Time to Be in Earnest (36 page)

Today is the anniversary of my husband’s birthday and inevitably it is a day for memory to take hold. It was an unpropitious day to be born, provoking in childhood the inevitable jokes and teasing. Connor would have been seventy-eight today and I am trying to picture him, like me stiffer in his walk, his strong fair hair now a thatch of grey. I know that he was glad to die and I never mourned him in the sense of wishing that it had not happened. I still miss him daily, which means that no day goes by in which he doesn’t enter into my mind: a sight which he would have relished, a joke which he would have enjoyed, something seen or read which could be shared with him, the reiteration of familiar gossip, opinions, prejudices, which are part of a marriage. And then there is the success and prosperity in which he never shared and which could have made such a difference to his comfort, and the grandchildren he longed to see but never did.

For much of his last years he was in and out of psychiatric hospitals, chiefly Goodmayes in Essex. It was, indeed still is, one of those impressive and forbidding Victorian edifices which, during my childhood, were called asylums. The word is beautiful, as is its meaning, but it was spoken then always with that mixture of fear and shame associated with the word “workhouse.” These large communities for the care of the mentally ill have, of course, been largely superseded by community care, which could be described more accurately as the absence of care in a community still largely resentful or frightened of mental illness. Connor was never unhappy in Goodmayes but then, as he said, education at a minor public school and subsequent army service prepared one for anything. For him and for very many, particularly those who could not possibly have survived outside, it was indeed an asylum.

I was living at the time with his parents in Ilford, where my father-in-law was still working as a general practitioner. Every Sunday I would take
the bus to the end of Goodmayes Lane and join the straggling stream of dispirited-looking men, women and children trudging up the driveway to the hospital. It was too reminiscent of similar journeys to a similar hospital taken in childhood with my father. All the visitors would be carrying baskets or bags containing the weekly offering of food. I usually carried fruit and a cake baked by my mother-in-law, in addition to cigarettes, any book I thought Connor might enjoy and pocket money to see him through the week. We would meet in one of the large day-rooms smelling as always of inadequately washed bodies and furniture polish. If the weather was fine we would walk in the grounds. The wards were large and barrack-like with small padded side-wards in which patients had occasionally to be incarcerated. Many of the modern drugs had not been developed and patients saw psychiatrists only infrequently. For many of them, the burnt-out schizophrenics, there was in fact little that could be done medically, but here at least they did find an asylum. Sometimes the care might have been a little rough and ready, but on my frequent visits I saw no unkindness—and much compassionate and sensitive caring.

I got to recognize the other visitors, since we went week after week. One, a very large woman, with a son built like a rugby player and ferocious in mien, took him a cooked meal for each day of the week in a series of heaped metal containers. She confided to me when we walked together up the drive: “George has been reclassified. He’s a voluntary patient now. Mind you, we’re not telling him!”

The hospital was a place where eccentricities and bizarre behaviour were tolerated as they rarely are with community care. I went once with Connor to a church service where the chaplain was in no way put out by the fact that a third of the congregation took the high kneeling hassocks and placed them on the pews so that the congregation looked as if it contained a proportion of formidable giants.

Connor, on admission, had decided to call himself Ted, and I got used to hearing him addressed by nurses and patients by that name. For some time he worked in the library but also captained the soccer team. I don’t know whether any games were played away, but those on the home ground had their moments of eccentricity. Connor was not pleased when, during one game, the goalkeeper began hearing his voices and stood immobile, eyes raised to heaven, while the ball whizzed past him into goal.

Only those who have lived with the mental illness of someone they love can understand what this entails. One suffers with the patient and for oneself. Another human being who was once a beloved companion
can become not only a stranger, but occasionally a malevolent stranger. It is easy sometimes to understand why mental illness was once seen as possession by an evil spirit. But at least I was spared the theory which some psychiatrists subsequently developed: that it was the family members who were ill, the patient who was sane, and that the family, particularly the parents, were responsible for the sickness. This theory is so cruel and wicked—I use the words with care—that it should surely never be put forward unless there is proof of its truth and something can be done about it. The additional burden this placed on parents, already trying to cope with little support with an intolerable burden, was frankly appalling. I suppose it principally arose from the psychiatrists’ need to relate emotionally to the patient. But too often it seemed a collusion; parents, in addition to being regarded as the cause of the illness, were denied information about its progress. I know of one case where a schizophrenic son subsequently drowned himself but the hospital at which he was a patient didn’t know that he was no longer in his room, since to enter it would have been a violation of his privacy.

The policy of treatment in the community, which began when I was working at the North West Metropolitan Regional Hospital Board and was enthusiastically implemented, has immeasurably increased the burden on families, many of whom live under a pressing cloud of daily anxiety which must at times seem insupportable. When will we learn not to legislate for, or introduce, so-called reforms unless and until we have the will and the means to finance them? Depressing as the old psychiatric hospitals were, at least they provided respite for the family, and control, care and support for the patient. If there is to be community care, there should also be small local in-patient and out-patient facilities to which patients can return in moments of crisis or when they have neglected to take their medication, and to which carers in the community can look for support and help. It might be necessary to have short-term compulsory orders to ensure that patients who won’t return to in-patient care voluntarily can be admitted until they are stabilized. But one would hope that these small units—I hate the word, but “hospital” hardly seems appropriate—can be attractive and welcoming and seen by the patients as true asylums. I suspect that there are many thousands of parents, wives, husbands, children coping with the mentally ill, in circumstances which no one should be asked to endure. It is surprising they are not more vocal, but it is difficult to criticize the system when the system is all you have, and to antagonize it might take away even the inadequate support which you at present receive.

