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I'm back home from a short admission for eye surgery. It was a wonderful experience that has me, wide awake in the middle of the night, reflecting in all directions. Who better to share some of this with than you?! It's a long email, I know, but you don't have to read it do you?!
I was admitted last summer for similar treatment - a detached retina - but that was in France and in French. This was the first time I'd been under the knife and the gasman in my own culture for 40 years - then it was appendicitis self-diagnosed (after first diagnosing bad bacon at breakfast and somewhat blaming my wife for it too! I've tried her hard since too, but we're still together.).
Both of these stereotypically medical-model events were in my alma mater, Edinburgh teaching hospitals, in which I'd done my medical training. But in that 40 years (still in Edinburgh) I've travelled many metaphorical miles away from medicine and surgery, through psychiatry and child psychiatry, to systemic practice and family therapy. I've thought, practiced and written prolifically during that time, but rather given those up in recent years as my main campaigning theme failed to take off.
In particular, AFT 20 years ago needed to focus on FT becoming a profession. So systemic practice, as I understood it within AFT, was left to founder along in the strapline and logo that remind me that I was involved in fighting and losing that argument then. I'm a family therapist too now so I accepted defeat gracefully!
Anyway, with 40 years more experience than then, what a wonderful participant observer experience it is to be in a hospital ward! No wonder they make soap opera after soap opera based in them. This is not the place for a script of my stay featuring the most superbly clinically and personally skilled staff, mostly from other cultures, and the amazing characters and life and health stories that emerge from your fellow patients, some played out as they happen in a quiet ward separated only by a curtain that revealed all you needed to know. What a range of discourses interplay gently in the theatre of ward life.
Most notable are the cultural and gender discourses. Some senior doctors are still socially unskilled masters of male medical mechanics - even though there are many junior women doctors who seem much brighter and better at all aspects of the job, but have to remain quiet about it. As we know, the nurses (the "mothering" part of the team) are those who do the equally important relating and caring around the medic's important fancy pants stuff.
My interest and admiration was greatest for the constant obvious straightforward unassuming enjoyment and dedication of the nursing staff, their human warmth, humour, quick wit and intelligence, engagement and sensitivity, while doing their physical tasks. I could imagine them as family therapists only they'd be much quicker and more fun than us! And this was most obvious with the core team of nurses who were working across culture and language. I imagine they were valued high fliers in their families, earning money in the UK to send back home. They wouldn't want to be, but I bet they could have been professors of something if that idea wasn't so foreign to them.
Anyway, here's some thoughts from the more technical operating "theatre". We're all wearing our funny costumes too! As I was being put under the general anaesthetic they knew I was a retired psychiatrist and there was the typical crack by real medics against shrinks. He said something about an Edinburgh neurologist who was aptly called something like Dotty Brain. I joked that she should have been a psychiatrist. Dr Gasman said he had absolutely no comment to make in the tone of one who was jokingly making it very clear what he thought of psychiatrists! Soon after this, he had even more of an upper hand over this ex-psychiatrist.
Now, I think I was simply wise - and systemically wise too - given my vulnerability, to have gone along in that way with the culture I was entrusting myself to. I'm sure their treatment of me would have been unaltered by being annoyed by any more witty and challenging rejoinder. But what I might have liked to have said, in hindsight and with 40 years of thinking behind me, was something along the lines of "Unless it's causing the car's fault, I'm most reassured to know that my garage mechanic's mind, interest and work are entirely undistracted by thinking of less concrete matters like how and where I drive it".
In another context I would have meant to provoke further thought and discussion - to challenge the doctor's so simple and exclusive world view, to introduce them to why I found ordinary medicine of limited interest. But I also do positively (not provocatively) mean what I said; that, as you go under their gas and knife, it is really really reassuring that the doctors are exclusively preoccupied, I mean 110%, with the simple world of biomechanics and keeping you alive and well while they do the most miraculous things to your eyes.
It's nice to find such superlative humanity and interpersonal skill and user-friendly practice alongside technical medicine and surgery. But I really really would prefer my surgeon to be good at surgery if push came to shove over bedside manners.
Nevertheless, even though my own AFT based campaign rather failed, systemic practice is in good health, if my experience this week in hospital is a measure of what has been happening in our NHS and welfare state.
Then, another huge drag backwards in time. I got home and opened my new (Journal of) "Family Therapy" as you do, and found Mark Rivett putting my name in lights as he has a shot at reviving my old campaign! Well you could have knocked me down with a feather! What can I say?! I'm going to have to dust off my old articles and get round to a long postponed plan to refresh and complete to my old website (where you'll find lots of it) - forallthat.com - in case anyone gets interested again! Many thanks, Mark. I'm enjoying this issue even if I've only got one eye working to read it just yet!
Or you could say that this email IS what I could say about it.
One last thought before I try to sleep again: If the anaesthetist only knew I was a Family Therapist, I think the whole dynamic would have been different. I think he'd have had no comment, or been ordinarily interested in what the job of FT entailed.
It's another fascinating case study and anthropological trail to see how members of the same tribe, medicine, learn or don't learn about the vast range of directions and specialisms you can go in, and how you then judge and fight those who end up in different parts of the forest. 'Psychiatry?! They're mad to think there's more to illness and it's cure than biomedical things" with the implication that there's nothing more to the whole of life than that deterministic view either. But a Family Therapist is allowed to be unenlightened because they're outside the pale anyway. (Non-PC reference intended).
Ex-Medic/Shrink, now Family Therapist