Monday, September 7, 2015
Making of a Child Psychiatrist: (20) On work
I returned the precious book to Fred, and told him how excited I had been to read it, and what I felt it had meant to me. He asked if I had read it all, and I was able to assure him I had struggled with some passages, but had worked through most of it. He reached into his school bag, brought out an old hard covered book, and said: “Well if you enjoyed that one, you may like to read this one…” The book was Alfred Adler’s ‘Understanding Human Nature’, originally written for the general public in 1927, and still in print.
I have to admit that I have had to refresh my experience of ‘Understanding’, and it has been delightful. The book is based on a series of weekly lectures, given by Dr. Adler, based in the premise that as psychologists or psychiatrists we may be able to help members of the general public through sharing our ideas about how the mind works. Even people without a scientific background or training can begin to understand the mind, and perhaps then learn to redirect their own lives. I love this idea; it resonates with who I think I have become. I have always thought that knowledge should be freely available, and not locked up in journals that demand payment to access them. Hence I applaud the recent development of so-called ‘Open Access Journals’ that demand a payment up front for the act of publication from the research paper authors or from their institution. This effectively allows a journal to make downloads free of charge to any interested reader or researcher.
In addition, if I review my career, over the last 40 years I have given up to 50 or so lectures a year to a wide range of audiences, which often included both professionals and members of the general public. In addition, up until about 5 years ago, I gave almost weekly interviews to press, radio and/or television about topics we have been researching, or aspects of child, adolescent and family psychiatry. Some would call that ‘self-seeking’, and there may be some truth in that. I know that several of my colleagues may have thought of (if not openly used) the term ‘media tart’, especially when, for a number of years I was a noisy member of a federal government media committee working towards suicide prevention. I prefer to think of my activities as raising the issues for discussion, and trying to educate the general public.
Was I influenced by ‘Understanding’ at the time I read it? I do not know. But sometimes when you read a book at a critical time of personal development it can have life-long impact.
The book is not an easy read. The original lectures, given to large audiences, were in German of course, and I suspect even the best of translators find the German sentence structure somewhat hard to morph into everyday English. But even today it is worthy of the struggle.
In the Introduction, there are a number of cautionary notes. ‘Individual Psychology’ in 1927 was not a complete science, and we should be cautious ‘in the desire to show how much one knows or has guessed concerning the character of one’s neighbour at dinner’. ‘The science of human nature compels us to modesty’, and we should not show off like ‘a little child’. ‘The process of transformation, moreover, must be conducted in such a way that it seems justified for the one changed’.
The essence of the book is about how we are formed in the early years within the context of our family or early life, and the patterns of behaviour so formed continue throughout later life. The corollary to this was that change toward a better way of living is possible with the right ideas, but that sometimes this took hard work to achieve. I cannot help thinking that just these two ideas could have had a profound impact on me. Adler and his students were so passionate about the utility of ‘Individual Psychology’ that they created several free Child Guidance Clinics in Vienna to help families set children on more positive pathways to adulthood.
Having begun to understand some of my personal underground mind, and drawing on the exciting ideas from both Freud and Adler, I renewed my contract with myself – to become a doctor (even perhaps a neurosurgeon). In addition, I think I determined that perhaps I needed to do some work.
Bob Bateman, my biology teacher, obviously had the same idea. I can recall an open day at school where I was demonstrating some of our experiments to interested parties. My parents were in attendance, and Bob drew them aside (but well within my range of hearing). He told them how much he had enjoyed teaching me, and that I had the potential to be a good student. But then the punch line - and I can remember his words as if they were spoken yesterday. “Your son could do very well in life, but he is extremely lazy. He seems to think he can get by on natural talent. He has four months until the final exams. If he does not do some serious work, he will fail.”
The statement was to galvanise me.
It was not that I did not know how to work. I had been involved in various forms of work for some years. When you have a girlfriend, and want to impress them, or at least keep up with them, you need money. As I remember it, in our family, there was little money for what might be termed ‘the extras’. I know that there had been a struggle to buy a telephone and a television (both when I was 13), and then later to buy a car. But we did not ever take holidays as a family, or ever go to the theatre. There was just not enough to spare. So I had begun to take on jobs.
