Bringing out the Best in a Psychiatrist (Nov/Dec 2006)Friday, 01 April 2011 07:59
Bringing Out the Best in a Psychiatrist
Published in Openmind Magazine November/December 2006
When I first arrived in England in 1968 I went to work in Whiteley Wood Clinic which was the professional clinic for the Department of Psychiatry at Sheffield University. The professor who had established both the department and the clinic, Professor Erwin Stengel, had just retired and Alec Jenner had come in his place. Stengel (no one called him Erwin) still spent a good deal of time at the clinic and would interview every new arrival, including my nine-year-old son Edward when he played in the clinic’s garden during the school holidays. I soon learned that when the matron of the clinic mentioned, ‘the professor’ she didn’t mean Alec who seemed in her eyes not to be maintaining the standards which Stengel had set.
One of the junior doctors told me about how Stengel had conducted his ward round. First Matron would inspect each ward to see that every patient had made his or her bed to the highest standard of neatness. Then, with the patients standing at attention beside their beds, Stengel, with his senior and junior registrars, Matron and a bevy of nurses following behind, walked slowly down the length of the ward, pausing briefly at each bed. He would inquire after the health of each patient, and each patient had to answer, ‘Very well, thank you, Professor.’ Any patient who tried to say something other than this would find that the procession immediately moved on, but a nurse would remain behind to order the patient to go to the matron’s office after the ward round. There Matron would deal with this troublesome patient in a way that ensured that he never spoke out of turn ever again.
One of Stengel’s many rules was that patients should not discuss their problems with one another but speak only to their psychiatrist when the psychiatrist invited them to do so. Alec abandoned Stengel’s style of ward round and instituted the professor’s case conference, a form of inquiry (inquisition?) which exists in the psychiatric system to this day, but, even though he didn’t enforce Stengel’s rule of no personal discussions between patients, the nurses still seemed to do so. The patients sat in the day room, saying very little. Their discussions with one another went on, as they always had, in the bathrooms. I discovered that the staff who knew most about any patient were the domestics who overhead, and probably joined in, the discussions in the bathrooms.
Patients at the clinic were especially well behaved, obedient and grateful. They had to be. The clinic took only the better type of patient. Any patient who didn’t conform to the rules, who got upset, threatened suicide, or, worst of all, got angry, was immediately dispatched to the big bin, Middlewood, where the patients too were very well behaved, obedient and grateful, but in much less pleasant surroundings. It is a mercy that Stengel and Matron couldn’t look into the future and see what happens now. Patients dare to criticise psychiatrists! What has the world come to?
To get a measure of the effrontery of ungrateful patients you have only to look up the website of the Highland Users Group and read their report called Psychiatrists: The views of 80 members of the Highland Users Group about why people are often reluctant to see a psychiatrist. The fact that it was a consultant psychiatrist who asked the group to carry out this research shows how ungrateful patients have worn down the doctors who should be receiving nothing but their patients’ total respect.
HUG held a series of meetings, and out of these discussions came the report. None of the results of these discussions, as listed in the report, would surprise the readers of Openmind. What would surprise and disconcert those professionals who guard their status jealously is the tone of the language in the report. Neither obsequious nor strident, it is the measured language of people who feel that they are talking to their equals. They wrote, ‘HUG members were at pains to say that many psychiatrists can be great helpers and healers, but the reality for many of us is that we have to live with experiences that are often traumatic and damaging. This sometimes means that there is little prospect of a speedy recovery. We felt that psychiatrists are in the privileged position of being witness to some of the inner pain we experience, but being witness to this means that they sometimes also have to deal with our disappointment and anger when those to whom we have turned for help are unable to find solutions that work. . . We have included some accounts of good and helpful experiences with psychiatrists. These are experiences that we feel should be the norm for all of us.’
Who could disagree with that?