Dorothy Rowe

Openmind September/October 2006  

The more things change the more they remain the same. The news pages of the last issue of Openmind carried a report which read, 'Mental health nurses should spend more of their time in direct clinical contact with patients and cut back on administrative duties, a government review has urged. . . Sophie Corlett, Mind's Policy Director, said she was "delighted" at the review's encouragement of a more active role for nurses engaging with patients. "Too often we hear of a lack of interaction between the two, particularly on wards where patients may feel alone and abandoned," she said.'  

Sophie could have said the same thing in the years between 1968 and 1986 when I was working in large psychiatric hospitals. Walk on any ward and what you would have found were the patients sitting somnolently in well-worn chairs and in the office the nurses talking and drinking coffee. Whether you were a patient or a psychologist you approached the door of the office at your peril. You would knock timidly, and eventually one of the nurses would glance up, annoyed at being interrupted. A few of the nurses liked the psychologists, and these were usually the nurses who were very kind to the patients, but most of the nurses saw the patients and the psychologists as nothing but unwanted interruptions to the important things that the nurses were doing. If you were not sufficiently humble and grateful you would be punished. Nurses punished psychologists by advising the psychiatrists that nothing would be gained by sending a patient to see a psychologist. If the psychiatrist insisted in doing this, the nurses saw to it that the patient received a solid dose of a sedative just before the time of his appointment with the psychologist. I won't try to describe the multitude of ways patients got punished. 

Nurses spoke to patients only to question them, give orders, and tease them for the nurses' entertainment. In behaving like this the nurses were carrying out their instructions. In the hierarchy of the psychiatric system nurses were required to speak to patients as their inferiors. Conversation with patients was forbidden. On rare occasions psychiatrists would allow themselves to get in conversation with a particularly interesting patient. They would then express surprise that the patient proved to be an ordinary human. Psychiatrists could risk a conversation because they were at the top, or near the top, of the hierarchy, whereas nurses had only the domestic staff between them and the very bottom of the hierarchy, the patients. They had to keep their distance. 

This way of thinking still pervades some of the psychiatric system, but the nurses' position is even more difficult now. In the bad old days nurses could tell themselves that they had to separate themselves from the patients because the patients had a mental illness. In this so-called enlightened era nurses get two confusing messages. Patients now have some mental disorder which is caused by a gene or some chemical imbalance. This is the same as a physical illness only it affects their mind. However, this mental/physical illness can be cured by talking.  The nurses are told that talking can make people with a mental disorder think differently, and that changing how they think cures their mental disorder. Is there any physical illness you can cure just by changing how you think? Certainly, if you do what your doctor tells you to do while remaining optimistic there's a fair chance that the course of your physical illness will be shortened, but thought alone never eradicated an infection or a cancer.  

It's no wonder that many nurses are confused about what they should do. Having a conversation with someone who is suffering extreme mental distress is never easy. Even if you're not trying to help the person think differently about their situation and you just want to chat, you can find that you are bewildered or painfully upset by what the person is telling you. It's no wonder that nurses, faced with a choice of having a difficult conversation or filling in a boring form, go for the form every time.  

The only way to solve this conflict is to abandon the metaphor of mental distress being an illness and to recognise what it actually is, our response to being hurt, betrayed, abandoned, shamed, humiliated, and finding ourselves unable to make some kind of sense of our lives that we can live with happily. We need people around us who accept us as we are, who look after us when we can't look after ourselves, who understand the processes that lead to our suffering, and who can demonstrate in themselves the courage and wisdom needed to learn from our suffering and face life again. 

Dorothy Rowe Beyond Fear second edition HarperCollins.

Openmind July/August 2006  

Colwyn Trevarthen is an unsung hero to recent generations of babies who were born to parents who, from the moment of their birth, talked to them, played with them, and saw them as people in their own right. Colwyn and his colleagues showed that babies are born ready to engage in conversations, discover the world and act on it. This isn't how babies have traditionally been seen. The Christian Church has always taught that babies were conceived in sin, born bad, and have to have the devil beaten out of them. Nowadays children might not be beaten as frequently as children were in the past, but they are oppressed by a series of competitive exams so onerous that a beating might seem more acceptable. For Freud original sin became the id, and babies were born, in his words, polymorphously sexually perverse. For Jung, babies were inhabited by The Shadow. For Melanie Klein, babies thought of nothing but the good breast and the bad breast, and spent their time being in the depressed or paranoid position. So-called sensible adults saw babies as unpleasant objects producing nothing but yells and smells, and best left with women foolish enough to find them interesting, while doctors theorised that, as babies didn't feel pain, they didn't need any pain relief no matter what was done to them. Even the women who found babies interesting were inclined to agree with the psychologist William James that to a baby the world was no more than a buzzing, booming confusion, and that the baby's first smile when six weeks old was the first sign that the baby had recognized his mother. 

