Dorothy Rowe

I was in Sydney last February when the new Prime Minister Kevin Rudd made his 'sorry' speech where he apologised on the behalf of all non-indigenous Australians to the Stolen Generation of Aboriginal people for what they had suffered at the hands of previous Australian governments. He had spent much time in meeting members of the Stolen Generation, and he drew on what they had told him in writing his speech. Listeners were left in no doubt what he was apologising for. There was no hint of that patronising tone much loved by many politicians but a sensitive awareness of the kind and degree of suffering the Stolen Generation and their families had endured, and an honest regret for the actions by politicians before him. He set out a carefully thought through plan for righting the wrongs of the past.

In the letters and diaries of the first English settlers at Sydney Cove in 1788, the tribes whose land the settlers were taking without recompense were described as being remarkably healthy. However, Aboriginal people soon began to succumb to the diseases the settlers brought with them. Within a few short years the representatives of the British government were reporting that all the Aboriginals would soon be dead and no longer an impediment to the settlers. To speed this along, a sweep of the whole island of Tasmania was arranged to flush out and kill all the remaining Tasmanian Aboriginals. However, once the Blue Mountains of NSW were crossed, opening the way to rich grazing territory, the settlers spread westward. Few of these men were accompanied by white women. Many Aboriginal women were raped or stolen, but equally many formed long term relationships with white men. The Aboriginal population started to increase.

In the long history of the British Empire many Englishmen married native women, but the children of these marriages were never accepted as being English. Yet the mere thought that these children, who were labelled as 'half-caste', or 'quarter-caste', should live as the natives did was equally unacceptable. In Australia it became government policy to round these children up, take them from their families, and put them in orphanages to be trained as servants for the whites. The story of three of these children was told in the film 'Rabbit Proof Fence'. The girls in this story did know who their family was, but young children couldn't name their family, and, if later they asked their keepers who their parents were, they were told that their parents were dead or that their parents had given them away.

This government policy of removal was developed in each of the Australian states around the time that the British Government was ordering that every county and borough in Britain should have an Asylum for the Lunatic Poor. In Australia the policy of removal didn't come to an end until the 1970s, which was when the Asylums for the Lunatic Poor, which many of Openmind's readers knew only too well, began to close. Has anyone in successive British governments ever apologised to those who had suffered in these asylums?

 Kevin Rudd's predecessor, John Howard, had adamantly refused to say sorry. He insisted that white Australians had nothing to apologise for. Why should they take responsibility for something their ancestors did? Yet Howard never missed an opportunity to share in the glory of the Australian soldiers at Gallipoli, Tobruk and the Kokoda Track, or of the brave settlers and the 'Aussie battlers' who made Australia great. Surely, if we want to take the credit for what our ancestors did, we should also take the blame.

Sorry Day on February 13 was a day of much ceremony at Parliament House in Canberra and much celebration across the country. Yet, within minutes of the ceremony ending, a radio talk show was inundated with calls from non-indigenous Australians declaring that they didn't want to be included in the Prime Minister's apology. In their way of seeing things, Aboriginal people received huge sums of tax payers' money they didn't deserve. It was a litany of 'It's not fair'. Hadn't they suffered, and no one was apologising to them.

To make an apology we have to recognise that the other person has suffered at our hands. We can be so entranced by our own suffering we can be unaware of anyone else's. If we say, 'I'm sorry you're upset' we are not acknowledging their suffering, but just noting that they're upset about something or other. In our apology we have to specify what we are apologising for, and we have to let the person tell us if we have failed to understand just what the injury was that we inflicted. Our apology must include both the promise to mend our ways and to make whatever recompense we can. A real apology requires a generosity of spirit which, alas, many people lack.

Every Australian schoolchild learns Dorothy Mackellar's poem My Country. We can all recite,

I love a sunburnt country,

A land of sweeping plains,

Of ragged mountain ranges,

Of droughts and flooding rains.

I love her far horizons,

I love her jewel sea,

Her beauty and her terror,

The wide brown land for me.

