An Accidental Psychiatric Nurse.

Part 21. Up the Pole.

‘Up the pole’ was commonly used at Oakwood Hospital in 1978 and I don’t think I’ve heard it again since then. Maybe it was peculiar to that hospital or maybe it was swept away in the asylum closure programme of the 1980s. ‘Floridly psychotic’ was the clinical alternative to ‘up the pole’, although it’s a mystery to me how medicine adopted the word ‘florid’. The idea of a botanical psychosis is appealing and if there is such a thing, I hope it’s called Blodeuwedd Syndrome after the character composed of flowers in the Mabinogion. A better alternative to both ‘up the pole’ and ‘floridly psychotic’ is ‘turbulence’, a word preferred by one patient I knew to describe his moments of madness: ‘Brace! Brace!’

According to my Google research, ‘up the pole’ can also mean pregnant, but only in Ireland. At Tooting Bec, a no-nonsense, straight-talking senior nurse rudely greeted news of Eira’s second pregnancy with ‘up the fucking duff again’. Honest at least. By this time we were actively looking for ways to move to Wales, a decision confirmed one Saturday afternoon when a real life ‘up the pole’ event occurred on the Deaf Unit.

To cut a long story short, he had an Andrew Tate type personality, although his faults could be excused by his age (18) and life experience (trauma and a childhood in care). He wore the brittle protective shell suit of a dominant alpha male, spending too much time lifting weights, checking his biceps and trying to wind people up. His communication in sign language was slick and articulate and he easily and often insulted, mocked and ridiculed other patients, using graphic signs and imagery that were surprisingly innovative and grossly offensive. There was nothing pathological about this in a strictly medical sense and indeed it probably fell within the normal limits for a certain subset of adolescent lads. On the other hand, it was certainly debatable whether the Deaf Unit was the right environment for him. Essentially, he represented the disadvantaged side of the more privileged Trump/Johnson/Tory donor coin.

This particular Saturday afternoon I felt compelled to have a word with him about another episode of signed abuse. His response was a well-delivered left hook to my eye, worthy of Henry Cooper in his prime. Luckily I’m not a trained boxer; if I were, I imagine my instinctual response would have been an immediate upper cut followed by instant dismissal. In fact, he instantly dismissed himself by fleeing outside, climbing a telegraph pole and refusing to come down. Following a quick risk assessment (what if he fell? Imagine the paperwork…) I dialled 999. Possibly the first time the Police had been called to Springfield Hospital. These days I understand they are regularly called to acute units around the country. Everything’s gone up the pole.

An Accidental Psychiatric Nurse.

Part 20. A Stitch in Time: the Case of Language Deprivation.

The Garden of Earthly Delights (detail). Hieronymous Bosch.

Arriving to work at the London Deaf Mental Health Unit in the late 80s and early 90s often felt like walking into an Hieronymous Bosch hellscape. The worst Deaf Club ever. The problem was unintentionally caused by well-meaning staff who were suffering from a mild case of Hearing Saviour Complex. In the early years their search and rescue missions had enjoyed some success, extracting a small number of deaf patients from one of Surrey’s learning disability hospitals and bringing them back to a semi-natural habitat in the microcosmic deaf world of the Deaf Unit. At the same time, a number of people, usually young adults, with actual neurodivergent or developmental issues joined them in this one-size-fits-all mental health laboratory. A kind of recreation of Oliver Sacks’ Awakenings in which exposure to BSL stirs people into life. Later, the Unit became a stopover for forensic patients from Rampton as part of their Home Office supervised journey back into the community. Routemaster 37/41 (Mental Health Act 1983), one slip and you find yourself recalled. On paper, these patients were ‘mentally disordered offenders’, but many had been deemed unfit to plead due to language and intellectual limitations rather than clear mental disorder. Often they had dangerously low levels of impulse control and explosive emotional dysregulation. The Unit was also home to an adolescent on the autistic spectrum; unusual, if not illegal, even for those times. This was his home in the sense that there was nowhere else to go and his family home was even more unsafe than this one. The common denominators for all these groups of patients were deafness and trauma. One of the problems was a lack of alternative placements for deaf people with developmental, intellectual, behavioural, emotional or psychiatric problems. But there was also a tension created by the Unit’s impulse to do the right thing and the precarious status of the Unit: the moral imperative to help was sometimes compromised by the economic imperative to accept any referral as long as the person was deaf. Although an NHS service, the Deaf Unit relied on supra-regional funding and therefore had to justify both its usefulness and its value for money. The Unit had a monopoly on deaf mental health services south of Birmingham, not by design but simply because there were no other providers. This was an accidental monopoly caused by generalised neglect of deaf people’s needs at local levels and not the kind of monopoly enjoyed by water companies, who literally shit on their customers with total impunity. The Deaf Unit was a sole provider in an unpredictable market, relying on the continuing goodwill of hard-pressed regional health authorities to cough up funding. One consequence of this was the drift towards accepting the most complex cases, resulting in a volatile patient mix. The unspoken belief was that a deaf environment would be an effective intervention in itself when in fact some patients needed much more specific help than we were equipped to offer. Just Being There was not enough for all those Awakenings.

Language deprivation was at the heart of many of the behavioural problems we were trying to contain. The most challenging patients had either been deprived of sign language as children or had some form of language disorder related to an intellectual disability. It only takes a moment’s reflection to realise the multitude of consequences for a child deprived of language. Recent research points to a critical period for first language acquisition between birth and 5 years old and that missing this milestone has an enduring limiting effect on brain development. The challenge of working with language deprivation is huge and yet the answer is obvious: focus on that critical period and make learning sign language affordable and accessible for hearing parents of deaf children.

An Accidental Psychiatric Nurse.

Part 19. Being Bad.

Coronation Street excels at two things: the double entendre and the sociopathic villain. For my money, the apogee of soap villainy remains Pat Phelan, a man who took ‘in for a penny, in for a pound’ to murderous extremes. The current manifestation of evil is a schoolboy character called Mason who has been convincingly tormenting fellow pupil Liam to the point of despair, perhaps suicide. Mason is not only a juvenile sociopath, he is also a budding entrepreneur, directing a sales team of lesser bullies charged with generating supplementary pocket money for him. With a combination of guile and intimidation he gets them to sell knocked-off vapes to the children of Weatherfield. These pawns in his nascent empire might get a small commission for their efforts, but it’s the reflected glory of being his associate and the threat of a beating if they fail to meet their sales quotas which appear to be the primary drivers for their obedience. Much like the premise of The Apprentice in which Lord Sugar, the inverted Lord Snooty ex-barrow boy, routinely humiliates wannabe tycoons in their quest to be his sidekick. If (Free)Mason is an apprenticed bully we are yet to meet his maker, the Grandmaster who has presumably shaped him into Coronation Street’s latest hate figure. So far Mason exists in a vacuum, without a backstory or the social or familial context that received wisdom says must surely have created such a monster. It would be a stroke of soap opera genius if it’s eventually revealed that his father was indeed the late Pat Phelan.

There’s a lot written about psychopaths and sociopaths. As a rule of thumb, you’re more likely to be managed by or ruled over by a psychopath than a sociopath and more likely to share a cell with a sociopath than a psychopath. If you find yoursef in the latter situation, you too are probably a sociopath and everything should be just fine. In summary, psychopaths are inclined to play the long game with a high degree of planning while sociopaths prefer the impulsive and unplanned gratification of rule-breaking, due to exposure to psychopaths in their formative years. The consensus seems to be that psychopaths are born and sociopaths are made. What can be made can be unmade, while birth is only reversible by death. I guess sociopathy is the lesser of two evils or the better of two prognoses.

Clowns and Flat Earthers.

