Depression comes in waves. A cold, black sea. I stop swimming and try to float, like I have been taught to do. But the undertow is dragging me out. Further and further, until I am out of my depth. And I am getting tired.

"A rainy night in Soho" The Pogues

Bernie came in wearing a T-shirt, which read: There is no finish line.
Greta sometimes wears one with the legend: If you don’t see what you want in the window – ask inside.
I have T-shirts that say: There is no last bus to miss and There is no ‘Good Ship Lollipop’
Someday I will write a paper: T-shirts: philosophy for the masses.
But not today, for I have other things on my mind.

Amanda. Is she really pregnant? If so, who is the father? One would immediately think of Freddie, but if she was telling the truth they have not had sex for a long time. Has she perhaps got a boyfriend? She goes to a lot of conferences.

It’s a funny business, this sex thing. Spike (you remember Spike – the serial shagger) says he has given it up. Says he prefers a brisk walk nowadays. Can’t say I blame him. In fact I am going off the idea of matrimony. I haven’t replied to Anastasia’s letter yet.
Getting married would get me out of here. But at what price?

They seem a bit lax about supervising my use of the internet, but I do have to be careful about photographs. I took another one (surreptitiously) in the old wing - stairs leading down to the ‘hydrotherapy room’. Of course it has not been used for years but I don’t think Freddie would like me to show the ‘unacceptable face’ of Victorian psychiatry. I don’t mean to be critical of the old mad doctors - they were doing their best. They really had the interest of their patients at heart.

We are all struggling to make some sense of all this: Life, I mean. Even the villains. Yes, what would we do without the villains? There would be no ‘cops and robbers’ on tv, no ‘soaps’, cinemas would close, theatres too – and of course the police and the prison service would be out of a job.

It is said that Dutch Schultz (America’s public enemy number 2 during the prohibition era), when he was found guilty, wept in the dock. He just couldn’t understand it. He was – in his own way ‘just trying to bring pleasure to people’.

It has been raining most of the day. But we have a ‘games room’ with snooker and table-tennis. Then of course there is 'occupational therapy' (your sponsorship ‘patch’ is now ready, girlzoot), where I am constructing a model theatre. The ‘theatre of the absurd’. I shall take a photo when it is finished – they won’t mind me putting that on the blog. (by the way, don’t think I don’t know that to be grammatically correct that should be ‘my putting’ but me sounds better).

I wonder what’s for supper. I hope it’s potato-cakes. I like those.

Food for thought

Derek waylaid me on the way to the lavatory.
‘How many psychiatrists does it take to change a light bulb?’
‘That’s an old joke, Derek.’
‘Go on – how many?’
I sighed. ‘One – but the bulb must want to change.’

‘Okay. Well, do you realise this old joke shoots a poisoned arrow into the Achilles heel of psychotherapy?’
‘Derek, what are you talking about?’
‘They’ve said it to me; they must have said it to you: the therapist can do nothing unless the client truly wants to change.’
‘Well?’
‘Don’t you see! It is the ‘catch-all’ copout: If you don’t get better it is not my fault – it’s because you don’t want to get better. It’s because you don’t want to change.’

Now, I must admit it is something that I had raised during my training. Something I was a bit uncomfortable with. But I had not received a satisfactory answer. I was actually told that I was ambivalent (that’s the word they used) towards the course.
I didn’t tell Derek this.

He continued. ‘I once replied, when they said this to me: well can you show me how to want to change?
‘The answer I got was “You are not ready for therapy.” And they gave me more pills.’

Of course, anyone with a working knowledge of Transactional Analysis could explain this apparent paradox using the ego-state model. But, crudely put: one part of your mind wants to get better, to change (the part that brought you to this consulting room), but another – deeper, more powerful - part does not want to get better, does not want to change.
Why? Because this ‘unconscious’ part is frightened to get better.
Why? Because your ‘illness’ is a defence mechanism, a series of strategies that are actually protecting you. Or, more precisely, protecting a vulnerable, scared inner child. To be still more accurate: these ‘strategies’ were effective at some time in the past in protecting you.
They have now become counter-productive or, at worst destructive. But, deep down, you are afraid to let go of them.

All the same, Derek is right. It should be the therapist’s job to explain this, and then work on it – with you. And not just say I can only help if you really WANT to change.

I wanted to change the subject – but Derek did it for me. ‘I suppose you’ve heard the rumours?’
‘What rumours?’
‘Amanda – she’s pregnant’

A legal surprise

Randolph Beresford-Smythe is from Tobago! And he hasn’t got a Home Counties accent.
He told me he changed his name after graduating from law school – he thought it would attract more clients. He didn’t tell what his real name was.

Anyway, perhaps this is an opportunity to turn a necessity into a virtue – as my old grandma used to say. Randolph told me that a black lawyer always gets that bit of extra respect from the court: political correctness and all that. And, he said, he wasn’t averse to ‘playing the race card’.