Australia is a land which can defeat and destroy those who try to force it to be fruitful. Last December a drought which has lasted for ten years was interrupted, not just by rain, but by torrents of rain which produced wild floods, destroying livestock, fences, roads, bridges and buildings. Farmers who in the drought were barely surviving saw what little they owned swept away by the floods.

Land in Australia is little suited to the English farming methods which have been imposed on it for the last two hundred years. As a result, much of the farming land is no longer fertile. Even without the drought, many farmers were struggling to make a livelihood. The suicide rate amongst Australian farmers is four times the national average. Despite government funded initiatives to support farmers financially through a difficult time, and to offer support from the mental health services, the suicide rate remains high. The problem seems to be the farmers themselves.

There is general agreement among those who know farmers well that they are hard-working and conscientious. They might enjoy a yarn over a beer with their mates, but this yarning is entirely in the masculine style of imparting information to one another. Nothing personal is ever discussed, and feelings are never mentioned. To do so would reveal the weakness that shows that you are not a real man.

All this is known, and farmers' wives try to push their silent, troubled menfolk to see a counsellor, but farmers have an unlimited store of good, practical reasons why they can't waste time talking to a stranger.

The problem of the high rate of depression and suicide amongst farmers is widely acknowledged and discussed in the media, but I've not come across any explanation as to why so many strong, silent, good men without warning kill themselves. Yet it is easily found if we look at how we create our sense of being a person.

Our sense of being a person is what we call 'I', 'me', 'myself'. We see our sense of being a person as having certain attributes. Some of these attributes we regard as being fairly trivial. We can discard these easily as our circumstances change, but other attributes seem to be absolutely central to our being. When our circumstances threaten to reveal that we actually lack the attributes in which we take most pride, it can seem to us that the only way to continue being the person we know ourselves to be is to die. This is the reasoning behind great acts of heroism. Since its inception, every winner of the Victoria Cross who survived has given, one way or another, the same reason for his bravery in action, 'It I hadn't done what I could to save my fellow soldiers I couldn't have lived with myself.' Suicide results from the same kind of reasoning.

Farmers see themselves as strong, practical, problem-solving men, capable of dealing with the variability of the climate, of world produce markets, and of the ecology of their land. To fail is to be weak, and to be weak is to be unmanly. If you've built your whole identity on these attributes, what do you do when the Australian continent behaves as it always does, with complete indifference to its inhabitants? Whether you're man, or beast, or insect, in Australia you either adapt or die.

When we seriously contemplate killing ourselves, what we are actually doing is trying to force reality to be what we want it to be. Reality, whether it is the Australian continent or not, never conforms to our wishes. We can choose to feel shamed or despairing because we cannot make reality do what we want and, in a desperate gesture, throw away our life. Or we can waste our whole life trying to get from reality something it can never give, such as trying to get from an unloving parent a declaration of their love for us. Or we can adapt in clever, creative ways to what reality has to offer, such as accepting the indifference of our parent and offering our love to those who know its value and will return it. To do the last we need to redefine the person we know ourselves to be.

Some Australian farmers are redefining themselves. Instead of trying to force their land to do what they want, they are learning new ways of farming which understand and co-operate with the beauty and the terror of the wide brown land.

Being appointed by Gordon Brown as the first Muslim minister and invited to the USA by the Department of Homeland Security did not prevent Shahid Malik from being detained and searched at Washington DC airport. In the USA now, simply being a Muslim is enough to be regarded as a possible terrorist. Such paranoia in America is not new. What Muslims are experiencing there now is similar but worse than what anyone considered to be a communist experienced in the USA in the 1950s.

The USA is a huge country containing many diverse people but they are held together by two ideas, that of God and the American people. Consequently, the great majority of Americans say that they believe in God. Moreover, it's not enough to be American in citizenship or residence. You must be American in your thoughts. A lack of right thinking shows that you are un-American. (It's impossible to be un-British because the British can't agree on what being British is.) In 1938 Congress set up the House Committee on Un-American Activities, and in 1947 this committee was given extraordinary powers to examine witnesses who were suspected of un-American activities and to deny work to anyone whose answers to the Committee's questions were unsatisfactory. From 1950 to 1954 the Committee was headed was headed by Joseph McCarthy, described by the British journalist James Cameron as 'a chancer and an opportunist and a liar'.

