and for no good reason, so it seemed to me, expressed some strong anti-American sentiments.  In particular there were two conflicting complaints: one was that America should have joined us earlier than 1941, the other that they should have kept out of Europe altogether and ‘left it to the British to finish Hitler off’.  I wouldn’t be surprised if there were some individuals who espoused either point of view depending on what company they were in.

Especially vocal on this subject was Harry, a strange man who had in the past campaigned for the Communist Party but at a later stage had done something of an about turn and decided that all the ills of the nation were due to the education of the working classes, night school (‘f***ing neet school’) being a particular target for his venom.

I think I can still recite Harry’s tirade about the American soldiers he encountered when in the army during the War.  It started off ‘F***ing Yanks! Their ´eads were so stuffed up with ´ow good their own country were, they’d never ´eard o´ Lancashire’ and the rest was 75% expletives.

In fact Harry had indirectly put his finger on the crucial point.  Like many of his generation, it was Harry’s head that had been so stuffed up with how good his country was that he expected everyone else to have heard of Lancashire.  It took some time for it to dawn on him (if it ever did) and the rest of us that we weren’t top dog anymore – it was America.  Even as Harry spoke, Mr Harold Wilson, who six years earlier had spoken of the ‘Britain that is going to be forged in the white heat of this revolution’ was busy managing our national decline.  And the reality was that it was the Americans and Russians who were, in the main, responsible for ‘finishing Hitler off’, and all but ending fascism in Europe.  Thanks to America also, we eventually, saw off communism too. 

The Moon Mission was not without its critics in the UK.  The historian Mr A.J.P. Taylor declared on television that it was all a fuss over nothing and of no historical consequence (‘the biggest non-event of my lifetime’) and his friend Mr Malcolm Muggeridge opined that, as a human achievement, it came nowhere near the verses of Mr T.S. Elliot.  Many people, myself included, held that money spent on sending people to the Moon would be better used to help alleviate world poverty and famine.  On the other hand, a supporter of the mission was, naturally, the popular astronomer Mr Patrick Moore, who argued that because spaceships have to travel through radiation and radiation is used to treat cancer, spending money on space travel would help patients suffering from cancer.

Whatever the case, there are certain things that cannot be disputed about the Apollo Moon Mission (unless, like some people, you think the whole thing was a hoax).  It was, to be sure, a triumph for the American people and their leaders, but also a triumph for humankind, a stunning demonstration of what men and women are capable of achieving when they work together.  For once, people all over the planet were able to share a collective sense of awe and wonder at a historical event that wasn’t a war or the imminence of war, or the detonation of a weapon of mass destruction, or the assassination of a world leader, or a great natural disaster.  It was something positive and exciting.  There was no anger or bitterness; nobody was threatened and nobody got hurt. And, of course, it was, and remains, a triumph for science

So, on that day 39 years ago, three men set off on their journey to the Moon.  And – for once – it didn’t rain in Lancashire.

Michael Heap, December 2007

Sunday, 12 August 2012

Hospitals or Supermarkets?

The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means (Aneurin Bevan on the NHS, 1952).

Doesn’t it follow that if people are pursuing healthier and safer lifestyles they will suffer fewer illnesses and accidents, therefore putting less demand on our National Health Service?  Does it not follow that if there were fewer demands on our NHS, medical staff would have more time and recourses to devote to those people who do have the misfortune to fall ill or suffer injury? 
And wouldn’t all of this be a good thing?
Apparently not!
At the time of the 1997 general election, the Conservative Government boasted that while they had been in power more people had been using the NHS than ever before.  And not long ago, one of the managers of a hospital rejoiced in the fact that since the adoption of a public-private initiative, the number of people attending the hospital had risen by 8%.
Recently I was reading a reader’s letter in the Rossendale Free Press (3.8.12), the local newspaper where I was born and brought up (and which I still have delivered, mainly to read the obituaries).  There had been concern that some people were unaware that a medical injuries unit had been opened in April 2012 in their locality.  The unit provides treatment for common minor injuries such as scalds, burns, stings, bites, and suspected broken bones.  The letter was from from Ms Susan Warburton, Head of Community Services, NHS East Lancashire, and brings us some good news.  The number of people being treated at the unit has been steadily increasing and is exceeding all expectation.  ‘I am delighted with the success of the unit’, she announces.

I have an image in my head of an undertaker rubbing his hands on hearing the news of a massacre.  Surely the fact that more injured people are coming to the unit is a cause for concern rather than delight?  Shouldn’t the course of action be to urge greater safety on the part of the public and to encourage them to keep their own first-aid facilities to hand in case they need them?  My own experience of being bitten, stung or burnt (in a minor way) is that I am perfectly capable of taking the right course of action myself without bothering the medical profession.  