He kept calling me ‘my dear chap… don’t you worry my dear chap, we shall get you a very good deal, I can tell you… some of these women are getting too big for their jolly old boots these days.'
And, glancing at a document he had taken from his briefcase, he continued ‘ And what might the lady be referring to when she cites unreasonable behaviour’
‘My being in the house?’ I suggest.
‘Ah, very good. I like a client with a sense of humour. So useful in times of adversity, I always say.'
‘How much adversity do you think we will encounter?’ I asked.
‘My dear chap, we will burn that bridge when we get to it.’ He smiled, lighting up the room.
After asking me some questions - routine stuff I suppose – he gathered up his papers and left. Stopping at the door to advise me ‘Chin up old chap, chin up’.

Derek and the lawnmower

Derek came over to me at breakfast – depressed as usual. I said to him ‘Doesn’t the warm weather cheer you up?’
‘No,’ he said. ‘It reminds me of summer in suburbia. The sound of lawns being mowed, cars being washed, dreams being broken. Suburbia drove me mad - literally.
‘ I looked out the front window one Sunday morning: the neat lawns, the tidy fences; the double-glazing, the cars on the drives. And suddenly the smallness of it all hit me: small boxes of houses, small gardens, small cars, small ambitions, small minds.
‘I went into the garage and filled the mower with petrol. I wasn’t watching what I was doing; I was dreaming of Africa. I filled the tank too full, and petrol sloshed over my shoes. I sighed, and carelessly lit a cigarette.
‘The rest, as they say, is history. They managed to save the house. In hospital I was visited by a psychiatrist. He didn’t believe it was an accident. Neither do I. Jung says there are no such things as accidents. I believe him.’

I feel sorry for Derek. As I have said before, there is so much of him that reminds me of myself. But I can’t hang around with depressives, can I?

I opted for the prunes. Roughage, that’s the thing. Though you can have too much fibre. It’s all a question of balance. The ‘third way’, as the Buddhists say. And you never see a constipated Buddhist.

Nocturnal ruminations

The lights will be going out shortly – not all over the world, but here at St Botolphs. And I am left alone with my medicated thoughts. Am I just a chemical factory on legs?

My last interview with Freddie has left me somewhat disturbed. You may say, well you have been disturbed for a long time – but I mean especially disturbed. Do I really have an unstable self-image? If so, how did I come by it? And, more importantly, what can I do about it?

Freddie seems to be relying on the medication. Of course, he is a pills-man. I haven’t had any proper therapy since Amanda went off sick. And that’s another puzzle: what’s wrong with her? And what did Freddie mean by his last cryptic remark.
So many questions, so few answers.

My solicitor is coming to see me tomorrow, about the divorce. It’s not the family solicitor: old Wilfred Brown, of Brown, Brown, Smith & Brown. The lesbian was quick off the mark and engaged his services weeks ago (it was his firm that drew up the divorce petition). I got my chap out of the phone book. I looked under ‘Lawyers’ and there was a whole raft of them. I chose one at random. Well, not exactly at random – I liked the name: Randolph Beresford-Smythe. If in doubt always go for the old double-barrelled name. England is supposed to be a classless society now - don’t you believe it: a posh sounding name and a Home Counties accent will get you further than any amount of degrees and diplomas.

Well, I am away to my lonely bed in this great, gabled, Victorian edifice. Samuel Beckett said ‘We are all born mad. Some remain so.’ (Waiting for Godot). Where were the mad treated before the rise of the asylums in the nineteenth century? Did you know that asylums came before psychiatrists? You’d think it would be the other way round. But no – it was only after the confinement of large numbers of the mad in asylums that a new profession came into being: that of the mad doctor, alienist or today the psychiatrist.

But I must get some sleep. I shall need all my wits about me when Randolph Beresford-Smythe arrives in the morning.

A problem

My bike - taken late evening in 'Ale Close'.
A strange name for a modern development but it was built on the site of the old 'Gin Alley', a notorious thoroughfare inhabited by loose women, pickpockets, drug addicts, footpads and highwaymen.
All this was long ago of course, and you don't get any of that now - except for the loose women.




Freddie says I should get rid of my bike. He says my idea of a trip to South America is a symptom of my illness. He showed me in the DSM IV (is this the latest edition, I wonder?) where one of the 9 symptoms of BPD is “identity disturbance: markedly and persistent unstable self-image or sense of self”.

He said my self-image is very unstable. I swing wildly from believing I can do anything (for example the South America trip) to thinking I am a total failure – this latter leading to my suicide attempt (where I failed again).

Anyway, he says that his son, Rupert, (I never knew he had a son!) is looking for a motorbike and he (Freddie) will, as he puts it, take it off my hands for £1375 as birthday present for the aforementioned Rupert. I told him that it was worth much more than this; the bike has only done 2600 miles - and most of those with a following wind. He merely shrugged and reminded me that my medical insurance did not cover all my bills. In fact I owed them exactly the aforesaid amount, so selling him the bike would wipe the slate clean – for the time being.

I don’t know what to do. If I sell the bike, bang goes my dream of South America – or even the south coast of England.
I wonder what Che Guevara would have done?