Some mothers did notice that their baby seemed to be born knowing the sound of their mother's voice. Colwyn showed that this was actually so. Developmental psychologists like Colwyn made some astounding discoveries. Babies come into the world ready to make sense of what is going on around them. They can track a moving object, distinguish human movement from the movement of objects, prefer the sound of the human voice to that of a machine, and prefer to look at a face, even a cartoon of a face, to looking at an object. As soon as babies see a face, they want to engage that face in conversation.  

It was these conversations between baby and mother that interested Colwyn. He set up a situation where the mother and baby were face to face with cameras filming each simultaneously. Thus the ebb and flow of the conversation, not just the sounds but the gestures and facial expressions could be recorded and the conversation mapped. It was clear that babies are born knowing how a conversation works. Babies initiated a conversation as often as their mother did. Babies understood the form of a conversation, a beginning, development, climax and conclusion, a form which relates as much to music as it does to language. Babies can show in their gestures their appreciation of the rhythmic qualities of language. In conversations with their baby depressed mothers behave very differently from non-depressed mothers. Depression runs in families, not via genes, but via conversations. 

The detailed photographs of babies in conversation with their mothers show that babies experience many more emotions than pain and pleasure. The pictures show babies interpreting everything they experience. This is what human beings do. We breathe and we interpret. Babies cannot put their interpretations into words but they can express them in emotions that are there to be read on their faces. They interpret the world, and, when they get it right, they beam with pride. When they get it wrong, they quiver and withdraw in shame.  

Babies show that they are agents, acting upon the world. This model of a human being who interprets, decides, and acts is one which is anathema to most psychiatrists and psychologists, and to some therapists. They prefer the model of a human being as a puppet manipulated on the strings of genes, or mental disorders, or traits, or factors, or abstractions like 'the unconscious'. The puppet model allows professionals to take pride in being 'the expert', and to enjoy the political power that position brings. Hence they have to resist any scientist who demonstrates what we all know, even though we sometimes deny it. We might say that it was our genes or our stars that made us do such and such, but we know that that that isn't how we experience ourselves. 

Colwyn's research group at Edinburgh University changed for the better the lives of babies and mothers, yet, when Colwyn retired, his laboratory was closed and the research group disbanded. He continues to research and teach, but with difficulty, because the university granted him the title of Emeritus but denied him a room in which he could work. Babies don't matter to those in power.

Openmind May/June 2006  

'Misery memoirs' is the latest catchphrase in publishing. Ever since Dave Pelzer's book A Child Called It became a best seller publishers have been keen to publish personal accounts of horrific childhoods. But why are these books so popular? Writing about this in the Observer Tim Adams listed 11 such books and commented, 'Since Pelzer sold many million copies of his books, there has been a kind of arms race of this kind of extreme confession.' Adams went on to point out how Oprah Winfrey in the USA and Richard Madeley and Judy Finnegan in the UK have promoted such books on their book shows. The talk shows Oprah and Richard and Judy purport not just to entertain us but in some way do us good. Reading books is good for us. Reading books about other people's extreme misery not only informs us about the terrible things that can happen in the world but it allows us to run through the gamut of emotions from shock and horror, through disgust, to the heart-warming happiness that comes when we discover that the narrator has survived such terrible suffering and is doing well. Feeling emotions does us good. 

Or so we are told. But does feeling emotions make us better people? An account of another person's suffering can lead us to feel the empathy which takes us out of our own small world and into that of another person, but this doesn't always happen. We can tell ourselves that we are feeling empathetic, and thus we can enjoy the glow of being virtuous, but at the same time the subject of our empathy can be feeling greatly misunderstood because we haven't bothered to take the time to inform ourselves accurately about what is going on in his life and what he is feeling. Accurate empathy requires the hard work of thought and observation, and an understanding of our own limitations in being able to imagine another person's world.  

Then there is the seductive emotion of feeling superior to the person who suffers, a feeling which often comes under the guise of pity. Pitying someone you see as inferior to you has more to do with vanity than it does with genuine concern. Straightforward pity is a painful emotion, especially when there is nothing we can do to help those who suffer. Many people protect themselves from the pain of pity by blaming the victim, something that those who believe that we live in a Just World are prone to do. In a Just World good people are rewarded and bad people punished. Since nothing in a Just World happens by chance, it follows that those who suffer deserve their misery. Women who are raped were asking for it: naughty children provoke their good parents into beating them. 