In March next year I will have spent exactly half my life in Wales. If that makes me half Welsh then the longer I stay the more complete will be my assimilation by osmosis, until my Englishness becomes undetectable and I enter a state of almost complete Welshhood, similar to a state of Grace. That would be the kind of Nirvana that an old social work colleague, an English blow-in like me, could only have dreamt of. While I’ve never really progressed beyond street Welsh, my work office cohabitee had mastered the formalities of the language and shamed me with her notekeeping and tribunal reports written in proper Welsh. Such was her enthusiasm for Wales that she confessed to me her wish for an elective transfusion of Welsh blood, preferably Bryn Fôn’s, for whom she had an unseemly midlife infatuation. Bryn Fôn was famously and incompetently set up as a firebomber, an event which enhanced his reputation and confirmed the conspiracy theorists’ biases. In an unrelated incident, this office mate shared with me a near death professional event after her TV spontaneously combusted and a fireman raked through the igneous remains of her video collection, pulling out her tin of illicit substances. Situations like this demand MENSA levels of thinking on your feet and I’ve found shifting the blame – adolescent children can be useful here – is the obvious first line of defence. Alternatively, you can try Post Office style gaslighting and go into flat out reality denial by prosecuting the fireman for possession, an approach neatly summed up by Justice Fraser back in 2019: ‘It amounts to the 21^st century equivalent of maintaining that the earth is flat’ (Bates v Post Office).

This has reminded me of a comment made by a former Director of Nursing at a meeting of community nurses that included district nurses, midwives, health visitors and CPNs. In the midst of what she thought was a validating pep talk she somehow brought cannabis into her monologue, telling the mental health nurses in the audience that she knew ‘most of them were sniffing cannabis.’ (To be fair, she was half right…) A combination of insult, ignorance and lack of self-awareness that left us all wondering how such people got to these positions and in whose interests it is to have them there. The answer seems to be collective self-interest; seniority for its own sake feeds off the self-serving belief that you are in charge of a well-oiled machine, not a clown car. When the doors, wheels and bonnet drop off and you’re still claiming the car’s roadworthy, you’re either a deluded Arthur Daley or the CEO of the Post Office.

Christmas at The Duke.

In the 1970s before ID was a thing, The Duke of Edinburgh was where we went for an underage pint. The Fountain was nearer but it was both dead and potentially deadly, depending on who was drinking there. The Cherry Tree was rabidly territorial and The Redstart was only for impressing first dates with its carpets and no bar billiards. The Duke turned a blind eye to most things and no one took liberties with the landlord and his wife; no toilets but the public (in)convenience was just round the corner, very tricky on frozen winter nights. Before becoming an underage drinker I’d briefly been in a ‘gang’ and these toilets fell into our purview. We imagined that the same man must be in the occupied cubicle every time we passed and so this imagined pervert became ‘Bog Man’. Around Guy Fawkes night one year we threw a banger under the cubicle door and ran away shouting ‘Bog Man you bastard.’ It is a surprise that I ended up in a caring profession really; no doubt an attempt to pay off my debt to the traumatised. Next door to the Duke was an antique shop run by a smooth-talking Michael Caine doppelganger, probably a fence for Maidstone’s stolen goods, who charmed the landlord’s wife and obviously ignored us. Above his shop was the changing room for Barming FC, so on alternate Saturdays customers were treated to the sound of crunching studs and muffled curses overhead. On Saturday mornings Mr Brimstead marked out the pitch and set up the goals, a treat for us who used jumpers for goalposts the rest of the time. Hitting the bar was just as thrilling as the sound of the ball hitting the net. On Christmas Day the Duke opened at 12 midday and the first drink was on the house.

Cheers everyone, especially Bog Man.

An Accidental Psychiatric Nurse.

Part 18. Syrup.

Somewhere in Scotland in the early 1980s an asylum held an unusual experiment in user-led services. Experts by experience were placed in key roles in pharmacotherapy; specifically, they were responsible for the syrups dispensed from the sticky bottles of Largactil and Melleril to patients who couldn’t be trusted to swallow their tablets. On a forgotten back ward, a trusted patient held a 10ml plastic beaker at eye level and filled it to its brim. ‘Bill needs a bit extra, he’s not well today,’ he said to the nurse nominally in charge of the medicine trolley.

This is not entirely true, but the syrup patient did exist and the nurse was indeed my old flatmate Neil. Neil and his syrup story came down together from Scotland and he went to work on the locked ward at Tooting Bec, known as RS1. I briefly worked on the admission ward above him, RS2, after qualifying, and on the top floor was RS3, better known as the DDU, (Drug Dependency Unit). The anonymous ‘names’ of those wards epitomise the dehumanising effects of institutional care at that time, as people were turned into medical classifications in human warehouses. The DDU was slightly different, as its focus was mostly on stopping illicit substances getting in while staff dished out the legitimate stuff in the form of the vivid green syrup. And we’re not talking absinthe.

On Saturday evenings the DDU staff prepared meals for themselves, sometimes with a dash of booze if Joe, the senior nursing officer, was in attendance. This was completely normalised professional misconduct, akin to parking on double yellows while the traffic warden keeps an eye on your car as you pop to the shops. When the old regime, including Joe, was swept aside by the iconoclast Ray Rowden – who wrote the manual on closing asylums- the alphabetical ward names went too, to be rechristened as trees. RS1 became Sycamore and RS2 became Rowan, although K1, one of the dementia wards, bizarrely became Krypton ward. I didn’t hang around to find out if the name changes had a humanising effect on the place, but I doubt it.

Joe had a psychopathic relative living in the nurses’ home who worked at the DDU. One night, after a heavy session in the social club, he went to the unit with a replica pistol and held it to a patient’s head. The next day Ray Rowden sent a memo to everyone in the nurses’ home to say he was banned from all parts of the hospital except the route from his room to the front gate, literally his dismissal pathway. A map was included to avoid confusion. Many years later, I met this man in the lobby of our inpatient unit in north Wales. In that moment of shocked mutual recognition I saw the look of someone whose past had caught up with him, similar to a concentration camp guard being greeted by Nazi hunters after 30 years under a false name in Argentina. In fact, he’d been working at Broadmoor Hospital and I presumed that even they wanted rid of him. He said he was here for a job interview so I promptly gave the interviewing panel my character assassination and he was never seen again.

The three wards shared a panic alarm. An ear-piercing klaxon with an indicator board by the entrance to each ward telling you where the disturbance was. The panic alarm successfully created panic, acting like a starting pistol for staff to charge blindly on to the staircase before checking the board. Having run back and checked, there would be a chorus of ‘It’s RS1!’ In and out like a human cuckoo clock stuck in the cuckoo’s nest.

Dead Language Society.

Anjela Duval

For the last few months Eira has been brushing up on her Latin with Duolingo and it seems to have paid off, as she’s elbowed herself into the top 1% of Duolinguists. The Duolingo model of learning is all about scoring points and getting promoted to the Diamond League, based on the ‘hit the target but miss the point’ school of pedagogy. Vedi, Vidi, Vinci. Learning a language is secondary to winning the race. I know next to nothing about the science of learning languages but I do know that the process is very good for your brain. With a diet of fish oils and Duolingo your neuroplasticity will thrive. I assume language learning starts with total immersion as babies and moves onto the theoretical stuff in the classroom with grammar, verbs, tenses, and the creepy eavesdropping of the language lab (‘écoutez et répetéz – ping’). The dénouement is the Duolingo league of gems. To comprehend language we don’t have to see the words that we hear and speak – except ofcourse with sign language where we must see and not hear – reading obviously comes later, otherwise babies would need to be literate before they could speak. Impossibly precocious. And with a dead language like Latin, why the need to hear it spoken on Duolingo, after all it only exists on paper? Actually, is it really dead if it’s still being read? Does a language die with its last native speaker if it can be raised from the dead by a future generation, as is happening with Cornish? The late linguistics expert, Professor Stanley Unwin, might have been able to enlighten me, although I can’t see anyone reviving his unique brand of gibberish.

Today, Welsh has a very healthy pulse despite the best efforts of some to snuff it out, notably with the notorious Welsh Not and The Blue Books. However, a few contemporary reactionaries with nineteenth century attitudes still like to flaunt their ignorance.

