PSYCHIATRY Past, Present and Future

Sidney Bloch, Stephen Green and Jeremy Holmes

This book appeared in a review by Lady Elaine Murphy of the House of Lords. She’d loved it. She called it “not a series of academic reviews but more the experience and wisdom gleaned during successful careers”. To me that sounded very cool. I was looking forward to some old shrinks reminiscing – bragging a bit of course, but also spilling the beans, admitting perhaps, with a touch of personal regret, to psychiatry’s many delusions and dead ends.

Gossip can be so educational.

I was hoping for a book a bit like Hellmann and Talmud’s “Ideally Speaking”. That’s a series of interviews with Jewish South Africans, in which 44 individuals look back on their lives to say how South Africa affected them – and what they did with their time on the planet. The baby-boomers in question (plus older siblings) were living in Israel, or Britain or America or Australia, or still in South Africa, and as usual with Jewish South Africans – I can vouch for this community, it’s the one I came from – they had plenty to say.

As it happens, “Psychiatry – Past, Present and Future” was exactly what Murphy said it wasn’t. It was a series of academic reviews! Expert doctor rehashes tired old lecture. Plus it came in tiny print with a drab grey cover. Not fair!

What was Lady Murphy thinking? Or after a day in the House of Lords does anything else seem interesting?

To be honest, I’ve had it with this type of reading material. I’m totally jaundiced. My bilirubin is a million.

Nevertheless I persisted – force of habit maybe – hacking my way through an academic briar patch that would have put off Br’er Rabbit (and he was born in a briar patch). The best was a review of cognitive therapy by its inventor, the American Aaron Beck. Another on psychodynamic psychiatry wasn’t bad – by Jeremy Holmes, the English go-to guy on the subject. And there was a thing on PTSD by an Israeli, Arieh Shalev, which was actually quite interesting. I’m trying to be reasonable here.

Funnily enough, there was one person who – Zelig like – appeared in both the psychiatry book and the South Africans book! That was Sidney Bloch, a Jewish South African psychiatrist now based in Melbourne. In the textbook, he gives a rather dry lecture on ethics in psychiatry. But in the memoirs he is fascinating. Firstly he talks about how he got into ethics, in the 1970s, through exposing the abuses of Soviet psychiatry. Then he talks about what it means to be a moral bystander: not in denial, but not doing much. Which is a pretty common kind of scenario generally.

Bloch remembers the fervour his youth group had for migrating to Israel, when they might instead have focussed on the local South African horrors. He recalls all the food they used to chuck away at summer camp, while so many people in the area were hungry. He describes too his recent attempts at reconciliation, when he tried to reconnect with old medical school alumni. One black doctor (blacks were segregated at his medical school) tells him, ‘It’s too late. You had your chance and missed it.’ Then an Afrikaner doctor (one of a small minority at that med. school) pours scorn on Bloch by saying, ‘We did more than you did, just by staying.’ But whatever the harsh truths, the interview is riveting, like many in “Ideally Speaking”.

By the time I got to child psychiatry – my own field – by the great Professor Sir Michael Rutter, I was ready to throw in the towel. I didn’t want to feel stupider than I already felt, so I junked it.

I’ll tell you about a good psychiatry book: George Vaillant’s “The Ego and Its Defense Mechanisms”. Despite its forbidding title, this book is a humdinger, dealing with human lives and the amazing ways they pan out. Vaillant, an American, draws on his own longitudinal (across many years) studies of (i) boys born into poverty and (ii) elite students at Harvard. Some of the kids in poverty overcome bad starts, even low IQ, to become pillars of their community. Some of the elite students lose the thread of their own lives. How does this happen?

Vaillant relates the lives of his subjects to the kinds of defence mechanisms they’ve used during those lives. In the process, we learn about defence mechanisms: their nature (unconscious), their purpose (to protect the mind from anxiety) their effectiveness (some better than others) and their maturation (usually in the cocoon of good, supportive relationships).

I don’t really like Freudian thinking, but defence mechanisms at least make sense to me. Reading Vaillant, I began to think of the mind as an octopus. A weird, amorphous animal, the octopus has an astonishing variety of defences. It can retreat into a crevice. It can squirt ink at you. It can poison you. It can swim away at top speed. It can tiptoe away on its tentacles. It can mimic other animals like fishes by swimming in an affected way. And similarly – if you’ll bear with me – the human mind can resort to the weirdest manoeuvres.

Anything but feel lost, or afraid, or rejected.