I have found that even in a rather irreligious country like Britain a great many people believe that they live in a Just World. A misery memoir allows such people to test their belief. As they read the book they can be looking for evidence that the writer is intrinsically bad. However, publishers like happy endings, and so each book ends with the author winning through, and thus showing that, if you are good, your rewards will follow as night the day. Dave Pelzer's royalty cheques confirm that. Yet in real life there is often no recompense for suffering.

Important though it may be for these authors to tell their story, their books can have a deleterious effect on those whose suffering is not on such a grand and obvious scale. Readers may come to overlook such suffering. Most people can agree that a child who is beaten and starved is suffering greatly. It is much harder to imagine ourselves into the silent suffering of those who, on the surface, seem to be leading ordinary lives. It is even harder to hold in our minds the differing viewpoints of all the people involved in the lives of those who suffer and see how we all suffer and we all inflict suffering, however unwittingly. Jonathan Franzen's great novel The Corrections tells the story of a family comprised of two elderly parents and three adult children. Franzen tells the story through the eyes of each member of the family. He shows the damage they did to each other, and the pain which each one felt. Franzen based his novel loosely on his own family, and so Oprah saw the book as a natural for her programme. Getting your book on Oprah's programme is every author's dream, but, when Franzen came to realise that Oprah expected him to turn his deep understanding of the complexities of human experience into nothing but an emotional roller-coaster for Oprah's audience, he withdrew his book. He knew that when we read we should do more than be just voyeurs of suffering. 

Openmind March/April 2006 

On the lower deck of London buses there is a space for wheelchairs, prams and pushchairs. Sometimes this space becomes a stage where all kinds of dramas are acted out. I was in the audience for one of these dramas when I was sitting facing this space and two women, locked in an intense conversation got on the bus. They had with them a baby in a pushchair and three children, boys aged, about eight, seven and six. Whatever these children did, they couldn't interrupt the women's conversation for more than a moment. The baby became restless and cried, and one woman, whom I took to be the mother, extracted a bottle from her bag and pushed it in the baby's mouth, all without ceasing to talk to her friend. However, the baby did get more of her attention than the oldest boy who pressed himself against her and tried to interrupt her conversation with a repeated question, but she ignored him and several times pushed him away.

The bus was crowded and the three boys had to cram themselves into small spaces in order to stay near the women. They soon tired of this, and, as soon as there was space, they started to climb up and stand on the handrails. The woman sitting beside me and I watched anxiously, fearing that the bus might suddenly stop and the boys crash to the floor, but the mother and her friend paid no notice at all. The smaller boys soon found this climbing too difficult, but the oldest boy was proud of his skill and tried to get his mother to look at what he was doing, but she did not.  

She did, however, pause in her talking long enough to give the seven-year-old boy a fifty pence piece. This only increased the oldest boy's entreaties. When she ignored him he moved to the side of the bus and kicked it several times as hard as he could. She didn't notice, so he returned to pressing himself against her and asking her for his money. This time she tried to silence him by picking him up as if he were a toddler and putting him on her lap. At first he tried to comply, hoping that this might lead her to actually talk to him, but he was far too big for her lap and he had to wriggle free. With this the mother looked at the woman sitting beside me and said, 'I don't know what's wrong with him. He's a terrible trouble to me.' Shamed at being brought to a stranger's notice, he moved away from her and stood silently for a while, but no doubt the thought that his brother had been given some money forced him to try again to get his mother to talk to him. He became more insistent, and finally she looked at him and began to explain in that 'trust me, I'm your mother' tone of voice (the tone that some women MPs adopt when talking to us, the public) that she couldn't give him any money because she needed what she had for their train fares. He was unconvinced, so then she told him that on Saturday, if he was good, she'd give him some money. He said, 'No you won't. You'll trick me and you won't give me any.' 

Children see other people through the prism of the way they have learned to see their parents. I grew up expecting that all women would be as untrustworthy as my mother, and that all men would be as kind and caring as my father. It was great surprise to discover that there were some women I could trust, and an even greater shock to discover that some men can be faithless and unkind. I had to learn how to make careful discriminations about people, but I know that many people go through life never questioning their habitual way of interpreting what other people do.  