The Blue Books of 1847. R. R. W. Lingen, Jellynger C. Symons and H. R. Vaughan Johnson

Welsh has been one of the most popular languages on Duolingo who, perversely, have just decided to stop updating it. Breton, on the other hand, has never made it onto the Duolingo menu. This week Instagram showed me a photo of the late Breton poet Anjela Duval. I had to look her up and discovered an unexpected story of a defender of faith, nature and language. Her position on the relationship between Brittany and France was, you could say, droit au but:

I loathe the sight of my country’s old people pining in homes for the toil they once knew, and the young mothers of my country speaking the language of the oppressor to their babies. (Kan an Douar).

Another unexpected discovery for me is that her poetry embodies the predicament faced by an endangered language: almost no one can read her poems, not only because the written form of Breton is unkown to many Breton speakers, but also because she wrote in a mixture of formal, vernacular and neologisms. The renaissance of Breton literature, I learned, was led by intellectuals disconnected from native speakers and yet Duval’s writing too was inaccessible to her neighbours, the farmers and peasants who worked the land around her. Some of her poems have been translated from the original Breton and those that I have read are filled with her passion for nature, tradition and regret for a way of life that she could see was disappearing. There is a profound rootedness in the land that she had lived, worked and died on; understandable for someone who had lived on the same 40 acre smallholding with her parents and who remained there after they died. The reviews of her life and work describe her as a mystic and a patriot and my sense is that she had a kind of pan-patriotism attached both to her specific culture and land and to the wider natural world that she shared with all creatures and peoples.

Welsh and Breton speakers share remarkably similar victim histories of language suppression and cultural oppression that have fuelled political ambitions of independence and nationalism in both peoples. Elements of the nationalist movement in Brittany flirted with Nazism before the war and a tiny minority of them actively collaborated during occupation. Today, Anjela Duval is an icon for Breton political activists who now seem more aligned with the centre and Left while the Front de Libération de la Bretagne have gone down the political cul de sac of burning second homes. The possibility of an independence referendum seems a very distant and unwinnable prospect for them.

ELVES

A people of elves
A degenerate people
A genocidal people
Drowned in red wine
Drowned in French pom-pom
And in the political slogans
A people resembling Elves
Playfully amusing themselves
In the abandoned heath
Dancing among the megaliths
To the sound of the toads
To the mysterious music
Of the wind and the sea
The lament of the streams
The rustling of the woods

And the enchantment of the Harp
And the bagpipe of the night-Festivals
Elves crouch in their hole
As soon as the Masters roar
As soon as the Frenchman’s roosters crow
A defeated people, drowned
Like the City of Ys in the ocean (1)

Some complain in the dark night
About their lost Liberties
While dancing like Elves
On the dried ground of the warren
And kneel every morning
Before the French-God.
Do back-breaking work,
During the day, during the week,
For the Country that sucks them…

Ah! People disintegrated
Turned to elves!
What miracle will be needed
To awaken you?

1) A legendary city submerged in the sea due to the wickedness of its people.

Translated by Lenora Tim.

Shane MacGowan, Grandad and Me. Part Two.

“The Hound of Ulster.” Mural by Mister Copy in Dundalk.

It was in a pub somewhere in County Kerry that I met the Hound of Ulster.

The first Hound of Ulster was a young man originally called Sétanta who was renamed as Cú Chulainn, or Culann’s Hound, after slaying Culann’s guard dog in an unfortunate mix up, obliging him to take both the dog’s place and the new name. Cú Chulainn was a terrible handful when provoked and is celebrated in Irish mythology for many things, including single handedly defending Ulster against the armies of Connaught. Hence his promotion from domestic hound to Hound of Ulster. This is alleged to have happened around the first century AD. Every town has one of these fearsome fighters; in the 1970s Maidstone had Banger Osbourne, who single handedly defended the town against squaddies from the local barracks. Legend.

In 1986 AD I went to the All Ireland Fleadh Cheoil in Kerry with friends from London – Kevin and Neil – 11 years before the Good Friday agreement brought peace to Kevin’s home city of Belfast. It was in Belfast that we started our trip to Kerry, but first we took a day trip to the Republican stronghold of Coal Island in County Tyrone where Kevin’s partner had grown up. The insane plan was to go shooting rabbits. Sure enough, we pulled up outside a house, Kevin ran in and came out with two shotguns and loaded them in the boot. As we headed out into bandit country an army helicopter rose up over the brow of the hill ahead. This was my first and last Apocalypse Now moment.

The next day in a Kerry bar I ordered my first pint south of the border and thought I’d discovered the never ending pint of Guinness: the barman gently pulled, stopping short of a pint, and put it on the bar. So I started drinking. He then topped it up, so I drank some more expecting another top up. His reaction told me it was still early days in my cultural learning curve.

Ofcourse there was the music and the craic. I got into conversation with an older man from the north and a few pints later I said you must look me up if you’re ever in London. “As soon as I set foot on British soil, I’ll be arrested,” he said, leaving the rest to my imagination. As he left our table, he winked and told me that he was the Long Kesh wrestling champion, The Hound of Ulster.

Shane MacGowan was indeed a poet and quite possibly a scholar. He knew all about Cú Chulainn and a lot more besides, as this three minute epic poem shows. Rammed with historical and literary references it’s breathtaking.

Shane MacGowan, Grandad and me. Part One.

Like a Cox’s Orange Pippin or a fragrant vine of hops, Grandad was a product of the Garden of England. The son of a gamekeeper, he’d learnt about life and death by observing his father breeding game for the killing fields that surrounded their home next to the burial chamber at Coldrum Longbarrow. Those pastures and woodlands were home to the foxes that provided sport for the West Kent Hunt whose master, the Honourable R. P. Nevill, also owned the land and was therefore his father’s employer and landlord. Not only one of ‘the unspeakable in full pursuit of the uneatable’ but also a fine example of the English landed gentry. According to his peers, at least. Grandad left this semi-feudal relationship to try his luck in the lumber forests of British Columbia. In 1910 he boarded the Mauritania and sailed to Vancouver via New York, hoping to convert a $100 into a small fortune. It didn’t go to plan and the war in France seemed to offer a way out. As we know, that didn’t go well and he ended up in the mud at the battle of the Canal du Nord where a bullet passed through his jaw and lodged in his chest. After ten years away he eventually made it back to home soil to sow his DNA, like a salmon driven towards its spawning grounds. He was a grounded person in the way a potato is grounded, deep in the soil. The soil provided vegetables for the family and apples and plums for the market to supplement his generous Canadian war pension, elevating him from serf to kulak. No hammer and sickle for him, preferring an axe and scythe with a shotgun to keep the bullfinches off the budding fruit.

‘The Hon. Ralph Pelham Nevill, 1879. Ralph Pelham Nevill (1832-1914), sportsman, huntsman, dog and cattle breeder, and High Sheriff of Kent. From The Sporting Gazette and Agricultural Journal, 11th October 1879.’

He used to sing a popular song from his days in Canada about a goat, a train and a regurgitated red shirt that made little sense to me. Now I know that song was Bill Grogan’s Goat. Along with the song he had a couple of catchphrases that bemused me and amused him: ‘Let me see said the blind man’ and ‘What’s for dinner? Bread and pullit.’ Then one day in the orchard he delivered some puzzling advice: ‘Never trust an Irishman.’

Why? Something on the news that day? The brewing Troubles in northern Ireland? A personal grudge? Had he been let down, done over or ripped off? Was it the Anglo-Irish war after the War to End all Wars or Ireland’s neutrality in the inevitable next one? Or was it just bigotry, plain and simple? He died before Shane MacGowan turned up, so it wasn’t him.

My first proper encounters with Irish people were at Coventry Poly. After a heavy night at the student union I turned my room into a vomitarium and left hastily in the morning to get to a lecture and avoid the cleaner. When I returned, my room was as clean as a mafia crime scene. Nothing to see here. The Irish fairy godmother had been in and removed all the evidence. In the Halls opposite me, called H Block, there were two Ramones lookalikes from northern Ireland who blasted Stiff Little Fingers from their window, ‘Alternative Ulster’ echoing off the cathedral walls. On a rare bus journey round the ring road I was slightly surprised to read ‘Smash H Block’ on the back of the seat in front of me and I thought, ‘those Irish boys really hate their hall of residence.’