Under McCarthy the committee wanted to find those people who had been members of the Communist Party or who simply had left-wing or radical views. Much of the committee's activities concentrated on Hollywood. Any actor, director, or writer who fell foul of the committee could be sent to jail or blacklisted. The only way a person could protect himself when appearing before the committee was to deny having any left-wing links and then name those of his friends and colleagues who did. Threatened with the loss their well-paid jobs, a luxurious lifestyle and cheering fans, many people named names. Among those who betrayed their colleagues were tough guy actor Humphrey Bogart, playwright Clifford Odets and director Elia Kazan.

Hollywood's golden couple were Lillian Hellman and her partner Dashiel Hammett. She was a brilliant dramatist and he a writer famous for his detective series The Thin Man. In the 1930s many people, unaware of the crimes of Stalin, joined or were sympathetic to the Communist Party because it seemed to offer hope during the great economic depression. Even though American communists did little more than discuss these ideas, Hammett was sent to jail, his income seized by the Internal Revenue, and he never worked again. Hellman's crimes were that she was Hammett's partner and she had visited the USSR at her government's request for a cultural event.

It took Hellman nearly 25 years to feel able to write about what happened to her after she received a subpoena to appear before the Committee. When she did write about these events, she called her book Scoundrel Time. In this she wrote, 'I had, up to the late 1940s, believed that the educated, the intellectual, lived by what they claimed to believe: freedom of thought and speech, the right of each man to his own convictions, a more than implied promise, therefore, of aid to those who might be persecuted. But only a few raised a finger when McCarthy and his boys appeared.' She concluded, 'Simply, then and now, I feel betrayed by the nonsense I had believed. I had no right to think that American intellectuals were people who would fight for anything if doing so would injure them.'

Before Hellman appeared before the Committee she wrote a letter to the Committee chairman, stating that she was prepared to answer questions about herself but that she wouldn't answer questions about other people. She knew that this was contempt of court, and for that she would be jailed. It was only a legal technicality which saved her from jail, but she, like Hammett, was blacklisted and unable to work. Hammett died not long after his release from jail. Hellman lived in near-penury until McCarthy left the scene and she could return to writing. But what followed was the Vietnam War and Richard Nixon, the only president forced to resign his presidency.

In her letter to the Committee Hellman spoke of the need for people to treat one another within the rules of 'simple human decency'. Survivors of the psychiatric system know what it is like to be betrayed, and to be treated without human decency. Indeed, few people over the course of their life escape being treated without decency. We should bear these experiences in mind whenever we hear the word 'Muslim' being used in the way the word 'Communist' was used in the 1950s to destroy innocent people.

Lillian Hellman Scoundrel Time Macmillan, London, 1976.

When Pepper wrote about how, when she had asked a member of her church for help, he had told her, 'You can't be a proper Christian because Christians don't get depressed,' (September/October 2007) I was not surprised. I knew how a great many people, who describe themselves as having a faith, behave with little kindness, generosity or concern for those who aren't seen as being suitable members of their community.

When I was a child my mother insisted that I attended Presbyterian Church and Sunday school, even though she never attended and my teenage sister, who did attend, refused to acknowledge my existence. Every Sunday I learnt my catechism and listened to the sermon, and no one in the church recognised my loneliness and offered me companionship, not even the minister whose favourite theme in his sermons was faith, hope and charity. 'Charity', he explained, meant 'love'.

Years later, when different groups, interested in mental health, invited me to give talks and workshops, I found a similar lack of concern amongst most of the different religious groups who contacted me. Local associations of MIND and various mental health charities, all managing on a shoestring, would take it as a matter of course to offer hospitality to an honoured guest, and, even when I waived my fee, would insist on giving me something as a token of their appreciation. With a few notable exceptions, religious groups assumed that I would work for free, be tardy in offering to pay my expenses, and unaware that I had simple human needs, such as needing protection from importuning members of the audience or feeling hungry or thirsty. This lack of concern I saw as the distain which people, who regard themselves as being especially good, show to outsiders.