I left the bus before the drama being played there had come to an end, but I left with that feeling of pity that dramas create in us. I pitied those children, but I also pitied those little girls who, as grown women, would encounter the eight-year-old grown up. He was a good looking boy, blond and blue eyed, with a tall, strong body. Women would fall in love with him, and he would see in them his mother, a woman whose serious attention he couldn't attract, who patronised and babied him, and aroused in him great anger, a woman whom he couldn't trust. It wouldn't matter it the woman who shared his bed was in fact kind, loving and trustworthy. Until he came to understand what he was doing, he would see in that woman only what he had learned to see.

Openmind January/February 2006  

It is extraordinary that, at a time when there is less disease and people live longer than at any other time in our history, amongst those who seek medical help, up to forty per cent of them have illnesses which may be given names like irritable bowel syndrome or fibromyalgia (niggling pains and tender areas in the large muscles of the back, neck and shoulders) but for which there is no identifiable cause. 'Literally millions of people are racked by back pain, tormented by abdominal gripes, alarmed by ringing in the ears, tortured by headaches, exhausted by sleep deprivation, frustrated with constipation, debilitated with nausea or faintness or anorexia, overwhelmed by the burden of obesity, terrified by shortness of breath or palpitations or just too sick and too tired to cope.' 

This is how the consultant physician and psychoanalytical psychotherapist Nick Read described what might be called an epidemic of functional illnesses. Doctors divide illnesses into functional and organic. Organic illnesses have a clearly defined pathology, each with a particular set of symptoms and organic changes which can be demonstrated in reliable tests. Functional illnesses have a wide variety of symptoms varying from person to person and in which few organic changes can be reliably demonstrated. People with functional illnesses may be given a many medical tests, and they may try every form of complementary medicine, but no physical cause of their symptoms is discovered and little relief gained. These are the illnesses which  Read studies, and the subject of his new book Sick and Tired: Healing the Illnesses Which Doctors Cannot Cure.  

Early in his work as a physician Dr Read found that many of the patients sent to him not only had a functional illness but that they seemed to suffer more distress in their lives than patients with organic illnesses. Now surveys have confirmed this impression. These surveys 'have shown clearly that patients with functional syndromes score more highly for anxiety and depression than healthy people or people with organic illnesses. They also tend to have experienced more threatening life events. For example, psychological distress is more prevalent in fibromyalgia than rheumatoid arthritis, and in irritable bowel syndrome compared with Crohn's disease or ulcerative colitis.'  

In his examination of how the world has changed since the end of the Second World War Dr Read shows how life is full of uncertainty and anxiety for a great many people. But, if it was just our way of living which led to functional illness, than all of us would be ill. By taking the time to listen to his patients and ask good questions Dr Read uncovered those ways of thinking which lead to suffering. His patients did not value and accept themselves, they viewed the world negatively and always expected the worst. The answer to the question why these ways of thinking led these people to a functional illness lay in the story of each person's life. There had been a crisis and a loss which were hugely significant to the person, yet the person did not want to admit this significance to himself. He felt that if he did so his life and his very being would fall apart. 

In his book Dr Read went to great pains to emphasise that 'in the whole of my medical career, I have yet to meet anybody I thought was imagining their symptoms, or making them up, but I have met thousands upon thousands of ill people who are struggling desperately to protect themselves from the potentially mind-shattering effects of unbearable life situations. These people don't deserve to be dismissed with a diagnosis that cannot be treated. Their illness needs to be understood as a state of disharmony involving the whole person - mind, body, spirit - within their particular social environment. And they need to be helped to uncover its meaning and to find an appropriate resolution for what caused it.' 

 Read illustrated this in his concise re-telling of some of his patients' stories. There was James, the solicitor, whose rumbling guts were reminders of his guilt about his dubious deals and forged accounts; Alison whose illness disappeared after she vented on Dr Read the lifetime of anger she'd kept hidden from her uncaring family; Peter for whom the mere thought of having to meet people made him feel he had to rush to the toilet and who had 'forgotten' a highly embarrassing incident at school involving bullies and an insensitive teacher; and Malcolm whose stomach pain was a defence against and a reminder of his unacknowledged guilt for his sister's death.  

It's been known for some time that loss, grief and depression often precede the organic illnesses of cancer and heart disease. Perhaps what is extraordinary is that many people, including doctors, still don't understand that mind and body are indivisible. 

Nick Read Sick and Tired: Healing the Illnesses That Doctors Can't Cure Weidenfeld and Nicolson, London, 2005.

