Tuesday, June 17, 2008

Idling With Ivor 4



The Patient Always Comes First

One of the greatest lessons in vulnerability and dependence anyone of us can get is that of being a patient.  Hence Doctors who have been patients at sometime themselves can really empathise with their charges.  Because of his suffering from TB and having been hospitalised for a considerable time Ivor tells us:

It was experiences like this (seeing a slowly deteriorating patient being passed over unconsciously by the attendant Doctor), as a patient, that made me careful of the feelings of patients and aware of the need to take the time to communicate as clearly as possible, so that the person has a full understanding of his illness and a clear picture of where he stands.  (Op. cit., 65)

One is left in no doubt as to the then state of mental hospitals or mental institutions in the late 1950s (and one might argue thus even today with respect to mental health treatment for the poor):

At the time I visited Grangegorman, the whole north-west of the city was neglected and run down, and there were only about 20,000 people living there.  Since all those neglected by society - the human refuse of Dublin society - were located in this area, it was as if the existence of this part of the city had to be denied.  (Ibid., 68)

 Psychiatric Illness is a Family Illness:

This insight I find interesting and quite logical after reading Ivor's account of the chronic agoraphobia suffered by a patient called Jane, the mother of three small children.  The grandmother looked after both her daughter, who was constantly confined to bed, and her grandchildren.  Ivor describes how he worked on getting to the source of Jane's illness, and he was so successful that this woman was able to come to the hospital alone for out-patient treatment.  No sooner had this woman improved considerably than the grandmother became very sick indeed.  Here is Ivor's account of why this happened:

I explained to him (the family's GP) that this was an extreme stress response due to the mother losing control over her daughter, who was now becoming independent and no longer needed her.  What had seemed like selfless care for her daughter was actually a desperate need to keep her daughter dependent and under control. (Ibid., 72)

The Importance of Separating from the Family of origin:

This heading reminds me of a book I once read by Dr Tony Humphreys called The Family, Leave it and Love it which is based on the same principle discussed by Ivor in his book.  Due to his early experience of working with the families of mentally ill people our unorthodox, sandal-wearing professor  has this to say:

From these and similar cases I realised the extent of the struggle which is involved for all of us in separating from our parental family and developing independence.  I knew this struggle already, of course, from my own experience of growing up in a family that was loving and caring but which saw itself as continuing indefinitely.  With the best will in the world, my parents did not intend to foster in their children the necessary separation and growth towards independence.  (Ibid., 73)

Beginning of Social Psychiatry:

In February 1960, having won a one-year fellowship to the US sponsored by the Eli Lilly pharmaceutical company, Ivor took up a post in the Massachusetts General and did an MS degree at The Harvard School of Public Health.  There, he was to learn the sound principles of social psychiatry and the principles of crisis theory from the likes of Professor Eric Lindemann and Dr Gerald Caplan.  I am delighted with the wonderful definition of crisis which Ivor quotes from the mouth of Gerald Caplan: "A crisis is an upset in the steady state, and...is provoked when an individual , faced with an obstacle to important life goals, finds that it is, for the time being, insurmountable through the utilisation of customary methods of problem solving." (Ibid., quoted 88).  I was also interested in Ivor's contention that trauma and crisis counsellors are not needed in the immediate aftermath of a particular crisis.  This, to my mind, is a wonderful insight:

Droves of crisis counsellors descend on the scene at the very time when most people are in the state of shock or psychic numbness, needing rest and support and not in any sense ready to deal with the emotional effects of the traumatic experience... Much later I realised that, when the time was right and people feel safe enough to be able to react emotionally, crisis intervention can begin and people can be helped to integrate the pain and anguish surrounding what happened.  (Ibid., 89-90)

Bear in mind that Ivor was studying crisis management way back in 1960 while it is now only accepted here in Ireland as a normal response when crises occur some forty years later.  Once again, we see here that our man was a unique, prophetic and probably eccentric voice crying in the wilderness of the late 20th century Ireland.

 

To be continued.


Walking the dogs, Donabate Beach, February, 2008

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