Growing Into Medicine (31 page)

I believe my patients were sometimes in the process of moving from the state of being in love to a relationship of a more mature kind where a different love could develop. Cathy quoted from
Captain Correlli’s Mandolin
: ‘Love itself is what is left over, when being in love has burned away.’ Much of Deirdre Johnson’s book is devoted to the state of falling in love. For me the wide reach of her analysis was a helpful guide to lines I might pursue as I try to understand my past. Two narrative angles particularly interested me.

I experienced the reality of her intrapersonal approach during my analysis. Any complaint about Ralph, and there were many, was met by an interpretation focused on me. My analyst never leapt to his defence or tried to explain the interaction between us.

Being relieved of the compulsive feeling of ‘I am not worthy’, with its unacknowledged counterpart of being better than others, I had the courage to try new things. To enjoy writing while being aware that I am most unlikely to get published; to practise my flute despite knowing I will never be good enough to play the first part in an orchestra. Above all, to live more fully in the moment and take delight in small things: the quality of evening light casting shadows across a green lawn, the mixed flocks of adolescent finches on my feeder, the taste of peas picked an hour before from the garden, the surprise of finding the apposite word or hidden metaphor in what I have written.

Deirdre Johnson’s chapter on individuation caught my attention. Quoting Jung, she defines the word as ‘the process by which a person becomes a psychological “individual”, that is, a separate, indivisible unity or “whole”.’ She expands the idea by saying it is a process within the human being that causes them to become what they uniquely have the potential to be.

I sense that Jung is saying something important but I have difficulty grasping his full meaning. A book by Adolf Guggenbuhl-Craig, a Swiss Jungian analyst, called
Marriage Dead or Alive
, makes a distinction between a state of wellbeing leading to happiness and Salvation which involves the question of life’s meaning and seems to be in some way equivalent to individuation. The word is taken from
a religious context. For me the word ‘soul’ comes trailing an odour of personal afterlife that I cannot believe in. He considers marriage can be a way for some people to find Salvation but he believes in the institution much less than I do, saying that there are many people for whom it is not a productive way of living.

My cousin Jenny believed that the natural state for human beings was in couples. I do not go that far, but I think many people could find their way to fulfilment and the rewards of love if they stuck to the work of marriage. I am glad that I was brought up to believe that marriage was for life, and it never occurred to me to consider the possibility that we might part.
Marriage Dead or Alive
was published in 1977 and carries echoes of that time. The author implies that unitary marriage has no pre-eminence for raising children, that they can grow equally well with a single woman or in a commune. Observing the number of young people who marry when they decide to start a family, I think his view is not shared very widely. I am old-fashioned enough to believe that the unit of one man and one woman, who get on well enough together without mental or physical cruelty, provides the best holding ground for a child. Having said that, I am sure a good relationship between two people of the same sex provides a more fruitful background for a child than a bad heterosexual atmosphere; but such an unconventional household creates complications. Both these aspects are brought to life in Jackie Kay’s wonderful poem ‘Mother and Donor and Deirdre’.

Guggenbuhl-Craig also suggests that married couples should share, and when possible live out, their sexual fantasies. I find this idea shocking. My own erotic fantasies, masochistic in nature, are essentially private and far removed from any actual sex play that would give me pleasure. One might see these fantasies as connected to my feelings of inadequacy, as though I was in some way deserving of punishment. However, the erotic effect of such imaginings cannot be explained so easily. I suspect they have very early foundations that could only be uncovered during a much longer and more intense analysis than I experienced. For me it was enough to be able to accept their presence without shame or confusion.

I can now see that my own marriage was a success because the projections that took place between us provided a good enough fit. I find it difficult to imagine what parts of Ralph he unconsciously pushed into me. When I try, I am reminded of the pet names we used soon after we were married. I became Pooh, a bear of very little brain. He was Tigger, a bouncy adolescent. Neither of these images is accurate, for my brain is not that little and he never bounced – but the use of these words released great tenderness between us. Perhaps I carried his fear of not being intelligent, and he my wish to be vivacious, the life and soul of the party. However this is understood, our collusive marriage provided a setting in which deep parts of ourselves could be fulfilled.

With the passing of time I become ever more grateful for one of his qualities that irritated me the most. His passion for the underdog, his tendency to put his prisoners before his family, often left me feeling neglected and unappreciated. Now it seems to me to be essential that in any couple there should be room for one or other, perhaps ideally one alternating with the other, to be free to devote their energies to the wider world. The nuclear family is, in my view, the best place for a child to develop. But society needs those who can act with altruism, thinking of others outside their small, personal circle. I take pride in the fact that Ralph was one of those people.

21

The Past in the Present

As a doctor I was fortunate to remain employed in clinical practice meeting patients until I was seventy years old. Ralph chose not to strive to go higher in the prison service, for he did not want to lose touch with individual prisoners. My brother Arthur left his job in engineering because he could see no upward path on which he could continue to work with his hands.

These thoughts suggest that there is a time in life when many people are faced with the choice between following earlier ambitions and settling for different goals. I never aspired to reach the top of anything and was glad that my peripatetic life, moving from prison to prison, provided an excuse to remain a medical generalist. My increasing confidence in the field of psychosexual medicine, where the number of new facts to be assimilated each year was not overwhelming, brought considerable satisfaction. But it was only after my analysis and the widening of my world through music and writing that I developed a hunger to be better at both, becoming ambitious at a time of failing stamina.