Openmind November/December 2005  

Don't you find that every item of health news always ends up telling you that you've got something wrong? Your favourite food is killing you, the exercise you do isn't enough or it's doing you damage, where you live is the worse area for pollution, your level of stress will lead to a heart attack, and what ever has gone wrong is worse at your age, whatever your age is. It's impossible for me to read a newspaper without the words 'ageing' and 'getting old' leaping out of the page at me. There was no way I was going to miss the words 'old age' in the Guardian's report on the British Association of Science conference in September, but when I read the headline I was amazed. It said, 'Old age starts at 80 as brains keep getting younger'.  

This report went on to say that, according to Ian Robertson, the dean of research at Trinity College Institute of Neuroscience, biologically and psychologically old age starts at eighty. Writing this on September 12, I have got 5 years, 3 months, and 5 days to go to old age. This cheers me up greatly. 

However, all of you who have decades to go before you turn 80 need to remember that you'll stay young to 80 only if you follow  Robertson's seven point plan. You'll have to maintain your aerobic fitness, which means lots of exercise, not just to keep your body strong and active but your brain as well. Along with physical activity you must maintain mental activity, which involves more than wondering who's going to be the next to be thrown out of Big Brother. And don't think you can get by believing that you've learnt everything you'll ever need to know.  Robertson said, 'The more you learn the more you can learn. It can have profound physiological effects on the brain.' You'll need to avoid high and prolonged stress, know a lot of people and interact with them often, eat healthily (fruit, vegetables and fish) and THINK YOUNG. 

Of course  Robertson hasn't discovered something new. He's simply looked carefully and systematically at people and their brains and how they lived their lives. He's confirmed for me what I've observed in my contemporaries, that the people who stay actively involved in life and who don't think of themselves as being old don't become old, even though their skin has a few more wrinkles and bits of their bodies don't work as well as they used to. For many years now I've thought that old age begins for individuals the moment they say something to the effect of, 'I don't know what the youth of today are coming to', and 'I'm not going to learn how to . . .' The first of these statements has always been popular because the old have always envied the young. The second of these statements became particularly important during the media and communications revolution that followed the Second World War. 

My generation grew up with motor cars and landline phones and most of us learned how to operate both. Those of us who had to do housework welcomed vacuum cleaners, washing machines and refrigerators. I first heard 'I'm not going to learn how to use that . .' when answer phones arrived in Australia. At that point my generation divided in two. Some of us saw immediately that answer phones would make our life easier, and others of us got all nervous if they were expected to leave a message. Now there are those of us who struggle daily with the new technology, whether it's our mobile phone, our computer or just trying to buy a train ticket at a station; and there are those of us who write letters and wait for a visit from the grandchild who knows how operate a video machine. Of course, those of us in the first group are dependent on younger generations in way that older people have never been dependent on the young. Where technology is concerned the young know more than the old because they understand the technology they grew up with. However, because it would be a rare person who understood all current technology, today knowledge is shared rather than passed down a hierarchy of the older to the younger. In conversations, texting, emails and on the web people share their knowledge, and it is done in a way where age is irrelevant. When I email AOL requesting a clarification of some instruction or I instruct Guardian Online to send an article to a colleague no one asks my age. Similarly, in conversations with friends twenty years my junior about the merits of a server or the benefits of a certain firewall, age is irrelevant. In such interactions you don't think young, you just have to think.

Openmind September/October 2005  

Sami Timimi, a child psychiatrist in Lincolnshire, has written a book called Naughty Boys which everyone involved in the care of children should read. Sami was born in Iraq and came to the UK when he was fourteen. As I know from my own experience, even if you come to a foreign culture knowing the language, the history and the literature of that culture, you still don't understand the subtleties not just of what you aren't allowed to say but what you aren't allowed to see. You soon find yourself like the boy in Hans Christian Anderson's story The Emperor's New Clothes. While the rest of the populace are admiring the sumptuous brilliance of the Emperor's garb you're saying, 'But he's naked.' In Sami's case the Emperor is his fellow psychiatrists, members of a profession which never forgets or forgives any member who betrays them. They haven't forgotten or forgiven Ronnie Laing and they won't forgive Sami. However, Sami considers that the fate of millions of children in the developed world being more important than his own career.  