However, all of this was very minor compared to what happened to many of my clients. Some clients would tell me how their vicar, minister or priest (I didn't have any Muslim clients) had told them that the disaster that had befallen them - their depression, or cancer, or bereavement - was punishment for their wickedness. Others told me how they had been excluded from their religious community because their suffering showed them to be unworthy of membership.

Those who suffer pose a threat to all those people who wish to believe that they live in a Just World where goodness is rewarded and wickedness punished. All religions teach that we live in a Just World, but differ in how they define good and bad, reward and punishment. A senior Anglican evangelical cleric once assured me that suffering is evidence of wickedness. If you believe this, you never have to feel the pain of pity. You see the sufferer as bringing his suffering upon himself. Some American evangelicals teach that, if you believe in Christ, He will make you rich. However, the evidence of earthly rewards for goodness is largely lacking, so it becomes necessary to believe in some reward after death, such as heaven, or paradise, or rebirth to a better life.

Even with a post-death reward, believers struggle to solve the conundrum which, stated simply, says God is all-good; God is all-powerful; suffering exists: for two of these statements to be true, the other has to be false. When Pepper asked for help she was asking her Christian helper to choose between believing that God is all-good or that God is all powerful. No wonder she was rejected.

If we believe in a God who takes a personal interest in us and expects us to be virtuous we can easily find ourselves trapped in a prison defined by good and bad, reward and punishment. All we have to do is to believe that we are, in essence, bad and unacceptable, unworthy of the right to exist, and thus we become focussed on a desperate need to be good while all the time doubting that we can ever meet the standard which our personal God has set.

Fortunately many people reject this form of religious belief. Instead they think in terms of some power which encompasses everything which exists and of which they are part. No longer needing to cling to the child-like certainty that demands a parent-like god, they accept the mystery and uncertainty of their existence. When they try to describe what they know and feel they might use mystical language, or religious language, or simply the language we use when we talk about nature or the creative process. Individual though these experiences are, there is a common core, whether we are, like Pepper, writing a poem, or, like me, looking at my garden. It is an experience which has nothing to do with reward for virtue or life after death. It is simply to do with being and belonging, and feeling at peace.

Openmind Sept/Oct 2007

Just Looking

When I was a child my mother made it clear to me that she regarded me as a peculiar child with odd habits. One of these habits was that I'd stand at the back door of our house, gaze across to the distant blue hills, and watch the sun set. Or I'd cross the road and disappear into the bush, re-appearing some time later with spray of gum nuts or a bunch of wildflowers. When I went to the beach I'd spend as much time peering into rock pools and watching the waves break as I'd spend swimming. Despite my mother's disapproval, I persisted because I enjoyed just looking, and it gave me a respite from the boredom and misery of home and school. I was very pleased when I discovered that the poet William Henry Davies agreed with me. He had written,

A poor life this if, full of care,

We have no time to stand and stare.

Many years later I realised that I was using an ability with which we're born but which can so easily be taken from us by our upbringing. It's the ability to look at the world around us disinterestedly and dispassionately. We look without any personal or selfish interest, and without any emotion or bias. Babies spend much of their time looking at the world in this way. Toddlers are endlessly curious about whatever they encounter. They find the world interesting simply because it exists. However, adults often interrupt this looking. Babies find their view blocked by the face of an adult who is trying to get their attention. A baby needs to have conversations with his mother in order to build up his bond with her, and then be able to generalise this bond to other people, but sometimes the mother's need for her baby's attention greater than the baby's need for hers. A baby may discover that not paying attention to his mother is something that incurs her displeasure. Many toddlers find that they are punished for being curious. Their mother's constant injunction, 'Don't touch!' becomes so painful that the toddlers find life easier if they give up being curious. Often toddlers are expected to find television much more interesting than playing in a garden or exploring the possibilities of sand and water. Older children may discover that their family assumes that joining in family conversations, however vacuous and repetitive, is infinitely more important than spending time on your own, when you can wander and look, daydream and think.