By the mid-Eighties things were moving on quickly as Grandad’s spurious advice looked more and more foolish. In 1985 Rum, Sodomy and the Lash was released, a year after I arrived in London. Thanks to my meticulous preparations at The Foresters, the pub opposite my flat in Tooting, I was ready for it. The pub did rebel songs, reels and ballads in the hall at the back and strippers on Saturday lunchtimes in the front bar. In the days before gastropubs and Wetherspoons you could enjoy a stripper peeling fag butts from her own butt after an exotic carpet routine, while the wife did the weekly shop. At The Foresters, the regulars included a group of shady undertakers from next door, dressed like Ronnie and Reggie Kray, who looked on without passing judgement. Professional at all times. We were all characters in a Dirty Old Town until Amhrán na bhFiann rang out and the lights came on at closing time.

An Accidental Psychiatric Nurse.

Part 17. Social Engineering.

Clockwise: Ben Ferencz, Otto Ohlendorf, Joseph Weits.

Two TV documentaries and a couple of local council decisions have triggered some thoughts on social engineering. Gwynedd council’s consultation on holiday homes ended this week, so maybe some respite from the complaints of the pro-2nd home lobby who view any state interference in our daily lives as a form of social engineering: 20mph speed limits; limits on selling houses; limits on planning permission; limits on cars in Ultra Low Emission Zones; limits on jetskis; limits on doing whatever we bloody well want. There’s no limit to their opposition to limits. I suspect they make an exception in the case of refugees whose freedoms they definitely would like to limit, including the freedom to be alive. Unlike these faux-outraged victims of the nanny state, most refugees are actual victims of actual social engineering in the shape of ethnic cleansing and genocide.

With the same potential for a positive community impact in the long term, but considerably lower key than its holiday home policy, is Gwynedd’s proposal to de-couple social workers from their NHS colleagues in Community Mental Health Teams, breaking away from the orthodoxy of the Partnership model of working. I thought I’d make an FOI request about this, because I’ve got nothing better to do, and now I’m wondering about social work and social engineering.

In the midst of all this worrying, this week I’ve watched two documentaries on extreme social engineering: Ordinary People investigating how ordinary Germans recruited to the Einsatzgruppen mobile killing units found themselves executing Jews across eastern Europe and Blue Box exploring Joseph Weits’ role in expanding Israel’s borders at the expense of Palestinian Arabs. It’s easy to draw the obvious conclusions and highlight the sad ironies, but beyond these I noticed some less obvious common threads. In Ordinary People the extraordinary Chief Prosecutor at Nuremberg, Ben Ferencz, notes the two mistakes made by the Nazis: keeping detailed records and letting him find them. Over in Palestine Joseph Weits was also keeping a record, but of his own thoughts in his personal diaries. No one in his family had properly read them until his great granddaughter, the maker of the documentary, came along and did. We hear the objection ‘I’m not comfortable with this’ repeated as she questions her family about grandpa Weits’ role in the expropriation of Arab properties and land. She has become grandpa’s Chief Prosecutor. Perversely, we see in these two documentaries individuals acting in ways they believe to be justified: Ohlendorf, well-educated, likeable and ideologically deranged, believes Jews are Marxists and enemies of the Third Reich whose children must also be killed to prevent their revengeful future threat to the regime; Weits, methodical and opportunistic, uses business ethics to rationalise the appropriation of Arab property, defending it in terms of a financial transaction, a purchase for which the other parties are properly compensated. He is celebrated as The Father of the Forest for his grand tree planting programme, less so as The Architect of the Transfer of Arabs to refugee camps. Ohlendorf goes to the gallows without a shred of doubt about his actions but we learn from Weits’ journals that he fears that among all the trees he planted are the seeds of a neverending conflict with his Arab neighbours.

Closer to home, Gwynedd’s Health and Wellbeing Department responded at length to my FOI about removing its social workers from CMHTs. They cited evidence that partnership working has essentially been a fudge with unrealistic ambitions and unclear outcomes. Their proposal is to focus on a preventative wellbeing social pathway across the continuum of care, leaving medical and clinical care with the Health Board. What exactly that might mean in practice isn’t clear but it’s a surprisingly bold move and if they’re ambitious enough I think it’s potential is profound and totally congruent with what I understand to be social work’s purpose and values. An opinion piece in the Psychiatric Bulletin by Rob Poole and Peter Huxley supports the view that both social care and social interventions to tackle the origins of mental ill health have slowly been eroded as mental health care has become decontextualised. The social workers that impressed me most were those who valued community work as much as casework, who were engaged politically and socially with community projects like housing and employment. They understood networks and often intervened at that level. In a sense they were social engineers, servicing the mechanics of social inclusion. A well-oiled society is a healthy society and offers protection against breakdowns. That kind of benevolent social engineering deserves a second chance.

An Accidental Psychiatric Nurse.

Part 16. This Year’s Model.

Prussian Pickelhaube

I was once a PhD student but my stamina ran out at the data analysis stage and instead of coming clean I avoided my supervisor. It didn’t help that he kept changing universities, moving further and further east on a parabolic trajectory which I calculated would eventually deposit him in Heligoland. Early on when I was still an active student, he organised a research day where students could meet and share their work. One presentation was from an army psychiatric nurse, a Major, in charge of the Catterick rehabilitation unit. Sounds a bit Gilbert and Sullivan although his demeanour was more Prussian (without a Pickelhaube, naturally). He had potential access to a huge dataset relating to new recruits, a goldmine for academic prospectors searching for psychological and social determinants of mental health problems. The supervisors in the room became visibly aroused as this fact dawned on them. My research was on recovery from psychosis so I asked him about his model of rehabilitation. ‘We’re in the grey man business,’ he said. ‘What’s that?’ I asked. ‘We fix the soldier and put him back in his unit where he blends in, unnoticed.’ The recovery movement wasn’t ready for this and I saw his supervisor shudder as she’d just published a book on it. The Major went on, in the clipped language of the mission briefing, that army rehab is about protecting your investment. More debt recovery than social recovery. The simple fact, he told us, is that losing a soldier during basic training is very costly, cannon fodder doesn’t come cheap. The Major’s rehab unit had one intended outcome: get the soldier back in service. I’ve no doubt he completed his PhD with military precision while mine fell apart with fatal procrastination.

The Recovery Model has enjoyed a good run. Mental health services have a peculiar attraction to models. There’s the obvious medical model and its first cousin the biological model. These two married into the social and psychological branches of the family, spawning the all-rounder biopsychosocial golden child or diathesis-stress model as it calls itself when trying to impress. The antipsychiatry model, by definition, has never been accepted into the family, although its less intimidating Critical Psychiatry sibling has been more successful. So too the gregarious social psychiatry relatives, allowed into the circle of trust on the basis that they’re not a threat despite their revolutionary tendencies. Out on a limb is the isolated branch of psychological medicine, somewhat lost by its decision to make itself deliberately homeless.

Nursing has a fickle relationship with models. They’re either a useful distraction from deeper problems or a cosmetic device giving the appearance of theory behind practice. Acute psychiatric care has always felt the pressure to be more therapeutic, more user-friendly, more efficient and less custodial. Some twenty years ago The Tidal Model and Refocusing were promoted as solutions, boosting their creators’ careers while making little or no impact on the experience of service users. Hardly surprising when the NHS bed stock has been at an all time low, mirrored by chronically low staff retention and recruitment on wards with occupancy rates beyond the risk threshold that increasingly only admit detained patients. It’s going to take more than a persuasive model to fix this state of affairs.

Shooting in the Dark. Part 2. The Greater Good or The Lesser of Two Weevils?

Barming Heath. Philosopher’s playground.