These are the children who, without their permission, have been made the subjects of an immense natural experiment, like the natural experiment that was conducted on foetuses whose mothers were prescribed thalidomide. This far bigger natural experiment will show what the long term effects are of a stimulant like Ritalin on the developing brains of children. In America over 1.6 million children have been prescribed such a stimulant while in Britain the figure is over 345,000. Some of these children are as young as two. Sami commented, 'Early in the twenty-first century we in the West are living in the bizarre paradox of Western governments spending billions each year to fight a war of drugs with the right hand whilst the left hand hands out millions of prescriptions for cocaine-like stimulants to its children.' 

These children, who are overwhelmingly boys, have been diagnosed with a new disease, unknown until recently, called ADHD (Attention Deficit Hyperactivity Disorder) where, according to the psychiatrists' Diagnostic and Statistical Manual, 'the essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity.' There have always been naughty boys around, boys who cannot or will not conform to what adults want. Sami wrote, 'I kept seeing these referrals describing "monstrous", "bizarrely behaved" "out of control children", then I would see them in the clinic and they would behave like angels. . I asked my colleagues to explain to me what diagnoses like ADHD, conduct disorder and Asperger's syndrome were, what was going on physically in these children, and how they "knew" which child had a conduct disorder caused by family problems as opposed to ADHD caused by an immature frontal lobe (in other words a physical problem in the development of the brain.) They couldn't explain this to me and didn't know how to differentiate physical from emotional or other environmental causes. Shockingly, I realized that the whole profession is built on subjective opinion masquerading as fact.' 

Sami found that a simple conversation with the parents and the child more often than not resolved a problem in the home or school and the disease disappeared. He also found that, 'Many of the families [he saw] have a far more sophisticated understanding of the psychosocial causes of behaviour problems than most psychiatrists and paediatricians I meet these days.' 

After I came Britain in 1968 I was continually astounded by the naivety of the consultant psychiatrists, most of them men and older than me. I studied them closely and came to see that psychiatry was an extremely conservative profession where those entering it were students who wouldn't question what they were told and would adhere to the customs and morals of the white English middle class even though the student mightn't come originally from such a group. Only minimal questioning of the concepts and methods of the profession was allowed, and the psychiatrist used these concepts and methods to maintain an impenetrable barrier between himself and his patients. It seems that little has changed since then. 

In Naughty Boys Sami shows how ADHD is a problem only in the developed world. Other cultures bring up their children differently and badly behaved children are not a problem. It seems that psychiatrists need to give up looking mythical immature frontal lobes, learn how to converse with their patients, while preparing for what ever happens to the Ritalin generation as they become adults. There is already some evidence from the USA that children who have been taught that the way to solve problems in living is to take a drug find it easy to switch from Ritalin to the illegal drugs which make solving life's problems unnecessary. The Emperor really has no clothes. 

Sami Timimi Naughty Boys Palgrave Macmillan, London, 2005.

OpenMind - Journal of the mental health association MIND

May/June 2005

Haven't We Done Well!

Dorothy Rowe

When I was preparing to go to Australia last winter a producer of a discussion series on an Australian TV channel contacted me about making a programme on depression. I suggested that the programme should be about those people who had devised their own methods for getting themselves out of the prison of depression. A few weeks later we recorded the programme and by then the producer had found a number of people who were prepared to talk about their own successful experiences. However, when I arrived at the studio I found that, in the interests of balance, the producer had invited a consultant psychiatrist.

I shouldn't have been surprised about this. In Australia mental health is dominated by psychiatrists who believe wholeheartedly in the medical model. As I had been told by my Australian psychologist colleagues, most Australian psychiatrists see mental disorders as physical illnesses best treated by drugs and ECT with the psychological therapies being no more than optional extras. There is no NHS in Australia, and, though each State supplies some mental health care, private medical insurance pays for visits to psychiatrists but not to psychologists.

Before we began recording the presenter, Jenny, told me she would start by asking me a question which would allow me to say briefly that no evidence had ever been found for lowered serotonin levels in depression. If there were such lowered levels by now there would be a physical test for depression but none has been devised. Jenny then turned to the consultant psychiatrist. He announced in the manner of Moses handing down the Ten Commandments, 'There is biological depression. I can tell by the way the light goes out in their eyes.'

Instantly I was transported back to the early 1970s in Britain when consultant psychiatrists were the guardians of the Absolute Truth of mental illness, when psychologists gave tests and wrote reports, and patients were obedient, unquestioning and grateful for being given drugs and ECT. In the studio my experience of the bad old days was repeated every time the psychiatrist spoke because, irrespective of what Jenny asked him, he repeated, 'There is biological depression. I can tell by the way the light goes out in their eyes.' He castigated me and other therapists for telling patients that they were bad and had to change. When I replied that, since only good people get depressed, my advice is always that they should become less good he sniffed disdainfully and looked away. He refused to acknowledge the people present who told how they had ended their mental torture without recourse to psychiatrists and drugs.