All of this is part of how the child learns to be good. Babies and toddlers know that they are dependent on the adults who care for them, and that not being good in the way the caring adults define 'good' puts them at risk of being unloved. Learning to be good isn't easy, even when the adults define 'good' in quite undemanding ways. The toddler may become so focussed on trying to be good and avoiding being bad that the child decides to forego the pleasure of disinterested and dispassionate looking at the world. Instead, everything has to be categorised in terms of 'being good' and 'being bad'.

Disinterested and dispassionate looking is all about being in the present. It concerns what is now. Being good is all about the past and the future - what you have done and whether the future holds rewards or punishments. Good people, that is, people who always feel that they aren't good enough, can lose altogether their ability to live in the present. They worry about the future and feel anxious about the past. Yet the present is where we all actually live. The past and the future don't exist. They're just ideas in our minds. Thus many good people lose touch with that innate ability to live in the present and be mindful of what is going on.

The Buddha advised his followers to be mindful of what was happening around them. In recent years many psychologists have taken up the concept of mindfulness and written books about it. One excellent book is The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn (Routledge). If depression or chronic unhappiness isn't your problem you might wonder why such a substantial book, which describes and explains common everyday experiences, which sets out regular exercises and the recording of such exercises, and which has an accompanying CD, is necessary for a person to rediscover an innate skill. However, if you've been taught since earliest childhood that mindfulness is bad, you'll think that you'll have to see mindfulness as good. Thus you'll still be trapped in the prison of seeing everything as either good or bad. Mindfulness is neither good nor bad but simply is.

Openmind July/August 2007

A Miracle in Northern Ireland

I still can't believe that I've seen Ian Paisley and Gerry Adams sitting down together and agreeing to share power in Northern Ireland. Some years ago Gerry Adams, Martin McGuinness and their colleagues in Sinn Fein saw that that they had to exchange the gun for the ballot box, but Ian Paisley wouldn't budge an inch until Sinn Fein IRA, as he always called them, admitted defeat and publicly repented of their sins. I was very familiar with this degree of intransigence. I'd been brought up in the Presbyterian Church and, though members of my family were not great church-goers, most of them, particularly on my mother's side, had that Presbyterian ability to believe that they were absolutely right, and that compromise and reconciliation were signs of weakness, not strength. They also shared Paisley's views about the utter wickedness of the Catholic Church.

The Australia I grew up in before and during World War Two, was, like Northern Ireland, divided into Catholics and Protestants. Catholic children went to Catholic schools: Protestant children went to state schools. Outside of school, each group hurled abuse at one another and never met to play together. Catholic and Protestant adults socialised quite separately. However, Catholics were not discriminated against economically as they were in Northern Ireland, and so the battles between the two groups were conducted socially and politically, and not with guns and bombs. During the war the Australian Federal government, wanting to increase the size of the population, created an immigrant programme which meant that by the 1960s the Catholic schools were bursting at the seams with the children of Catholic migrants. The Church relaxed the rules which banned Catholic parents from sending their children to state schools, and within a few short years the enmity and division between Catholics and Protestants vanished.

When I arrived in England in 1968 the Troubles in Northern Ireland were just beginning. On my visits to Northern Ireland I found myself dusting off some old skills that I'd learnt as a child. Brought up a Protestant, I was taught how to recognise a Catholic in the first moments of meeting - the name, the school, the number of children in the family. I heard again the same hate-filled mythologies, the ones espoused by the Protestants about the Catholics, and the ones espoused by the Catholics about the Protestants, only now I knew them to be the same set of ideas with which all groups define their enemies. Enemies, whoever they may be, are always dirty, aggressive, lying, greedy, cruel and totally selfish, while your group, whatever it is, is always clean, unaggressive, truthful, generous, kind and totally unselfish. (George Bush applies these same sets of terms to terrorists and to the American People).

Members of a religious faith usually see themselves as being superior to those who don't share their beliefs. Many Presbyterians have the same attitude towards their ideas, all of which they see as being incontrovertible. Such people are untroubled by doubt. Indeed, they cannot afford to doubt because to them to doubt was to give way to a weakness which would overwhelm and destroy them. Whenever I heard Paisley holding forth about how wicked the Catholics were and how he would never exchange a word with Adams or McGuinness I felt that nothing would change in Northern Ireland until Paisley departed this life and went to heaven where he would spend eternity instructing God.