Surely, adopting the above advice could result in fewer people having to attend the clinic and then the NHS would save money because they wouldn’t need so many staff …….. ah! … ahem! …. yes … I see!
Sick people attending NHS clinics and hospitals are no longer patients (i.e. ‘suffering’); they are ‘service users’, ‘consumers’ or ‘customers’ and success is judged by how many there are.  Is our health service now thus part of the service industry and isn’t one of its major purposes to provide jobs for people and ensure that they hold on to their jobs?

Wednesday, 18 April 2012

Stories for Posterity 3: Child Psychotherapy at the Royal Free Hospital in the 1970s

This is the third of my stories about events I have witnessed that I believe should be ‘preserved for posterity’.  Once again it concerns children.

In the 1970s, I worked for over four years in the Department of Psychiatry at the Royal Free Hospital, Hampstead, London.  For the first three years I was undergoing training in clinical psychology.  I worked mainly with adult patients but I also did some sessions with children.  There were two clinical teams there that took referrals for children, adolescents and families; one was headed by Dr Joan Cornwell and the other by Dr Alick Elithorn.  Dr Cornwell’s was the larger team and included a number of psychotherapists who were training at the nearby Tavistock Institute, as well as qualified staff.  Every week there would be a case presentation by a therapist, often attended by a woman called Isca Wittenberg who came up from the Tavistock in a supervisory capacity. 

The dominant school of therapy in which most therapists had been trained or were training was the psychoanalytic approach of Melanie Klein.  The therapists were taught to interpret, often directly to the child, much of what the child did or said in therapy by reference to certain bodily parts, how big these parts were, what the child wanted to do with them, what he or she unconsciously thought about the therapist and wanted to do with her, and so on.  (I did not formally train in child psychotherapy and was, accordingly, limited to using more mundane methods in my efforts to help children who were referred to me).  

As an example, I recall a case presentation in which the therapist described how in one session a child she was seeing, a boy I shall call ‘John’ who had either encopresis or enuresis (I am not sure now), was playing with some toy soldiers.  While he was doing this, the therapist gave an elaborate explanation to him of how the soldiers represented penises of different size and what his playing with them revealed about his fantasies.  It was either in this or a similar presentation that the therapist described how the boy would put his hands over his ears while she was offering these interpretations. 

When, nearly 35 years later, I recall these and other similar events, I think about how people in any other context might land themselves in trouble by this kind of activity with a child and how the law would distinguish the licit and illicit circumstances in which such activity takes place.  I do recall reading a letter that the mother of one child had written to his therapist, describing how her son had arrived home confused and upset from his last session in which the therapist had referred to penises.  The mother, while expressing gratitude to the therapist for the help she was giving her son, expressed the view that she really oughtn’t to be talking about penises with him.  It was evident that the mother was unable to relate this to her son’s problems.

There appeared to me to be no lack of restraint, such as the requirement for good evidence, on the notions that the staff were willing to entertain and express.  For example, I remember at a case discussion the presenter referring to a little boy she had seen who was born with a medical problem that impaired his hearing.  One member of staff immediately interjected, ‘I wonder what he didn’t want to hear!’  It seemed that those present at least did not share the view that I imagine most people would have of this comment. 

Indeed in many important aspects, the ideas about child development and childcare that informed the work of most of the staff would be alien to those held by the majority of the public, including parents and others professionally involved with children.  It was also clear that amongst those most hostile were the psychiatrists on the adult wing.  I recall an invited case presentation to the whole psychiatric department given by two of the psychotherapists from the unit, who chose to discuss several session of family therapy they had undertaken in the case of boy with incontinence.  The rationale of their opting for family therapy was that they considered the boy’s wetting to be a manifestation of unacknowledged or unresolved emotional conflicts in the family as a whole.  When, at the meeting, the time came time for questions and discussion, the psychiatrists from the adult department expressed with some vigour their disdain for the therapists’ theory and outrage that the entire family had to be subjected to this kind of treatment on account of the boy’s having a not uncommon problem.  As it happened, the therapists reported that the family stopped attending after about five sessions, the boy still being incontinent.  I was surprised that the therapists had chosen to present one of their failures, but what I have to say later may go some way to explaining this.

