#1 : Little David's Big Problem

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I’m sitting in my clinic on a wet Thursday morning – it always seems to be raining in the hills east of Manchester (UK) – when in walks a wiry older man, with a bad cough. I’ve known him for many years, and have struggled with him and his chronic bronchitis for long enough. But this time, he’s bringing his 6-year-old grandson with him. And he doesn’t know what to do. He tells me I must send little David to “the clinic” – he and his aging wife cannot cope with him a moment longer. David is up at 6 o’clock in the morning, roaring around the house, and not going to bed until midnight. He’s a nightmare. Something has to be done, and fast.

Now being a GP was never my first choice. Mental health had been my long-standing goal since I was a schoolboy, so in between sorting out sore throats, back pains, and intestinal issues, whenever I had the chance I dipped my toes into psychiatry. I’d even instituted special clinic times on a Wednesday morning, to spend longer trying to work out what went wrong in the mind. So when David was brought along, I thought, why not give it a go. So I negotiated with his granddad. “Certainly”, I said, “I’ll send him. But let him come to my special clinic first”.

Well, you might have thought – what kind of “therapy” could I possibly offer a 6-year-old? What possible qualifications did I have to meddle in the mind of a small child? Happily, for both me and David, and his exhausted grandparents, there was no-one in officialdom at that time, to tell me not to. So it was arranged. The following Wednesday, in comes David, and sits beside my desk, his little legs dangling off the edge of the chair. His grandparents, sitting in the waiting room, have known me well enough by this time to trust my judgement, at least to begin with.

What would you have done? When you are 6 years old, you don’t have a large vocabulary. A number of things interest you, especially if they are sugary or made of ice cream – but erudite conversations about emotional disturbances are hardly likely to enlighten your enquiring mind. And yet the symptoms are obvious enough. David rushed around. It was as if he was being driven by something inside which would not let either him, nor his immediate family, have any peace.

Perhaps a course of mindfulness might assist. Would diverting his attention for 20 minutes or so, once a week, help? Could I intrigue him with erudite psychoanalytic theories of a quasi-Freudian hue, or even an elaborate seminar on obscure brain chemicals? Whatever else these were, they were utterly impractical – and the medical problem that David posed was real and pressing. The practical consequences were overwhelming – he didn’t rest, nor did he allow his immediate family to do so either. Something had to be done. And I had remarkably limited time in which to do it – the hospital clinic had already been mentioned, and if things didn’t change pronto, I would have to capitulate and send him on.

Can I indulge my pet hate here? Today, I would probably have been sued for not filling this little lad up, with noxious medical chemicals. The medical basis for which is that if you don’t understand what the patient is telling you – put a stop to all the brouhaha, by turning things off at source. All psychiatric drugs have been accused of acting solely by “intoxication” – an accusation not by me, but by an eminent lecturer in psychiatry, in a prodigious London university. Suffice it to say, the last thing I reached for with David, was my prescription pad.

So there we sat. He a restless 6-year old. Me, some 40 years older, with a mighty curious itch to know what really made minds tick. David was one of those who helped me enormously during that 20 year stint. And he did so by simplifying, not by complicating.

What would YOU talk to a 6-year-old about? Would you have emphasised just how “naughty” he was being? Just how dreadful a time he was giving his long-suffering grandparents, who were really rather too old for that sort of thing? Besides, you could have pointed out, they had never done anything wrong to him, nothing that could possibly warrant this intrusive and destructive behaviour. Because, make no mistake about it, David’s behaviour was unmistakeable, indeed that was its central feature – I’m here, I’m agitated, and I want you to know – this was his message, not so much in words, but in deeds. And loud enough for you to notice – and ever louder until you did.

Now David’s picture is characteristic of virtually all mental afflictions of whatever kind. He’s suffering, he doesn’t know why, he cannot tell you why – but things will keep going badly wrong until he does. Conversely, if he knew, he’d be cured. At least that was what I relied on. I knew I was stepping out into the void. Both his grandparents, and indeed he himself, were relying on me – yet it was something I'd never done before. But what I was taking with me on this mini-expedition, was an inveterate optimism – I had become convinced that there was a simple key to this enigma, there was a simple solution to what currently seemed inexplicable. Something was driving a healthy 6-year-old to harm not only himself, but his immediate family, upon whose loving support his very life depended. And it was likely to be something he could eventually fully understand, providing we could first, both of us, work out just what it was.