What I didn't know then but I know now is how much most people change when they are in their late seventies. (Paisley is 80.) So many things no longer matter. You might have spent your adult life putting on a front of being strong and uncompromising, but now it doesn't matter anymore. At the same time you see some things mattering even more. Surveying the huge sweep of time that you've lived, you see that living is more important than dying, and that people are people the world over. The differences between different groups of people don't make one group superior to the other. Ian Paisley mightn't express the changes in his own thinking in the way I've described them here, but these changes have allowed him to discover that compromise and reconciliation are not weaknesses but strengths. Now he can say 'Yes' where before he would say only 'No'.

However, Ian Paisley may have changed, and the people of Northern Ireland may now be governing themselves, but one thing hasn't changed. Unlike Australia, the Catholic children still go to their Catholic schools and the Protestant children go to their Protestant schools. A mere 5 per cent of children go to schools which take children from any religion. Has Ian Paisley brought lasting peace, or is this just a lull in the storm?

Dorothy Rowe Friends and Enemies HarperCollins.

Dorothy Rowe My Dearest Enemy, My Dangerous Friend: The Making and Breaking of Sibling Bonds Routledge

Openmind May/June 2007

Conversations between Ordinary People

They happened to be sitting side by side at the workshop I was running in Australia, he, Barry, a consultant psychiatrist and she, Miriam, a visitor to a long-stay psychiatric hospital, and, so she told us, no stranger to depression herself. Barry said, 'At my hospital a colleague and I will spend up to two hours on an intake interview. There'll be other discussions with other professionals. I don't think patients realise how much time we spend talking about them.' Miriam said, 'I have specific tasks I need to do, but whenever I can I'll just sit with a patient. We don't talk about anything special - it might be that we just talk about what fruit's in season - and when I get up to go the person thanks me for talking to them. I think that's so sad, that they thank me for talking to them.'

If you're a professional in the psychiatric system, whether in a hospital or in the community, you have to spend time talking with your colleagues about the patients. Information needs to be passed on and programmes of care drawn up. Pooling knowledge is essential to get a well-rounded picture of a patient. Where one person may have encountered a problem with a patient another may have found a way around it. Only a colleague can understand and not condemn the feelings of anger and helplessness that a particular patient can arouse in a professional who is trying to help. Barry told us about one of his patients who was unsparing with his anger directed at every professional he encountered. Barry said, 'When you're subjected to such an attack it's very hard to remember that underneath this anger is a very uncertain, lonely, depressed young man.'

Perhaps the recipients of the professionals' services don't want to acknowledge that the professionals do discuss them because the thought that you're being talked about behind your back can be very disturbing. As children we knew that when our parents or our teachers talked about us they usually didn't emerge from such discussions full of praise for us. Instead we were faced with criticism and sometimes punishment. There's a troubling similarity between being summoned to the school principle's office and to your consultant's office. In such a setting discussions are not between equals.

In some situations it is appropriate that the discussion is not between equals. When we consult a doctor about the state of our health we want the doctor to know more about this aspect of ourselves than we know ourselves. But in other situations inequality is not appropriate. When I was in Sydney recently I decided to consult a GP about some blemishes on my hands and arms. To counteract the very common skin cancers which all Australians develop GPs are organised to deal with this talk daily and to remove any blemish or wart which might turn cancerous. To do this they have what looks like a small fire extinguisher which emits a freezing foam. I was in the clinic with my GP and a nurse when another doctor, a tall, breezy man, walked in, demanded where this instrument was and, having found it, hoped it wasn't empty. I said, 'It might be. I've just been done,' and held up my hands. He looked at me unsmiling, closed his eyes, turned his head away and spoke to the nurse. Apparently he believed that patients should speak only when they are spoken to. Had I met this man at, say, a reception, and spoken to him without first being introduced, I'm sure he would have spoken to me most affably.