My first job was at a holiday hotel kitchen in the Nayland Rock Complex in Westbrook. I was a kitchen hand. What this meant in the main was that I had to fill a large industrial dishwasher. It was my job to ensure that food scraps were scraped off prior to stacking, so as not to clog the machinery and ensure that every piece of crockery and cutlery came out pristine. In emptying the machine, I had to stack everything to drain, dry and cool down. In between, I had all sorts of odd jobs around the kitchen. It was only a few hours a day covering breakfast, morning tea and lunch, but I was paid in real money. For a fourteen year old, it was a dream come true.
The following summer, I found a job working at a café on the seafront at Westgate at the height of summer. The job was varied. It began with selling ice creams from a large icebox on a trolley with slightly wonky wheels. I had to push the trolley along the promenade, and dive in and out to get the asked for item. I also had responsibility for ensuring the change to the customer was correct, and that I could account for items sold and the money collected; if I was short on change it would have had to come out of my wages at the end of the week. Apart from being out in what passed for sunshine in an English summer, there was a major advantage to this job. That was that I could watch the beach, all the girls in swimsuits, and the shenanigins that went with a beach side holiday. The downside was that I could not join in, because I had a schedule that I took very seriously. When in the café, I did a range of menial tasks, cleaning tables and high chairs, replacing cutlery, picking up rubbish and sweeping up sand from the floor. I was fairly well liked and acceptable, so later in the season I was taught how to work the soft serve ice cream machine, and found myself serving queues of patrons. I found I like the job, and the sense of managing under pressure. Most of all, and a bonus over the hotel job, I loved interacting with the customers. I had always been told as a child that I could ‘talk the hind leg off a donkey’, and this was to become a tremendous asset in the world of work with customers, when I later worked in a sausage factory, and then in a petrol station, and later in a pub. It was not such a useful skill later in my early medical student career, where I was sometimes accused of being glib and superficial. But that is another story. Anyway, I must have been thought to be reasonable at the job odf serving ice cream, because I was able to return the following year for some weeks.
A job a bit later in the year came after return from the skiing holiday in Saas Fee. I had applied to Margate Hospital for a nurse assistant job, and was lucky enough to get taken on for a whole two weeks. I was nervous to begin with, knowing none of the daily routines or the expectations, but the full time nursing staff were kindly and supportive. Not that I did not get to do many of the lowly jobs they might have found tedious. I helped to make beds, learning how to do ‘hospital corners’. I delivered, collected, cleaned out and stacked bedpans for sterilising. I delivered and then collected wee bottles from the elderly men on the ward. I learned simple testing routines. I learned how to carefully turn people in bed, and got to assist in transfers around and between wards.
One of the extraordinary events surrounded a now frail elderly man in his 80s called Mr. Betteridge. He had attended art classes with my mother, and had enjoyed her support and conversation. I had seen him around Westgate over many years, but would not say that I knew him. He happened to be on the ward. I was asked to help him into the bath, scrub his back, sponge him down, dry him off and return him to his bed. It was a shock to my young system, but I said nothing; I accepted my lot, and very carefully worked to do a caring job. We talked about the daily news. Mr Betteridge was never to recognise me, and that was no problem; I refrained from making the link to my mother. Afterwards, I was bemused, yet felt a strange sense of pride in doing the job. It was my first experience of really taking responsibility for someone’s care, and I have always held onto the sense of privilege deriving from such an ordinary job.
When I reflected on my two weeks work experience, I had been enthralled by almost everything I was asked to do, and it confirmed the general direction I wanted to take toward some sort of medical career.
So when Bob Bateman told my parents I was lazy, and would never get anywhere unless I worked hard, I was incensed, but also further bemused. I knew how to work hard, and felt I had proved that in my jobs. What I had never had to do was to apply the same sense of effort and joy to study. I had never had to; it had always come so easily. I made a clear decision; I would show him and my parents that I could study, and was worthy of a place at University. Somehow, there was a coming together of ideas I had read in both the Freud and the Adler books, and my experiences of real world work, as well as the re-commitment to myself to overcome my supposed laziness. In the next few months, I ate rapidly, did not want to watch television, could not wait to get to the textbooks in my bedroom, I hardly socialised, and for probably the first time in my life I applied myself.