Basil Hume, one-time Catholic Archbishop of Westminster, said that the worst thing about getting old was the fatigue. My family is a long-lived one and I am blessed with a long-lasting constitution. At eighty-three I am fit, still reasonably sane and mobile. While my friends collapse around me I go on living an independent and full life. A shudder of unwarranted pride runs through me when strangers say I do not look my age – as if my looks were somehow my doing rather than the genes my parents bequeathed to me.

But. . . I cannot deny my age. Nothing works quite as well as it did. My feet and the end of the garden are further away. I lose things more often, finding my glasses in the fridge and the butter in my toolbox. . . I exaggerate, but only a little. After mislaying the notebook with ideas for this book I spent twenty-four hours searching, only to look again in its designated place – an old drug company folder – and find it tucked inside, grinning at me. Recent memories become fuzzy like a television set on the blink. The picture may disappear beyond recall. Then it can blaze into view as an unconscious connection mends that particular electrical circuit in the brain.

The loss of energy is exasperating. I used to work in the garden for four hours without a break. Now, after an hour, I find myself wandering round looking at the weeds and the dead heads on the roses. I have learned to read this behaviour as a sign that I need to sit in my chair. There, I have exchanged the cryptic for the concise crossword.

People say one makes one’s own luck. I cannot agree, for it was not my own effort that prevented me being born in the deserts of Somalia at a time of drought. But my nature helps me to see the best in situations and I try to foster such an outlook. I remember, more than twenty years ago, deciding to compose my face into, not exactly a smile, but an expression that held the promise of a smile. I was surprised by the resulting friendliness of those on the tills of supermarkets, on buses and in queues.

An important bulwark against the depression of old age is to accept that the slope is not steadily downhill. A sudden slip: incapacity takes a step nearer. Then the fall levels out and one adapts to the new limits. For a while Jenny and I talked with animation about these shared experiences, agreeing that the changes were of interest, both of us trying to adapt and laughing when we failed. Alas, she can no longer remember her recent words and has no ability left to analyse her situation. Having said that, I am grateful that she still knows who I am and we can still re-live our shared experiences, though in ever more repetitive sentences.

Having survived Ralph’s death and been relieved of much
generalised anxiety as a result of psychoanalysis, I stopped asking myself about the meaning of life. Previously I had been assailed by questions about why we are in the world, and by the anguish of not being able to explain the horrors and pains of existence.

For the last ten years I have lived much more in the present, getting what spiritual nourishment I needed from the attempt to write and from the simple pleasures of family, friendship and daily living. Was my previous interest in the inner life driven by nothing but a search to escape from feeling stupid and clumsy? I have wondered if I am in some way less sensitive. Worrying about such matters had brought no answers but now the reality of death draws nearer and I have to face the trials of old age. I am trying to make sense of the past and to find some fortitude to live the rest of my life.

I hope that the musings in the last chapter and this one may be of interest to readers who are also coping with retirement and on the path into old age. Perhaps they too find their curiosity about the inner life roused once again. Returning to Jung’s idea of individuation I find it is suggested that such a state can be approached in many ways – for some through marriage, for others via creative activity or a passion for something outside oneself. I asked one of my friends, who seems to be the most complete person I have ever met, how she did it. Her answer was immediate. ‘Until I discovered Beethoven I lacked self-confidence and felt I should be like other people. My love of music drove me to be myself.’

Perhaps for my parents that passion was medicine. Their experience in the same medical school provided an opportunity for shared gossip and memories of their teachers. Although they recognised some poor practice and some bad doctors, their belief in the rectitude of the profession and its value to society underpinned their lives and their relationship. As I search for meaning in my own life I realise that their belief in medicine took the place of allegiance to a religion. Instead of finding friends from within a church congregation, their somewhat limited social life was almost entirely among doctors. Their role models were all medical men they had known or read about.

No teacher at medical school inspired me with any passion until I met Michael Balint. Then I became genuinely excited by the possibilities of my work. Today’s training prepares doctors for the enormous difference between hospital medicine and the unorganised chaos of a general practice surgery. I had no such preparation and the only experience I could turn to was that of my pragmatic father. When I read Balint’s book
The Doctor, His Patient and the Illness
I discovered a father figure interested in the uncertainties that I had not been able to formulate into questions. He was prepared to look at ideas about why the patient had come and what the doctor’s role might be. This distancing of the doctor from the immediate situation allowed for the consideration of emotional factors and the possibility of the body/mind approach, which has given me so much satisfaction.

I knew from many of his patients that my father’s traditional, paternalistic method of working had been of the greatest help to many people. Indeed it is a style of doctoring that has great strengths. I can imagine that when I become seriously ill I will want a doctor whose opinion I can trust and who does not offer me too many choices. But I also know that one or two of my father’s patients felt neglected when he rushed into advice about hobbies or activities instead of listening to their troubles.

When faced with the undifferentiated complaints and minor illnesses that make up the bulk of a general practitioner’s surgery, I was different from my father. I found myself more interested in the unspoken messages that were the concern of Michael Balint and later of Tom Main. For me, those teachers added meaning and depth to my life as a doctor. But I did not worship the practice of medicine in the way of my parents, and continued to search in a rather unfocused way to find reasons for living.

Although I was a bridesmaid three times as a small girl, I attended my first routine church service when I left home for boarding school. There I was faced with the dilemma of faith that confronts all children who are brought up in a godless household and then exposed to traditional Christian worship. One of my grandchildren
reminded me of my confusions when I was driving him home from some outing. We stopped at traffic lights.

‘Granny, do you believe in God? Mummy doesn’t.’

The lights would change at any moment. ‘Well. . . it depends what you mean by God.’ Not a very satisfactory answer for a six-year-old.