All right, I half knew the answer already – I had inside information which had come to me from my privileged position as a family doctor, so I didn’t go into this adventure entirely blindfold. But I want to emphasise why I felt fully justified in taking this stand, this position which was entirely unorthodox, and possibly unprofessional in other circumstances. By that time I knew that human beings were really rather wonderful – underneath. They didn’t want to do and be all the destructive things that seem to have been thrust upon them – if only they knew the way out. David certainly didn’t. Until he did. 

So the backstory is that David was born to a single mum. She had had a hard time, and a drug habit. Overdosing on heroin, she’d died. I’d known the whole three generational family for a number of years, which is the overwhelming bliss of family medicine, so these were basic life facts about David that I didn’t need to be told. Which was just as well, because neither he nor his exasperated grandparents could tell me, nor could they possibly have realized why this information was so crucial to the whole scene. Here, the simple fact around which the whole scenario turns was obscure. It’s an obscurity which you can find in every singe mental affliction. Indeed that’s 100% why they afflict. And why, if you're as optimistic as I am, they can all be cured, once clarity is restored.

So back to David. We chatted away that first Wednesday, with me asking about what he got up to, what he liked, what he didn’t, and him responding in kind. Same again the following week, and indeed into week three. I didn’t have any particular goal in mind, apart from engaging his attention as fully as I could, and communicating to him that I was relaxed and secure, and would discuss anything that came up.

Imagine my incredulity when in week four, unlike the previous three, he started playing with the date-stamp on my desk, doodling, eye-contact had gone, as if he’d lost interest. Then, out of the blue, he staggered me by saying, bluntly, as if it was the most obvious thing in the world – “It’s over”. “What’s over?” I spluttered. You could have cut my astonishment with a knife. Here was a 6-year-old “consulting” with a medical expert of considerable standing, and confidently saying “It’s finished”.

Well I knew I was “highly qualified” – but the basic truth was that I had absolutely no idea what I had done. “Over?” What could possibly be “over”? You may be sure I asked him soon enough. And his reply, spoken with the innocence of a 6-year-old, speaks volumes. You really do have to listen, ever so carefully. “You were the first person to tell me, mum wasn’t coming back”.

To tell the truth, I couldn’t remember ever saying that. What must have happened is that he’ll have mentioned her return, and I would have gently explained that when people die, they don’t. He must have been told that she was with Jesus, or had gone on holiday, or some other non-explicable euphemism, which, being oh-so-medically qualified, I could not let slip by, uncontested.

End of that story – and the beginning of all the rest. Here was David “communicating” with his body language – asking non-verbally why his mother had rejected him. No one told him. No one was asked. He could only conclude that it had all been his fault – he was being “punished” – it must have been for something he’d done – she must really have hated him. His mind was clouded – it didn’t compute – he couldn’t work it out, he simply didn’t know.

And the reason why all this happened is a pearl of enormous price – David had no way of telling himself what was actually the root of his aberrant behaviour, of his painful symptoms. The whole subject of mum, her disappearance, what to do about it, became swathed in agony – too much to even look at, at all clearly. He needed an external reference point, a supportive, believable, trustworthy, but neutral point of contact which allowed him to join up the wounds.

This is what I see happening here. And indeed, what I’ve seen happening to every mental affliction I have come across since. And the optimism comes from what happened next. Once David saw the connections, then but not before, all his symptoms evaporated. And to think that modern psychiatry tells you to swaddle the mind under a numbing blanket of drugs, when what is really needed is to deploy nuanced means to use the mind to cut the knot. In David’s case, I had already been given a clue, by virtue of my unique family doctor status. In almost all other cases, the hidden key is kept hidden, and no-one, especially not the sufferer will let you, or themselves get close enough to find it. Not unaided, that is.

No wonder psychiatry today is in a mess. David couldn’t know, he couldn’t join up the dots. When he did, his extraneous behaviour vanished. I’ve found precisely this pattern all over. More severe traumas tend to be buried deeper, so requiring more confident strategies and fewer drugs – but the end point is the same. Remove what ails the mind, and it blossoms. Next come even more dramatic examples than David. Serial killers and other murderers work in murk – until illumination hits them. Watch this space.

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NOTE These posts are a new venture for me. I’ll aim for twice monthly. If you like what I write, please encourage me by responding, either with or without paying. You can always read the academic background to it all, free, by clicking The Simple Science of Sanity. Thanx.

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MEDICAL NOTE – never stop psychiatric drugs abruptly – seek expert help. I’m happy to answer Qs & As (if slowly), but can no longer discuss individual cases, I closed my clinic when I retired.

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Next – #2 : Alec practised garrotting his pillow, aiming for me.

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