What has now brought these memories to my mind is the current publicity surrounding a film entitled Le Mur or The Wall in France concerning psychoanalytic theories of autism and the psychoanalytic treatment of autistic children.  The underlying message of the film is that psychoanalysis provides a misleading and potentially damaging account of autism; that it does not offer an effective treatment modality; and that there are now behavioural and educative programmes that can have profoundly beneficial effects for autistic children.  The film also reveals the powerful influence that psychoanalysis exerts on French psychiatry.  Three of the psychoanalysts who were interviewed in the film have successfully sued the film’s producers, who have been fined and charged legal costs and have been forced to remove the film from the internet.  .

It is clear from the accounts of those interviewed in the film that, in France at least, psychoanalysts continue to adhere to an early, and now little-held theory of autism, namely that the source of the autistic child’s problems is a failure of the parents, particularly the mother, to bond emotionally with the child - hence the expression ‘refrigerator mother’.  Nowadays, mainstream psychiatrists and psychologists consider the condition to be a developmental brain disorder with a genetic basis.

Viewing the film (before it was censored), rekindled many of the memories of my time at the child psychiatry unit and these include the level of criticism and belittlement that staff expressed about the mothers of the children referred to the unit – not directly, but in case discussions, conversations, and clinical notes and records.  In other words, because of her own emotional weaknesses, Mother was usually to blame.  I have a particular memory that encapsulates this attitude.  One of the therapists had interviewed the family of a child with emotional problems, the mother of whom had a physical disability of some severity which affected her gross body movements and articulation (though her intellect was spared).  The therapist illustrated this poor woman’s difficulties by vividly re-enacting her responses to some of the questions raised in the interview, the purpose clearly being to convey to us what she believed to be the damaging impact on the child of having a mother who was incapacitated in this way.  The outcome of the assessment of the family was that it was proposed to have the child sent to a residential school away from the mother.  I do not believe this happened and I recall reading a most aggrieved letter that the mother wrote to the therapist in question, informing her that there was no way that she would allow her to break up her family.     

If, to me and others, the ideas and practices of the staff at the unit seem, as I noted earlier, ‘alien’, is it not fair to ask, ‘Who are we to judge these “experts”?’ and should it not be insisted that what matters most is how successful they were in helping the children overcome their problems?  This is exactly what I would say to myself at the time, being mindful that I was only a neophyte psychologist myself.  However, I have to say that as time went by I could see very little evidence that the children, young people, and families who attended the unit derived much benefit; in fact, the majority defaulted on their attendance after a few appointments, usually one or two.  In other words, ‘The punters voted with their feet’. (I confirmed this by periodically studying random samples of patients’ files as a way to learn more about child and family therapy; for the reason given it proved a disappointing exercise.)  

It seemed to me that the people working in the unit should have been aware of all this and been questioning the validity and utility of the theory and practices in which they had trained or were training.  Yet everyone seemed curiously indifferent to outcome; the main source of interest – indeed fascination – seemed to be what the children did in their therapy sessions and how it was to be interpreted.  For example, at the case presentation of John and the game of soldiers, the therapist revealed that he had been in therapy for quite some time (at least a year - my memory is unclear on this point).  Someone asked in passing what was the current status of his presenting problem, incontinence.  The therapist stated, as though this were a minor detail, that his problem was unchanged.  Yet at the end of the meeting she was highly praised by those attending for her skill, insight and ingenuity.  It was also agreed that it was time to draw the boy’s therapy to a close; this process would require another six months of therapy to deal with ‘separation issues’. 

If there was any criticism or questioning at all about ideas and practices, the response was usually to interpret this in terms of the dogma espoused at the unit, ‘negative counter-transference’ being a favourite expression at such times.  

I was reminded of this indifference as to outcome when viewing Le Mur. Towards the end of the film, the therapists were asked what an autistic child can gain from psychoanalysis.  Their reactions suggest that they considered the question to be completely absurd.  The response of one of them was to put his head down for an inordinate length of time, look back up, grin, and announce, ‘the pleasure of taking interest in a soap bubble’.

Looking back, I believe that my time on the unit taught me more about child psychotherapists than children themselves.  The experiences at the unit that I have described are ones that colleagues have also informed me they themselves have had at similar departments.  I need to say that I have since had experience of other child and adolescent services which I would highly commend for offering a range of psychological interventions and which encourage a more critical approach to the work undertaken.  Also, nowadays there is greater emphasis by NHS managers on continual audit, cost-effectiveness, and performance and outcome measures. 

Incidentally, one of the adult psychiatrists at the Royal Free Hospital (Dr Sylvio Benaim) informed me that he once had dinner with Melanie Klein (she died in 1960); he mentioned behaviour therapy (then up-and-coming) and she told him that she thought there was ‘something in it’.