One lively, passionate woman told how, after the death of her son, she had become so deeply depressed and frightened she couldn't leave her house. A friend discovered her plight and after that came every day to sit quietly with her. Gradually her friend coaxed her into the garden and then to the shops and back to driving her car again. The big change came when, in talking things over with her friend, she decided that, 'I'm me, and if other people don't like me that's their problem, not mine.' A quietly confident young man told how he had lost his nerve in dealing with people and from this lost his job, his home and his wife. Desperate and despairing, he decided to take responsibility for himself. He joined a self-help group, read books which helped him think about himself and how he saw the world, and through this put together a plan to re-build his life, something he was now doing very successfully.

Over the years I have heard a great many such stories but I never fail to be thrilled by the courage that people show when they take responsibility for themselves and step into the unknown. It is people like this who have, since the early 1970s, transformed the way mental health care is now seen in Britain. It would be a foolhardy British psychiatrist who would behave like this Australian one, because even those British psychiatrists who wish that mental disorder could be explained and treated as being no more than a physical aberration have to admit that they have to take account of how the individual sees himself and his world, and of what terrible demands life makes upon us all. Moreover, in the psychiatric system, there is general agreement that all people should be treated with dignity and respect. Of course these principles are not always adhered to, and much more remains to be done, while we must always be vigilant against the forces of unreason in high places, but, as I thought over the events of that evening in Sydney, I felt that all of us who in one way or another have been involved in changing mental health care and understanding in Britain could allow ourselves a moment of self-congratulation. Haven't we've all done well!

OpenMind - Journal of the mental health association MIND

March/April 2005

Happy Kids Make Happy Parents

Dorothy Rowe

I avoided the worst of the winter by visiting my son Edward in Sydney. On our way to the beach one day Edward pointed out to me a parked car which had a sticker on its rear window which read, 'Smiles for Kids. Child psychologist' followed by a mobile phone number. 'You ought to have a sticker like that on your car,' he said. I shall spare you the list of suggestions he then produced. Edward has never shown the respect for psychologists which we psychologists think we deserve.

The slogan 'Smiles for Kids' worried me. In Australia most psychologists work privately and are allowed to advertise. There is keen competition for work. Some psychologists feel that their advertisements should include more than a statement of their qualifications and a list of the problems about which they have special expertise. But, if truth in advertising matters, can psychologists guarantee that their clients will live happily ever after?

Advertising slogans are not necessarily aimed at the person who will use the product. They can be aimed at the person who will pay for the product. 'Smiles for Kids' does just that. Most parents for altruistic reasons want their children to be happy, but there is also a selfish reason for parents wanting their children to be happy, or, at least, being seen to be happy. If children smile it is proof that their parents are good parents. Unhappy children are showing that something is wrong. The parents have failed, and are continuing to fail to put things right.

It was significant that 'Smiles for Kids' was being displayed in one of Sydney's wealthiest suburbs. Out in the great sprawl of Sydney's western suburbs, places like Campbelltown and Cabramatta, where unemployment, poverty, drugs, and gang warfare are endemic, parents know that they are doing a good job if their children are healthy, adequately fed, and getting an education. Being happy is an add-on extra for special occasions like Christmas and birthdays. But, in the wealthy suburbs along the beaches and the harbour, children lack for nothing. They get food, clothes, toys, entertainment, holidays, comforts of all sorts in great abundance. They go to the best schools. They exude enormous health. How dare they be unhappy!

Yet many of them are very unhappy, and with good reason. Along with the material things they can get parents who never stop to listen to them, who give them things rather than attention, parents who always think they're right and the child wrong, parents who fight, drink, take drugs, are unfaithful, divorce, have serial partners. They encounter step-parents and step-siblings, family fights over money and all that bitter nonsense that can go on in families. They encounter loss and death. And they encounter their parents' demand that they should appear to be happy.

In past generations children were required to show their gratitude for all that their parents had done for them. I remember being very resentful when my mother demanded my gratitude because by the time I was in my teens I could see that what care she gave me was solely in terms of what other people would say if she failed to provide this care. She saw that I was fed, clothed and attended school, but private matters like my persistent cough and my unhappiness she felt she could safely ignore. I felt sorry for myself then but now I feel even sorrier for children who have to express their gratitude to their parents by being happy. I could get away with a muttered 'Thanks' and a dutiful kiss on my mother's cheek. I didn't have to pretend I was happy all the time.