Oh, and as I was leaving I asked how Amanda was.
‘She’s all right’ was the terse answer.
‘Well give her my love’ I said.
‘I think you’ve already done that’ he replied, bleakly.
What can he mean?

A

I have had a letter from my dear Anna. I asked if I could reproduce it here (all my posts are now scrutinized by either Greta or Bernie) and it was agreed that I could - but with certain parts censored. - I don't know why. Anyway here it is:

Allo Georgie

I am looking forward to us splicing our nuptials. Such excitement, eh?

On the nightXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXyjama cord.

My brother Sven he is coming over for the wedding. He is – what you are calling – giving me away.
Sven is pretty big fish in Swedish film pond. I ask him bring over video to show you example of his work: very tasteful, beautifully lit. (we could watch on our wedding night). So much is Sven in demand, but he is making space in his busy schedules to be with us on our happiest of days - just as soon as we are fixing date of course.

And don’t you be worrying about XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXom all night pharmacy.

Be sure you are getting a good solicitor for the divorcings. That cow of a wife is slippery customer, be making no mistake of that. She is out to take you for all she can get.

Of course she does have not the slightest knowing of our plans for wedding lock. And I am making sure she does not get a sniff of them with that outrageous conk of hers.

The horrible clergy person is round the house all times of the day and night – oh and that is reminding of me: as you know we are not much of the religion in Sweden so your little Anna is not wanting the church wedding with choirboys organs, and stuff. Just a simple ceremoniously – so long as is legal, eh?

Oh also. Your little cherubim has gotten a part timely job so as to make a bit of money for maybe helping out with the expenses of honeymoon. Three nights of the week I am pulling at the King’s Head, the pints of beer. Jake (the landlord) says business has perked up since I been giving them beer- handles a good yank. The boys who drink there say I make good head on beer. They like that much.

Some of the boys are chatting me down when they had a few. Asking to walk me home and such. But not to worry. I tell them, I am not walking home with any ones of you. Besides, Jake has the big Mercedes car and he gives me lift every evening after we close. Such a fine vehicle with the large spaciousness and the reclining leather seats. Of course I am preferring the Volvo, being my own country car, but as they say ‘barmaids can’t be choosers’ ( little Swedish joke to cheer you up).

Must be closing for now my Georgie, as the old bat wife (soon to be ex, eh?) is wanting me to curl her hair.

Oh, and when you go to bed tonight you shouXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXetter in the morning.

Yours in matrimony

Anna

Tea time

This is a picture of my Monday tea. You may call it dinner – or even supper – we call it tea.
They serve it very nicely, as you can see.
We have a choice. I chose the potato croquettes and the fish fingers. I didn’t choose the peas – they come with the fish fingers.

For example: if you choose chips and egg, you would get baked beans with that – even if you had not ordered the beans. Because they come with the egg.


I did not eat all of the peas. There was nothing wrong with them. I just did not fancy them.
The egg custard was very nice too. Although I did not eat the pastry. I asked for a spoon and I spooned out the custard (flavoured with nutmeg – gives it a lift).
When I say I did not eat the pastry, I did eat the crinkly edge of the tart, which is quite crusty because it is above the custard filling. I like that. But I did not eat the rest of the pastry because the filling makes it quite soggy.
They don’t complain if you leave anything. Which is good.

Case Review

I have read through Mr Turner’s case notes and talked to staff and ‘key workers’

We have reached a compromise: Mr Turner will be allowed limited access to the Internet, under strict supervision. And before anyone starts fulminating about ‘Freedom of Speech’, and citing ‘Civil Liberties’ let me make a couple of points:

Mr Turner is resident here under the provisions of the Mental Health Act. He is being detained because it is felt that he may be a danger to himself or to others. And here he will remain until I (and my colleagues) consider that such danger no longer exists.

A patient’s records are, of course, strictly confidential. And I am not prepared to comment on Mr Turner’s ‘blog’ entry where he raises the possibility of a diagnosis of ‘Borderline Personality. It is the duty of myself and my staff to decide on an appropriate treatment programme for each patient. In the case of Mr Turner we are agreed that untrammelled Internet access would seriously impede his treatment. On the other hand, some free expression could be beneficial. Hence the compromise.

I suggest that anyone who would like to know more about ‘Borderline Personality Disorder’ refers to the DSM. The Diagnostic and Statistical Manual contains definitions of psychiatric disorders. These definitions – which are criteria based – are the results of consensus building from hundreds of psychiatrists of many different perspectives and belief systems from all over the world. Definitions are regularly being revised as research and other information becomes available.

Frederick Foggatty, Clinical Director

Dr Amanda Foggatty

Dr Foggatty has been granted indefinite sick leave.
We all wish her a speedy recovery and look forward to her resuming duties here at St Boloph’s.

In her absence I am assuming responsibility for the day to day running of the unit, and will be conducting a review of all Amanda’s cases – amongst them, that of Mr George Turner.

Frederick Foggatty M.D. M.Psch. F.R.C.P.