From the Sidelines

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume IX · Number 2 · Winter 1966 FROM THE SIDELINES GEORGE H. DAY, U.A., MX).* Most of my life I have been on the sidelines of psychiatry, following the moves in the game with intense absorption; but during World War II I was actually a player. Beyond any doubt I can claim to have practised Coarse Psychiatry. It came about thus. Before the war I was ajoint-superintendent of a tuberculosis sanatorium. To save time and ink I would fill in Army documents describing myselfas a Phthisiologist. You can guess what happened. In due course I was posted to the Northfield Military Psychiatric Hospital, where in no time I became an Army Psychiatrist complete with danger money, and where I had a unique opportunity of observing my delightful colleagues. At Northfield I discovered that there were two distinct schools ofpsychiatry with quite a gulf between, which everyone tacitly pretended did not exist. On the one hand there were those who had acquired or were contemplating acquiring their Diploma ofPsychological Medicine. They looked rather depressed and subdued (naturally enough, for the jollification drugs had not yet been invented); but in their eyes was to be discerned that faraway look, envisaging a Medical Superintendent's gracious home with tennis court, fruit, flower, and vegetable gardens, all kept in apple-pie order by trusty patients serving life sentences. They did not talk shop so much as the others, but they were much more soldierly and much more adroit at Oneupmanship. The others, older and greyer, had undergone * Medical Director, The Mundesley Rehabilitation Unit, Mundesley, England. This paper is a deplorably unoriginal address inflicted upon the Cambridge Psychiatric Society on November 27th, 1964. 191 analysis, mostly in Vienna; and their orientation, ofcourse, was psychoanalytical . All they wanted in their post-war civilian life was a room in a good postal address with a couch, a desk, and a dozen or so long-term patients to keep the pot boiling. I threw my lot in with this latter group. There was really no choice, but as my analysis had been Jungian I was odd-man-out among all these top-notch Freudians. They treated me with the greatest respect much as they would treat a foreign colleague with unknown potentialities and language difficulties, speaking very slowly and distinctly with a tendency to expressive gesticulations. Fortune never smiled on me so sweetly either before or since: it seemed I could not put a foot wrong, and I was soon taken on the teaching staffand given some trainees to knock into shape. And I was never found out. I took good care ofthat; but it was sometimes a close thing. We used to have Case Conferences at Northfield when someone, usually an egregiousJunior Psychiatrist (possibly seeking preferment), would produce a difficult case. He would narrate the history and then the patient would be brought in and be subjected to a free-for-all session of embarrassing questions punctuated by long awkward silences while we all stared at him. Then he was allowed to withdraw and the fun began. Now, after a few ofthese sessions I noticed something, which once again I'm surprised that no one else seemed to notice, which was that each psychiatrist would make out a strong case for his own favorite diagnosis. Thus Psychiatrist A would plump for schizophrenia, B for an agitated depression, C for hysteria , D for psychopathic personality, E for obsessional state, and F (a woman psychiatrist, I remember) invariably put in a plea for Repressed Homosexuality. By the time my turn came there weren't any of the recognised categories left to play; so I would shrug and smile secretly as ifI could easily double four no-trumps but decided to pass. I became quite good at this. But one lesson I did learn was the importance in Psychiatry ofhaving a Thing about something; and as a Coarse Psychiatrist I have always followed this convention. It doesn't matter much what you have a Thing about. Choose anything at random-—say, Front Doors. My opening gambit with a patient then will be: "Tell me about the front door of the house where you spent...