This episode left me not affronted but disappointed. When I first came to England over thirty years ago and went to work in big psychiatric hospitals this was how all the doctors behaved. It's no wonder that the long-stay patients felt exceedingly grateful if someone who wasn't a patient stopped and had a chat with them. As I observed these doctors closely I could see that they felt secure in themselves only when they were in the role of the doctor. They were incapable of simply being themselves. Nowadays I encounter doctors who know that they are good at their job but they are simply themselves, ordinary people. The GP I consulted in Sydney was like this. Professionals who know themselves to be ordinary people are likely to have the skills of being able to convey to their patients that conversations between professionals about them are not detrimental to them. They are also likely to know the importance of taking time for a chat. The content of a chat may be utterly trivial but in the exercise of chatting we confirm one another's existence. No wonder we can come away from a chat with our heart lightened. We can give thanks for that!

A Most Important Attachment

Openmind March/April 2007

Twenty years ago, when I was working in Lincolnshire, one of my clients was a young married woman who was deeply depressed. There was certainly much in her life to trouble her. Her husband worked long hours and she was at home with their three small children. Her account of her childhood showed her parents to be authoritarian and punitive, and, living nearby, they still demanded much of her attention. I felt that there was something more in her background that played a major part in her distress. In fact I was searching for some secret when the problem was right there, staring me in the face had I the wit to see it. At least it was the kind of problem that vast numbers of psychologists had overlooked. We all knew a great deal about Attachment Theory, how babies form an attachment to their mother and how the response of the mother to the baby determines the nature of that attachment. What we ignored was that most children have siblings, and that these relationships can be very important, if not the most important, in a person's life.

My client was the eldest of five. Their parents made no attempt to understand their children but instead used the children as objects on which to vent their feelings. As the eldest my client felt responsible for her siblings and she did what she could to protect them from her parents. Even though they were now all grown up, my client still felt responsible for her siblings, but she had even less control over her siblings' circumstances than she had when she was a child. She had failed to protect them from their parents, and now she was failing to protect them from the multitude of disasters that occur in everyday life. She blamed herself for her failure, and thus she turned the sorrow she felt for her siblings into depression.

I now know much more about siblings than I did then. Research on siblings is very limited, but there is a wealth of information in biographies and in fiction where the writer has drawn of his own childhood experiences. Moreover, people told me, indeed, rushed to tell me stories about their siblings which were often filled with anguish and pain. The fact that the events which a person described happened decades before did not diminish the passion with which the person told the story. Often the story-teller ended with, 'If my sister knew I was telling you this she'd kill me.' I knew what this meant. In my book My Dearest Enemy, My Dangerous Friend I have told some stories about my big sister and me which I have never told before, and I expect some repercussions.

The reason that psychologists have studied mother-child relationships rather than sibling relationships is that mother-child relationships, various though they may be, have a simple theme. In order to develop as a person, a baby has to form an attachment to some mothering-figure. Even when the mothering-figure is not very motherly at all, the baby will try to make the best of what's on offer. In sibling relationships there is no one theme. I came to the conclusion that the only thing that can be said about all sibling relationships is that there is no one thing that can be said about all sibling relationships. They are all different, as they must be because there are such wide variations in family circumstances and in the siblings' ages. However, allowing that there are always exceptions, it was possible to draw some conclusions.

First, siblings do become attached to one another, although this isn't necessarily a loving attachment. For many, even most siblings, it is a love-hate relationship. But the very early attachment is strong, and most people find it impossible to walk away from a sibling in the way they would leave a faithless lover or erstwhile friend. Bearing in mind that our sibling relationship can be the longest in our life and vary over time, generally speaking there are three kinds of attachment: a close, loving attachment, a mixture of affection and irritation, and a hostile or indifferent relationship. Often a close, loving relationship arises in childhood because the children realise that their parents are incapable of parenting them, and that they have to cling to one another in order to survive. This was what had happened in my client's family.

Like many oldest children, my client continued to feel responsible for her siblings, and so she suffered. She was in a similar position to those people who want to bridge a life-long gap between them and their sibling. This can happen only if both siblings are prepared to discuss their differences and to change some of their ideas about one another. Would my client's siblings have been prepared to take responsibility for themselves? I do not know.