Apart from some adolescent fretting over the meaning of life and looking for some answers in the usual places – Sartre, Camus, Kafka – I haven’t read any proper philosophy. Nothing by Kant, Wittgenstein or Descartes, although I did get myself a little series of books on the history of philosophy so I could pretend to be a philosopher when I was around sixteen. My friend Noel brought up Bishop Berkeley once during a late summer evening on Barming Heath, as he pulled on a Sobranie and I took a drag from a No. 6. The sticking point was the continued existence of unperceived objects. Does a thing still exist if no one can see it? It’s the kind of thing that can keep you up at night – do I exist when I’m asleep?

There was a young man who said God,
must think it exceedingly odd
if he finds that the tree
continues to be
when no one’s about in the Quad.

There was a chapter on utilitarianism in one of those philosophy books. On the surface utilitarianism has plenty of pragmatic appeal. It doesn’t bother with the meaning of life or the existence of things, just how to lead a good life by reducing tricky ethical questions to a simple wellbeing algorithm: the greatest good for the greatest number. Scratch the surface though and it can get messy. How can you make calculations on what’s best when the consequences are inherently unknowable? No need to worry, because nothing is certain, so just make sure you’re guided by the moral imperative to do good for the greatest number. Politicians tend to fail on this one. They’d like us to believe they’re in it for the greater good but these days few of us believe that as they turn out to be in it for themselves or driven by ideological certainty.

I believe Gwynedd council’s plan to implement Article 4 is driven by the moral imperative to right a wrong for the greater good. A few days after writing the previous blog I was contacted by The Daily Post who wanted to quote from it. I didn’t have high hopes of instant fame as I knew no one would read it. Daily Post readers go straight to the death notices which is where I expect my next newspaper appearance to be. They had seen a reference to it in a Facebook group called ‘Gwyneddites against Article 4 and all Social Engineering’. An interesting name, maybe a newly discovered tribe of Anarcho-Syndicalists? In the spirit of non-compliance I ignored their screening question (‘are you for or against?’) and they let me in. They have since changed their name to ‘People of Gwynedd Against Article 4’. The group has been crowdfunding for an advert in The Cambrian News and to finance a legal challenge to Article 4. The legal fund is aiming for £50,000 with any unspent money going to a local homelessness charity. That’s right, a group that contains a fair number of holiday home owners wants to help the homeless…The final copy of the advert was shared in the group. I read it and decided I didn’t want to be associated with it, so left the group. Like all Facebook groups with a grievance, it’s an opportunity for some people to vent extreme views, often anonymously. The power of these forums to turn opinion/bigotry into fact is remarkable. When people say Facebook is a cesspit, it’s that corrosive alchemy that springs to mind. Trump, Putin, Musk, Farage, Tufton Street and the rest know the value of social media cesspits. Benign social influencers, suicide enablers, conspiracy theorists and political turds swimming together in a virtual septic tank.

My week with the Gwyneddites wasn’t a clever ruse de guerre, although if disguising yourself as a neutral merchant ship before letting go with a broadside is ok with Jack Aubrey, it’s ok with me. If anything, I suspect that it’s the Gwyneddites who are camouflaging themselves, dressing in a hero’s cape to save the people of Gwynedd from its perfidious council. Their ruse de guerre is the Trojan Horse. The message in the advert and repeated in many of the group’s posts is that Article 4 will be a catastrophe for ‘locals’ while benefitting holiday home owners whose properties will go up in value. Possibly, but isn’t it also useful to mobilise ‘locals’ against Article 4 if your agenda is to maintain the status quo, leaving the holiday home market untouched and unregulated? A number of the group’s posts reminded members not to focus on second homes to avoid alienating the ‘locals’.

Article 4 exposes the wider disagreements about regulation and deregulation. According to the Gwyneddites,regulating housing will turn off the trickle down effect that deregulation delivers. What does it matter if a minority get rich if the majority are better off too? All for the greater good, surely. Jack Aubrey hadn’t read much philosophy but you can’t go far wrong if you follow his advice: one must always choose the lesser of two weevils. That would be Article 4 and regulation for me.

Shooting in the Dark. Part 1. Second Homes and Unintended Consequences.

“You may ask yourself, “What is that beautiful house?”
You may ask yourself, “Where does that highway go to?”
And you may ask yourself, “Am I right, am I wrong?”
And you may say to yourself, “My God, what have I done?”

‘Once in a Lifetime.’ Talking Heads.

Gwynedd council is considering something quite extraordinary. Through a recent consultation it announced its intention to directly interfere in the housing market, that most sacred of all UK institutions. From September 1st 2024 the freedom to buy and sell new holiday homes will be managed by the council’s planners. It’s a daring step deemed necessary by the challenges faced by some of the county’s communities.

In parts of Gwynedd over 80% of residents can’t afford to buy a house where they live. And you may ask yourself, ‘So what?’ And you may say to yourself, ‘Look at Cornwall, the Lake District…St Tropez.’ Everyone’s priced out of the housing market, it’s just a hierarchy of affordability, a continuum from homeless to property portfolio. It’s called gentrification. That’s how markets work, communities change, nothing lasts forever. That was the opinion of an Abersoch estate agent in the 1980s after a letter bomb was sent to his offices. Recently, another Abersoch estate agent has shared his opinions in letters to the local MP and Abersoch residents warning of a new threat to holiday home ownership, property values and jobs. Not firebombers this time but elected councillors at Gwynedd council armed with an Article 4 Direction, an economic incendiary device for Pen Llŷn. So he says.

And you may ask yourself, ‘Am I right, am I wrong?’

The Article 4 Direction will give Gwynedd Council discretionary powers over the sale of houses as second homes or holiday lets by requiring planning permission for them, with the aim of controlling future proliferation. Using an Article 4 Direction to restrict second homes is unprecedented. Will it work? On the face of it, it’s a shot in the dark, but from the Council’s position a necessary one. They’ve fired off everything else in their armoury and discovered they were using blanks; the 150% tax on second homes was gamed by switching to holiday lets and applying for small business rate relief resulting in a loss of income to the council. Where there’s a way there’s a loophole. The problem with shooting in the dark ofcourse is that you risk hitting the wrong target or shooting yourself in the foot. Self-harm is the favoured argument of today’s Abersoch estate agent – the second home market collapses, your house loses value, local tradespeople lose business and the economy nosedives. On social media there are hysterical claims that the policy will be a violation of human rights. Exactly which one is beyond my understanding of the Human Rights Act and is never made explicit. Seems that for some people the right to sell your house at an unaffordable price as a second home trumps the right of local people to a roof over their heads: the human right to achieve the maximum price for your house regardless of the consequences.

In its report, the Council offers evidence for Article 4 based on a set of highly negative impact assessments of second homes and holiday lets on a number of indicators: house prices; affordability; Welsh language; population change and rural services. At the same time, they undermine their position by pointing out weaknesses with this evidence due to inconsistencies in the collection of accurate data for second homes. The strategy has been described as ‘action learning’ which may be a euphemism for ‘making it up as you go along.’ No wonder many cages have been rattled. Nevertheless, the data in the table below is screaming ‘something needs to be done.’ Over 50% of houses in Abersoch, for example, are holiday homes and the village has the lowest percentage of Welsh speakers in Pen Llŷn at 43.5%. At that unsustainable rate, Huw Maguire’s fears will become reality: ‘We do not want to see a country where the lights go off in September, October and do not come on for three months…’

Abersoch is unaffordable and losing Welsh speakers, but is that because of second homes? Declining numbers of Welsh speakers may not actually be causally related to increasing numbers of holiday homes. In his report to the Welsh Government, Dr Simon Brooks makes some uncomfortable observations for those who attribute afffordability issues and the decline in Welsh speakers to holiday homes. He starts with the assumption that second homes push up prices. Even Gwynedd council itself has failed to find clear evidence for this assumption in an earlier report, according to Brooks. In fact, inward permanent migration by people with the financial means to outbid locals is the greater culprit here. Secondly, the same phenomenon of permanent migration also undermines the assumption that fewer second homes would reduce prices and open up the market to locals, as locals would still be competing with outside buyers with more capital who want to move to the area. Short of Gwynedd declaring UDI, the attractions of the area will always tempt inward migration.