I remember watching with my younger daughter a programme on the television in which a team of psychiatrists and social workers were in session with the family of a schizophrenic boy, indulging in some kind of family therapy. I felt outraged at the intrusion. What exactly, anyway, is a normal family? There can be few in which the relationships are without tension or even occasional acrimony, or in which some unhappiness is not endured. By what right have these outsiders, these experts, come in to meddle in other people’s lives when, in reality, they have so little to offer? At least I never had to endure that kind of intrusion. It is an injustice about which, perhaps not surprisingly, I can become vehement.

I am writing this on the train from Edinburgh to King’s Cross, following my address to the Scottish Medico-Legal Society. The carriage is almost empty and I’m enjoying what I like best, a quiet uninterrupted journey. At York a man got in and immediately began using his mobile telephone. I had a horrible fear that this was the end of peace, but he made only the single call. One would like to see carriages set aside for people who want to conduct their business in loud voices throughout a journey, but I am always reluctant to add to prohibitions. Perhaps it’s better to have notices asking people to use mobile phones only when standing in the corridor or between compartments. That might get the message over that this is not an acceptable practice.

The first part of this journey is the most exciting; rugged coastline before and after Berwick, the wild sea rolling in over jagged rocks, and the first gorse, bright yellow on the headlands. Then the Tweed, flowing under the last bridge to merge with the sea at Berwick. We are now in calmer country and the weather has changed from dull to rainy; raindrops, like silver tadpoles, weaving and spurting down the panes. The north seems to be painted boldly in dark oils, the south in watercolours. But now the blurred countryside is seen as a pointilliste painting, the fields as yet only smudged with the acid yellow of the rape.

It has been an enjoyable visit. Edinburgh is a splendid city, but one in which a southerner will always feel a stranger, even if—as on this occasion—a welcome stranger. It offers that greatest of city delights, the
unexpected glimpse down narrow roadways or cobbled passages of glittering water and far hills.

Grandson James met me off the train yesterday and drove me south to walk on a wide, firm and deserted beach before dropping me at my hotel. This was The Witchery, snuggling down under the castle. It is primarily a restaurant with only two rooms for visitors, one a suite called the Inner Sanctum. This was furnished almost exactly as it would have been for a Victorian visitor and his wife. It looked like a theatre set that was in danger of overpowering the action. Here, artfully arranged, was high Victorian clutter, a large bronze head of the Queen presiding over more artefacts than one would find in a row of antique shops. The nineteenth-century travelling couple would be ushered into a room in which they would feel immediately at home, indeed their luggage is already here: leather suitcases, tartan rugs, an officer’s red jacket arranged on a stand. The large sitting-room has tartan rugs as well as a tartan carpet. Both rooms are crowded with family pictures in silver frames, sentimental coloured prints, an open photograph album on a stand, large floral arrangements, innumerable knick-knacks crowding every surface. The bedroom is dominated by a high, wide four-poster bed with a scarlet canopy and eight huge tapestry or embroidered cushions. All this brilliantly arranged reconstruction of another age was combined with cleverly concealed modern conveniences: television, fax, telephones, although the eight different taps in the bathroom could be more properly described as a challenge rather than a convenience. I suspect that I shall one day use this room, or one very like it, in a novel. The description of a room can be as revealing of character as dialogue or action.

My lecture was held in the demonstration lecture hall of the School of Medicine, a pleasantly proportioned semi-circular room with high, ranked seats and a space in front of the speaker’s desk obviously intended to hold a postmortem table. I was aware of its absence and could picture an autopsy—perhaps on the victims of Burke and Hare—being undertaken under the fascinated gaze of passers-by who had walked in from the street to watch this demonstration of scientific cleverness. After the lecture, which could perhaps be more accurately described as a talk, a small group of us had an excellent dinner at The Witchery. I enjoyed the company very much—forensic pathologists are never dull—and I was seated next to a Procurator Fiscal and was able to discuss some of the differences between Scottish and English law. He is close to the
Chargé d’Instruction
in France, and told me that during a police investigation he
can ask for any information which he thinks would be helpful, including information on the background of suspects or the defendant. This means that much more is known about the background and details of the case by the time it comes to court than happens in England, probably resulting in a higher level of convictions. We talked about the “Not Proven” verdict
^*
and agreed that Madeleine Smith, the twenty-one-year-old Glasgow architect’s daughter tried in 1857 for the murder by arsenic of her lover, Emile L’Angelier, would almost certainly have been found guilty and hanged had she been tried south of the border.

This dinner conversation reminded me of the time during my service in the Home Office when I was concerned with juvenile law and had to come to a conference in Edinburgh to discuss the Scottish panel system as opposed to the English and Welsh juvenile courts. At first I thought there were obvious advantages in dealing with children, particularly younger children, in an informal setting where they face not a juvenile magistrate but a panel of men and women experienced in child care who discuss all the circumstances of the offence with the parents and who arrive at a decision about what should be done. But it later seemed to me, as it still does, that the treatment model has its defects; in particular there is a risk that the juvenile will be deprived of the protection under the law which his elder brother would get if brought before a court on, for example, a charge of grievous bodily harm. The panels at that time had the power to direct that the child could be sent to a special school, and probably still have that power. In other words, a child is deprived of his or her liberty without the order of a court of law. This dichotomy between treatment and control under the law seems to me at the heart of juvenile justice. In the youth courts, for example, the children have legal aid and the services of a defending counsel. This is absolutely right, yet there is the danger that the child may learn from an early age that it is possible to get off if you are represented by someone clever enough to establish reasonable doubt. G. K. Chesterton wrote, “Children, being honest, love justice; adults, being corrupt, naturally prefer mercy.” What children expect of any legal process is simple. If you have done wrong you will be punished; if you are not guilty, you will be
let off. This is hardly commensurate with our present system of criminal justice.