In the society I grew up in a grateful child was a good child. A good child shows that the parents are good parents. All I had to do was to bear my misery as best I could. Nowadays a happy child is a good child. Children who lead miserable lives not only have to bear their misery as best they can, they have to pretend to be happy. I wonder if the psychologist who promises 'Smiles for Kids' understands this, and so tells the unhappy child that in his situation it is appropriate to be unhappy. Does she help the child to understand the source of his misery and to see that he is not to blame for what adults do? Or will the psychologist side with the parents who are paying his fees and instruct the child in the simplistic techniques which cognitive behavioural therapy allows unthinking, shallow psychologists to use?

All that a psychologist can do for a client, adult or child, is to help him sort out which aspects of his situation are his responsibility and which the responsibility of others, to moderate the condemnatory attitude he has toward himself, and thus acquire the courage and wisdom to deal with the crises, losses and pain life will undoubtedly bring. What's a snappy slogan for that?

OpenMind - Journal of the mental health association MIND

Jan/Feb 2005

How Much Space Is Your Space?

Dorothy Rowe

A few weeks ago I caught a train from Bristol to Paddington. I'd booked an aisle seat at a table for four. Two women sat opposite me. The window seat beside me was booked but still empty when the train, now packed with commuters, pulled out of the station. At Bath more passengers crowded in. A man leaned over me to read the booking slip above the window seat, and indicated that he wanted to sit down there. I stood up to let him in and, without a please or thank you, he hurled himself into the seat.

When the two women opposite and I had sat down each of us had been careful to take up no more than our quarter of the space. Small though the table was, when we placed our belongings on it we made sure they didn't intrude into another person's share of the table top and, if a danger of that happening arose, we apologised. But not this man. He was an average-sized, middle-aged man, yet his bum had no sooner hit the seat than he spread out of it, trying to take up all the space he felt he needed. His arm came across the middle armrest into my seat space and I shrank away. He forcefully kicked out his legs, and when they encountered the legs of the woman opposite him it was he who grunted and groaned in complaint. She pulled her legs back, trying to tuck them into a tiny space.

Then began the battle of the newspapers. I was reading the Guardian which I had folded so that it was no wider than I was. He opened his Daily Telegraph fully and so covered what I was reading. Silently I pushed his paper away. He grunted complainingly, turned the page, and covered my paper again. I pulled my paper out from under and put it on top of his. He pulled his paper away quite angrily and made a great play of folding it back to the size of a single page of broadsheet. In doing this he pushed his paper toward the face of the woman sitting opposite him. She held the magazine she was reading higher, and this action pushed his paper back towards him. He sighed loudly with impatience, shoved his paper aside and then proceeded to invade all our space by calling his wife on his mobile and in a posh, loud voice discussed their social arrangements for the evening.

This man confirmed all the prejudices women have about how men take up all the room, how they sit with their legs spread out and take both armrests. He also confirmed the political prejudices of at least one of us. But we three women had done what most women always do. We shrank away, giving up our rightful space, trying to make ourselves smaller and smaller. It was only when this man prevented me from reading that I got angry and fought back.

However, whether we occupy our own space, or intrude into the space of others, or, when intruded upon, shrink away, isn't a matter of whether we're male or female. For both men and women it's a matter of how much we value ourselves and how much we considered the rights and needs of other people. The man on the train might have seen himself as having high self-esteem, but his complete disregard for others shows that his self-esteem was simply vanity. People who value themselves and are aware of the rights and needs of others will occasionally shrink away when they see that someone else's need of extra space should be met as a matter of courtesy. Courtesy to one another is the oil that enables our society to operate smoothly. However, if we don't value ourselves we can come to feel that we haven't the right to inhabit our own space. We daren't take up our rightful space and instead yield it to others and not protest when others intrude. Women who don't value themselves will often try to be as thin as possible so as not to take up more space than they feel they deserve. Men who don't value themselves can be very frightened of men like the man on the train, men who take up more than their rightful share of space and who, if intruded upon, will attack. To protect themselves from such attacks men who don't value themselves develop defences such as a self-deprecating sense of humour which is a kind of giving up your own space.

Our sense of the space we need around us develops very early, before we've got language, and, unless we bring it clearly to mind and think about it, we can be unaware when we intrude into other people's space and then wonder why we're rejected, or we can be intruded upon and not understand why this make us miserable. It is essential that we know and value our own space.