The third assumption is that a fall in house prices is desirable. Bluntly, homeowners don’t usually celebrate when the value of their property goes down or when they find themselves in negative equity. Gwynedd council predicts a 95% drop in valuations post-Article 4 but in truth that’s another shot in the dark – by definition, unprecedented events are unpredictable. Finally, Brooks looks at the assumption that holiday homes harm the Welsh language and suggests that they might actually act as buffers or sponges, ‘absorbing houses that would otherwise be bought by new residents unable to speak Welsh.’ On the other hand, he does acknowledge that the inability to compete with richer buyers leads to some Welsh speakers leaving the area, depleting the local ‘stock’ of Welsh speakers. Brooks sums up the issue very well:

Article 4 is a minefield of unpredictability: the unpredictable impact on Welsh speakers and local home ownership; unpredictable unintended consequences on tradespeople and tourism; unpredictable impact on property values; unpredictable outcome measures using an unknown baseline of holiday homes in an untried real world socioeconomic experiment. Unpredictabilty and shooting in the dark are not good for wellbeing but neither are dying communities. In the end it boils down to a debate between self-interest and self-preservation: the freedom to sell and the freedom to be sold out, the individual or the community. It’s a Once in a Lifetime shot in the dark.

And you may ask yourself, “Am I right, am I wrong?”
And you may say to yourself, “My God, what have I done?”

Druids, Romans and other Invaders.

The pavilions and tents have been taken down and the sheep and cattle are back in the Eisteddfod field. Maybe mushrooms by next month. Left behind on the verges of Pen Llŷn are the Druids in a frozen procession of the literati. Literati who wrote nothing down, much of what we know about them coming from the Romans. History is written by the victors. The Romans fostered an imperialist hatred of Druids, demonising them to make extermination easier when they finally caught up with them on the other side of the Menai Straits, slaughtering men, women and children, burning the bodies on flaming pyres. After that they set about a scorched earth policy on the island, destroying sacred oak groves, temples and altars, killing everyone in their path. These days it’s The Cheshire Set and Griff (‘I didn’t really buy a second home in Wales. I bought a second village’) Rhys Jones who are the invaders, playing a long game with their own cunning scorched earth variant. When I think of Druids I think of mistletoe, apparently a symbol of fertility and rebirth to them. Is that why Iolo Morganwg dreamed up the Gorsedd of the Bards in his effort to reinvigorate and celebrate the language and culture of Wales? The first Eisteddfod was held in 1176, without Druids. The ‘modern’ version owes its pageantry and rituals entirely to Iolo’s fertile eighteenth century imagination. When I delved into the nature of Iolo Morganwg, real name Edward Williams, I learned that he was some kind of flawed genius: a poet, a supporter of the French Revolution, a pacifist and a fraud; driven, according to the great Welsh socialist historian Gwyn Alf Williams, by ‘a Welsh resentment against arrogant English, a south Wales resentment against arrogant northerners, a Glamorgan resentment against the rest and a Iolo resentment against any who snubbed him.’ The National Eisteddfod owes much to the power of one man’s multiple grudges.

This was my first Eisteddfod. The build up started with a slow burn of bunting, flags and Croeso signs in every village but quickly ignited into a roadside tableaux of Druids, dragons, Welsh maids, sea captains in baths and scarecrow farmers on vintage tractors, transforming the area into a loveable caricature of itself in the days before the festival began. It coincided with peak tourist season and I wondered if some of the second homers were perplexed by the sudden change in signage:

I really should have done my homework before going. Luckily, I’d had the foresight to empty my bladder before getting into the inappropriately named shuttle bus which moved imperceptibly with other traffic towards the field of dreams, mocked by signs on the way saying ‘Nearly there’ and ‘20 mph’. At the end of the day, waiting for the bus back, all hope of seeing home again was draining away and when it finally turned up I felt an immediate kinship with the last diplomat helicoptered off the embassy roof in Saigon. On the plus side, my bus pass was legal tender. At the last minute I was tipped off about the Eisteddfod app, which I downloaded but didn’t study. When I opened it on the Eisteddfod field and looked at the virtual map I had a sudden flashback to childhood visits to London zoo: the panic that I’m not going to be able to see absolutely everything. Who needs a map…I had a great time and there’s always next year, Pontypridd.

An Accidental Psychiatric Nurse.

Part 15. Skin.

We had to spend eight weeks at St Thomas’ Hospital to get some idea of what real nursing was all about. For some reason, perhaps for my spiritual benefit, I was sent to a rheumatology and dermatology ward run by a pious German ward sister who dropped to her knees at the start of each shift to pray for her patients. I don’t know if they were reassured or unnerved by her invocations or indeed if any Divine intervention transpired. Like St Thomas I had my doubts. She didn’t notice me for the duration of the placement which was probably a blessing and a sign that I was beyond the reach of thoughts and prayers. The placement was a study in being supernumerary, aka the art of being a spare part. The staff didn’t really know what to do with me, so they had me loading and unloading the steriliser in the sluice room and meticulously cleaning dressing trolleys. Sometimes they gave me the terrifying responsibility of monitoring drips, enough to induce OCD in someone leaning towards innumeracy on the maths spectrum. One side of the ward looked out over Westminster bridge and the Houses of Parliament, so between bedpans I would chat to the patients with the best views. At break times there was the chance to step on and off the perpetual paternoster, St Thomas’ human-carrying rosary bead. Not many people know that in the 1980s St Thomas’ Nightingale School of Nursing was actually an NHS alternative to a Swiss finishing school for doctors’ daughters in search of eligible future doctor-husbands. Every month the medical students held a ‘Hop’, a disco that was part cattle market and part Lisdoonvarna matchmaking festival. The Nightingales were stratified by their plumage, signalling seniority by the frilliness of their hats and the complexity of their belt buckles. When we qualified we had a ceremony at St Thomas’ where the Chief Nursing Officer presented our certificates. I had been expecting at least a Pavlova-style crenellated chef’s hat and a buckle like a Legionnaire’s scutum, but she was actually in civvies. She was so senior she was off the uniform scale. The hospital catchment area was West Lambeth, at that time a run-down inner city borough, while the Nightingale student catchment area was the prosperous Home Counties; the patients were cared for in an upside down version of Upstairs, Downstairs, Cheltenham ladies doing the Lambeth Walk.

The dermatology patients had all sorts of terrible conditions, including the most severe forms of eczema and the type of psoriasis that the brilliant Dennis Potter suffered from. Some had patchwork skin grafts. Some sat in buckets of potassium iodide up to their knees and others were smothered in creams and emollients and mummified in bandages. The placement may have been boring sometimes but I did learn about the human capacity to endure suffering, while the ability to rub oily creams onto people in a professional manner can be useful.

Back at Tooting Bec, Gwen was a medium long stay resident with shocking eczema that needed daily treatment with super greasy lotions. She would enter the day room shining like a polished snooker ball after her treatment and take her usual seat opposite Stanley. Stanley kept a keen eye on the ward, announcing the arrival of staff by their name and car registration or, as in the case of my friend Neil, by their distinguishing features: ‘easily identifiable by white socks’. He often passed notes under the office door with updates on patients and memorably one appeared saying ‘Gwen, no knickers’. Stanley spent his mornings at the local bookies but never volunteered any more detail than that. Gwen roamed around the hospital grounds, visiting the patients’ canteen, the industrial therapy unit and loitering outside the entrance to the school of nursing, where she sometimes defecated on the floor. The Head of the School, Denis D’Cruz, invited us to interpret this shitting on his doorstep behaviour in the manner of a Freudian Groom of the Stool or George III’s poo-fixated physician. Some time after I left Tooting Bec, Gwen flew past me and Eira near Tooting Broadway tube station wearing just a vest and knickers and hospital issue Pillow Paws slippers. Her skin was on fire with eczema. Stanley would have been very upset.