Thursday, 22 March 2012

True Stories for Posterity 2: The Children of Bocholt

This is another story that I wish to be ‘recorded for posterity’ in case no record now exists and all those involved have died. It was told to me in the 1980s by a witness I shall call John. I have no reason to disbelieve John, but some details are a little uncertain or incomplete because of shortcomings in John’s memory of the events and my memory of what John told me. 

During the Second World War John was a soldier in the British Army. Right at the end of the war he was in Bocholt in Germany. One day he and his comrades came across two groups of soldiers from opposing sides. John told me that he thought that the soldiers from one group were Canadian and that those from the other group were East European. The latter, who had some children with them, were being threatened by the Allied troops and in an apparent attempt to placate their assailants they pushed the children towards them and made gestures indicating that the children were available for sexual exploitation. Nearby was some kind of military structure for housing a small number of soldiers and equipment (I cannot now remember the name John gave to this).  

John looked on in horror at the next sequel of events. The Allied soldiers pushed the other soldiers and the children into this construction and shut them inside. They had a large gun with them (again I cannot remember what John called this). Having thus entombed the enemy troops and the children, the Allied soldiers then took aim with the gun and fired a shell that blew up the construction and its contents.   

For many years afterwards, the memory of this incident played on John’s mind every single day. ‘Why did I not push the gun over before they could fire it?’ was the question he repeatedly asked himself. 

There is a sad sequel to this story. It is not necessary to record this for posterity and for John’s sake I shall not do so. It may suffice for me to say that John was not a bad man and I am sure that the events that led to my meeting him would never had occurred had he not been witness to this terrible incident.

Friday, 24 February 2012

True Stories for Posterity 1: Mr J.W.H. Gastall

I may be no different from most people in feeling that there are certain incidents that I have witnessed in my life, an account of which ought to exist somewhere in some form or other, lest any record of their having occurred at all is lost. 
In my case, most of these incidents seem to be events that should never have happened.  Particularly, they are occasions when certain individuals were allowed to do things that they shouldn’t have done and nobody seemed too concerned.  Likewise, however, there are times when people have acted with remarkable humanity, courage, and generosity but once again no recognition of this is to be found anywhere.  It seems to me wrong and unfair that any acknowledgement of these events – good or bad - should cease to exist altogether, even in the minds of the people concerned, who will anyway die at some stage if they haven’t already done so.   
That the stories of these events are available to the public is perhaps of most immediate concern, rather than whether anyone actually avails himself or herself of the information.  We may say that they should be ‘preserved for posterity’.  I also believe that the storyteller should be dispassionate and unmotivated by malice or self-interest, and should strive to present a fair and factual account, with due acknowledgement of the problems of bias, misinterpretation, misinformation and faulty memory.
The following is the first of some stories that I want to ‘preserve for posterity’.  
Two stories for posterity concerning Mr J.W.H. Gastall
The memory of this event has stayed with me for 53 years at the time of writing.  In the 1950s I attended a junior school in Lancashire called Waterfoot County Council School.  Our headmaster was John W. H. Gastall (1913-1997), who was once a professional footballer.  Mr Gastall used to punish his pupils by hitting them with a leather strap on their hands or buttocks.  Now and again he would administer the punishment in the school hall while all the pupils were in their classrooms.  The child he was strapping would first have to go round the hall and open each classroom door so that the whole school could listen to what was happening.

One such child was 'Shirley'.  She was about 8 years old and came from a poor family; her clothes were scruffy and she was one of those children who always seemed to have a trail of mucus streaming down one nostril to her upper lip.  'Shirley' got into trouble when she stole a watch from one of her classmates.  She was found out and Mr Gastall gave her four strokes of the strap.  I remember the door of the classroom opening and the class then went quiet as we listened to the sound of Mr Gastall's strap landing on 'Shirley' as she sobbed and yelped with each lashing. Some girls who knew 'Shirley' happened to be in our classroom at the time and they started giggling amongst themsleves until reprimanded by our teacher.  After a minute, the classrom door was closed and we all got on with our work.
The next incident, of which I was informed separately by two former pupils of Waterfoot School, happened after I had left.  Mr Gastall once repeatedly lashed with his strap a little boy, whom I shall call ‘Mark’, as a punishment for truanting.  While he was doing this, Mark’s shrieks and pleas for mercy echoed round the school to the amusement of other pupils.  I understand that the teacher present remarked on the severity of the thrashing once Mr Gastall had finished.  He then explained to the other little children present that he had been particularly harsh with Mark on this occasion as he had truanted on the Queen’s birthday.   Her Majesty would, I am sure, have been most appreciative.