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Openmind January/February 2007

Farewell to Chemical Imbalance

How often have you heard that a chemical imbalance is the cause of depression? A hundred times? If you're as old as me you've heard it a thousand times, and said by psychiatrists in tones of absolute certainty. It's why the SSRI drugs were made specifically to put serotonin in the brain and thus right the imbalance.

However, without telling the rest of us, psychiatrists have changed their minds. A few weeks ago I was browsing the Royal College of Psychiatrists' website. The pamphlet on bipolar disorder had been removed and I wanted to see if a new one was in place. It was, and some curious changes had been made. I then looked at their pamphlet on depression. It's a very long pamphlet, written in a chatty way. Under the heading, 'Why does it [depression] happen?' is a statement which says that sometimes there's an obvious reason for becoming depressed and sometimes there isn't. It's different for different people. Then there's a list of the things that can lead you to be depressed. These are: things that happen in our lives; circumstances; physical illness; personality ('This may be because of our genes, because of experiences in our early life, or both.'); alcohol; gender ('Women seem to get depressed more than men do. It may be that men are less likely to admit their feelings and bottle them up, or express them in aggression or through drinking heavily. Women are likely to have the double stress of having to work and look after children.'); and genes (depression can run in families). And that's it. No chemical imbalance.

There's never been any evidence for a chemical imbalance in the brain when a person is depressed. That idea was abandoned by scientists thirty years ago. However, a lack of scientific evidence has never stopped some psychiatrists from claiming black was white. It took the Royal College many years to accept that the minor tranquillisers are addictive; that the monoamine oxidise inhibitors are addictive; and, more recently, that the SSRI drugs can provoke suicidal and hostile thoughts. But it does seem, at last, that the Royal College has accepted that depression has far more to do with how we see ourselves and how we deal with our lives than it does with the physical make-up of our bodies.

Even the Institute of Psychiatry at the Maudsley Hospital has moved in that direction. They're holding a conference in April 2007 called, 'Depression: Brain Causes - Body Consequences'. On their website the preamble about the conference states,

Depression cannot be described any longer as a simple disorder of the brain, but rather as a series of behavioural and biological changes that span mind, brain, genes, body - and indeed affects both psychological and physical health. . . The experts will present neurobiological, psychological, genetic and evolutionary models, with particular emphasis on the mechanisms linking the brain to the endocrine and the immune systems, and therefore linking depression to physical health.

So everything about us is involved in getting depressed. Not a simple explanation in sight.

What about manic depression, or, as we have to call it now, bipolar disorder? What's happened to the gene that's supposed to cause this? The Royal College's new pamphlet on this disorder says:

We don't have a complete answer to this, but:

• research suggests that it runs in families - it seems to have more to do with genes than with upbringing. there seems to be a physical problem with the brain systems which control our moods - this is why the symptoms of bipolar disorder can often be controlled with medication
• episodes of illness can sometimes be brought on by stressful experiences or physical illness.

What do they mean by 'brain systems'? No neuroscientist talks about brain systems. Do you ever get the feeling that some psychiatrists think that the public is so stupid they can be fobbed off with any nonsense?

Ever since the late nineteenth century when the German psychiatrist Kraepelin described depression as a mental illness psychiatrists have been trying to find a physical cause for this illness. Vast amounts of time and money have been spent on this fruitless enterprise. If only Kraepelin and his colleagues had seen their patients, not as specimens to be studied, but as fellow human beings who could describe and discuss what was happening to them. If this had happened we would have come to understand a great deal more about being depressed than we do today. In those intervening years we might have seen how it is our ideas that create pain, suffering, conflicts, poverty, cruelty, intolerance, selfishness, hatred, envy and stupidity, and that these ideas damage us. But they are just ideas, and we are free to change them. If only Kraepelin and his colleagues had understood that.

 http://www.rcpsych.ac.uk/ http://www.iop.kcl.ac.uk/apps/depression/introduction.aspx

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?

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Dorothy Rowe