An Accidental Psychiatric Nurse.

Part 14. Playing your cards right.

“Straight people love the idea of the closet: those who come out can be celebrated, those stuck in mocked, and it produces a convenient scapegoat for widespread social homophobia…”. Huw Lemmey. ‘ A Sordid Scandal.’

As I was collecting my thoughts about this week’s news, Huw Lemmey’s commentary on the Huw Edwards story dropped into my inbox and saved me the bother. It’s very good. For what they’re worth, my thoughts were wandering in a different direction, towards the reporting of BBC Huw’s turmoil as an example of what Birnbaum awkwardly called ‘sanism’. Like ableism or audism, sanism discriminates, invalidates and stigmatises. It drives invalidating beliefs about mental health and, at its most extreme, denies the legitimacy of emotional and psychological distress. Birnbaum’s primary concern was with the right to treatment for mental illness but this week’s news has reminded me that the very right to be mentally ill can be denied. The usual social media suspects have been quick to accuse Huw Edwards of ‘playing the mental health card’, proudly trumpeting their sanism in public. For them, the mental health card is like the get-out-of-jail-free card, giving the holder permission to swerve justice, to deceive and to dodge responsiblity. It’s the victim card whipped out to court the sympathy vote. It’s Harvey Weinstein with his Zimmer frame or Ernest Saunders and his disappearing Alzheimer’s. Except, they did commit crimes. The Police say Huw Edwards did not. He’s not excusing himself with the mental health card, his mental health crisis is entirely understandable in the face of his public execution: read all about it, newsreader becomes headline news. If the bigots are angry it’s because they feel cheated of the spectacle of a prolonged public fall from grace.

I’ve noticed that bigots take a No Surrender approach to the moral high ground, the place where they live in a state of heightened moral panic. TV personalities have replaced News of the World vicars as the targets for their prurience and outrage. I can understand vicars, but why newsreaders should have to live by a higher moral code is beyond me. It’s not like The Sun’s journalists are leading by example. If you’re on the telly you can expect shed loads of opprobrium to be heaped upon you, an inferno of dystopian Rogerian therapy – conditional negative disregard – if you slip up. Moral carte blanche for members of the Houses of Parliament and the House of Windsor, but not for him off the telly in your house.

Conscious and unconscious sanism can be found in mental health services and among mental health professionals, often as a means of exclusion or to cover up inadequacies. Arbitrary thresholds of severity and risk are applied to exclude, allocate and discharge, sometimes on the basis that the distress is a ‘normal’ reaction to a life event or trauma. You might argue that this is a necessary approach in a system that’s expected to pick up the pieces for a broken society and starved of the resources to do it. People diagnosed with personality disorder might not agree, victims of the ‘not psychologically-minded’ and ‘unwilling to change’ professional brush off. I came across one professional who could be relied upon to close difficult cases, known as ‘The Terminator’ – gallows humour or abuse? Some wards would have a resident custodian of the deserving and undeserving, the ill and the malingerer, loaded with a huge attributional bias towards ‘it’s all behavioural’. I’ve been amazed to hear these words in dementia care services, pretty much the most cut-and-dried illness in psychiatry. Early in my time as a CPN I was told in a ward round that my patient with probable bipolar disorder was a ‘wanker’ because he had a history of substance misuse. The right to be mad or sad has to be earned in some people’s eyes.

An Accidental Psychiatric Nurse.

Part 13. Lost Souls: Kontainment, Katyn and Mrs K.

The Penrhos Polish Home was on my patch. The plot was once the site of Penyberth, an historic farmhouse dating back to the Middle Ages that had played host to poets and pilgrims but was stubbornly destroyed to build an RAF training camp, parts of which were famously set on fire in 1936 by Saunders Lewis, Lewis Valentine and DJ Williams. A landmark event in modern Welsh nationalism and commemorated in Tân yn Llŷn. At the same time, the Nazis had already established internment camps, the prototypical Death Camps which eventually propelled a small number of surviving Poles on their journey to Penrhos, joining other survivors from Soviet labour camps. After the war the camp became a home for Polish ex-servicemen and by the time I arrived its residents had been drawn from all parts of the Polish diaspora, many of them refugees from both Nazi and Soviet oppression. Pilgrims of an unwilling sort. One of these was Mrs K. Mrs K lived in one of the gentrified barrack blocks which, despite being modernised, could not hide their original use. It didn’t take much imagination to see its resemblance to other ghosts of camps from the past too, the ones hiding in German, Polish and Siberian forests. Every plot of land has a plot to reveal according to Clare Wills’ opening essay in ‘The Family Plot’.

The first essay explores the long-hidden tragedy of Ireland’s homes for unmarried mothers and their babies while the second essay describes the silent complexities of the depiction of abortion in fiction. The two essays are connected by themes of unwanted pregnancy and society’s (and by proxy our) willingness to abandon mothers and children caught in a No Man’s Land of moral disapproval. Consciously or unconsciously, the Irish nuns and backstreet abortionists filled this moral vacuum, doing society’s dirty work behind closed doors. ‘The Family Plot’ in the title is ambiguous and multilayered – literally when families are buried together, one on top of the other – and ironically when the remains of Irish babies are disinterred from unmarked mass graves, their passing not even registered by the institution or the state. Plots of shame. In these awful cases of the unwanted and unborn, ‘Plot’ is a conspiracy between families, nuns and the funding authorities who sent mothers to these places. Adding insult to injury, the sub-plot is that these were also money-making institutions, gleaning cash from private adoptions and forced labour. ‘Plot’ as narrative is a further layer of meaning that Wills addresses in her discussion of abortion in the arts; more accurately, she argues that art has largely lost the plot when it comes to the ‘real’ experience of abortion, using it as a device to develop a story while neglecting the lived (sic) experience. Losing the plot, or more usually finding a plot when none exists, is a defining characteristic of mental disorder and historically containment has been society’s response. ‘Life Pushed Aside: The Last Asylums’ is the last essay in the collection and it’s this one that reminded me of Mrs K.

Like all good writing, ‘Life Pushed Aside’ makes you think and reflect, especially if you have an interest in the history of asylums, the pre-Largactil era of Psychosurgery and Art Brut (I knew this genre as Outsider Art). Using autobiography, archival research and genealogical detective work, Wills tells a story of lives lost in what she calls the ‘after life’ of Netherne Hospital. The concept of ‘after life’ is strikingly literal, referring to those patients on back wards destined to see out their days in containment, their previous lives over and their lost souls now existing in an institutional after life. Discovering the scraps of artwork left behind by one Netherne patient, J.J.Beegan, Wills sets about bringing the artist back to life and finding meaning in his pictures. She speculates that the strange figures drawn with charred matchsticks on Izal toilet paper represented people from his past life, a virtual community of familiars drawn from memory, a reminder of who he once was. Mrs K may have been doing the same thing.

Mrs K had great presence: dark-haired, elegant and aloof; she wore bright red lipstick to appointments but gave very little away. All of her male relatives, including her father, were among the 22,000 members of the Polish elite murdered in the Katyn Massacre. With her mother she was deported to a slave labour camp in the USSR and together they were released when Hitler invaded the Soviet Union, making their way to the UK via Iran and the Middle East. I don’t know how a person is meant to process this kind of trauma and neither I suspect did the post-war London psychiatrist who performed the leucotomy on her. Perhaps it was the charismatic neurosurgeon, Wylie McKissock, mentioned by Wills in her essay: “he was quite prepared to travel down to whatever the hospital was on a Saturday morning and do three or four leucotomies and then drive away again.” My difficulty engaging with her was undoubtedly due to the emotional and intellectual damage this procedure had inflicted on her rather than any putative underlying mental disorder. It seems to me now that the leucotomy was, to say the least, a crude form of internalised containment – Wills points to this in the Netherne records where lobotomies were sometimes justified in the management of unruly behaviours and emotional states.

While Mrs K was verbally reticent, she freely expressed herself through art. She and J.J.Beegan were kindred spirits; like him, she used whatever was to hand, mostly cardboard, tin foil and string, creating beautiful human forms that she hung from the ceiling in her room. Her room started to fill up with these angel-like figures around our heads and I was none the wiser as to their significance. Wills’ interpretation of Beegan’s drawings seems as good as any to me, that Mrs K’s creations were of people from her past life, specifically her family whose lives were taken in Katyn forest.

Mrs K took her own life in a desperately dramatic way. Maybe there was a better afterlife waiting for her. The Polish Home has changed hands and the plot will get a new lease of life. Life goes on.

The Final Whistle.

Dad’s been living with us for six months now. We often talk about his schooldays, work and deaf friends. Although I knew these names and faces from childhood visits to deaf clubs, I only had a child’s understanding of who they were. In recent months, Dad has shared more details of their lives with some extra adult content. I suppose he thinks I’m mature enough to cope by now. So far Dad’s outlived most of them. At ninety seven he’s not sentimental about this; he accepts the inevitable and the approaching final whistle without the denial that offers false comfort to some of us younger folk. After school he trained as a chairmaker in a small firm in the centre of town. The foreman had a deaf brother and was an able signer. Some time later, the foreman told Dad that another deaf lad was joining the company. He arrived the next day with his handsome fur-coated mother. He attached himself to Dad for the day and when they knocked off he followed him to the bus stop. ‘What are you doing?’ asked Dad. ‘I don’t know where to go,’ replied the lad, evidently completely unprepared for the outside world. A few moments later his father tapped him on the shoulder and took him home. The young man quickly became worldly-wise and discovered the excitement of The Turf, spending too much time with betting slips and not enough time at his bench, resulting in his dismissal. This was Ken* the footballer, not to be confused with foghorn Ken of the sonic-booming voice who had gone deaf later in life. I worked with this Ken at the sweet factory for a couple of months in my gap year and he took great care of me, shielding me from the older bawdy women on the production line. Other deaf men followed footballer Ken at the workshop, reluctantly mentored by Dad who preferred to be left alone with his tools. I met the two Kens and others as a child at the deaf club: Graham, who could eat cucumbers like a circus sword swallower and Laurence whose steeply sloping forehead fascinated me for several years. There was Arthur too, the militant Londoner who seemed perpetually angry, with a reputation for upsetting the Missioners. Ken joined a hearing football team and was regularly in the referee’s book for playing on after the whistle. Officially classed as dissent, but with Ken’s particular mitigating circumstances I strongly suspect ungentlemanly conduct by the referee. Ken too had an ungentlemanly streak with a predisposition towards playing away, although according to Dad his wife liked to play the field too. On top of this, Dad tells me that Ken’s sister, also deaf, lodged with Arthur the militant and his wife and was his long-term lover. Arthur’s wife seems to have been a reluctant participant in this ménage à trois. Perhaps the stress of his domestic setup explains why Arthur appeared so close to boiling point most of the time. He finally boiled over with a cardiac arrest, blowing his top at the final whistle.

* real people, fictitious names.

An Accidental Psychiatric Nurse.

Part 12. Peer Review.

This morning I read a review of The Crisis of Democratic Capitalism by Martin Wolf. My subscription to The London Review of Books is a sound investment for people like me who rely on other people’s opinions to hide their lack of erudition. The reviewer was David Runciman who happens to be the 4th Viscount of Doxford and Professor of Politics at Cambridge University. I only know this because his name seemed familiar so I looked him up and discovered that it was his father, WG Runciman, sociologist and 3rd Viscount of Doxford, whose book on Weber had bored me rigid as an undergraduate. Had I known at the time that a viscount is ranked fourth in the peerage, below an earl but above a baron, I’m sure I would have been more excited by his critique of Weber. Anything to do with Weber tended to send me into a coma and even now I can feel myself drifting into an altered state of consciousness. I recall it being said that much of Weber’s work was a debate with Marx’s ghost – one among the many determined to disturb the poor man’s eternal rest – a kind of dialectical spiritualism no doubt. Weberian scholars can correct me, but as far as I know Weber didn’t produce a manifesto for change or a vision of a better society. ‘Weberian’ doesn’t carry the same weight of disapprobation as ‘Marxist’, except in a diminishing number of subversive sociology departments.

In Runciman’s review he accuses Wolf of being long on analysis and short on solutions, failing to tell us how democracy and capitalism can coexist harmoniously without reform, much as Weber failed to offer guidance on how to change society for the better. The mechanics of how to solve a problem are usually much more difficult to describe than the analysis of the what and why of a problem. Goals are straightforward, but how to achieve them is complicated. I must have written hundreds of care plans with service users, some of them absolute masterpieces of their genre, bristling with SMART goals and outcome measures. And what of the how? ‘Attend appointments with CPN’ and ‘Take medication as prescribed’ or the even more ambitious ‘Ten sessions of CBT’ don’t constitute a roadmap to recovery. They’re more like Harry Potter spells and Hail Marys but at least they satisfy the basic requirements of random casenote audits. The phrase ‘if it’s not written down it didn’t happen’ just sprang into my mind and now I’m wondering if that makes the concept of oral history redundant and if we can make things happen just by writing them down. Simple.

An Accidental Psychiatric Nurse

Part 11. The exercise of restraint.

I only spent three years at Tooting Bec, just enough time to get my exit visa known officially as an RMN certificate. Others weren’t so fortunate. Patients obviously, but also Andrew from our training group who failed his final exams after three attempts. It was a mystery to me how he managed this feat as he was intelligent, gentle and compassionate. At the same time, he had a naivete that left him ill-equipped for the harsh complexities of psychiatry. He had worked as a theatrical dresser and perhaps that environment was better suited to his personality than the rawness of disturbed mental states and the sometimes physical nursing response to them. I left the hospital with a Nightingale badge and a copy of the Nightingale prayer. The badge has gone but the prayer sits in a drawer with other documents like my Last Will and Testament and a certificate in ‘Control and Restraint (Shield Work)’ from Three Bridges Regional Secure Unit. The worst and most inappropriate course I have ever done. I suspect that the learning outcomes may have been set by Charles Bronson:

1. competently inflict therapeutic levels of pain and document appropriately;
2. survive strangulation using a range of clever manoeuvres that you won’t remember when being strangled;
3. manage siege situations involving hostage-taking as if you were a Strangeways prison officer.

The trainers were over-enthusiastic advocates of role play as an aid to learning. I’m reminded of this by the permanent scar on my shin from a metal bed thrown at me in the ‘Patient Barricaded in a Side Room’ scenario. I was dressed in inferior Robocop protective gear with a perspex shield that offered inadequate protection from flying bedroom furniture. The same trainer had pretended to bite my genitals in an earlier exercise called something like ‘Escorting Patient up Three Flights of Stairs in a Controlled Manner’. I was meant to be holding his head as the other members of my team held him in fancy wrist locks. ‘Nearly lost your family allowance there,’ quipped the Bronson protégé as I laughed nervously. The Nightingale Prayer didn’t cover these eventualities. One of the other trainees seemed better suited to this style of nursing, evidenced by his stoic refusal to submit to any pain from the wrist-bending locks. Even the trainers gave up and I pondered if he might have an Achilles heel, maybe his ears like the housewives’ nemesis Mick McManus, but that particular move wasn’t on Charles Bronson’s curriculum.

The Three Bridges course was absurdly disproportionate even for a Regional Secure Unit in 1988. Ten years later in 1998, David Bennett died in a Medium Secure Unit in Norfolk, at least partly due to improper restraint and partly, as an inquiry later revealed, due to institutional racism in the NHS. Thirty years later in 2018, legislation finally hit the statute books aimed at reducing the harm caused by restraint, known as Seni’s Law (Mental Health Units (Use of Force) Act 2018). Maybe Andrew had a lucky escape. He never got his exit visa, his certificate or his Nightingale badge, but I hope he held on to his gentle innocence.