The Tale of a Reluctant Psychoanalyst

It might make it a little easier to understand what is to follow if I give you some of my background before I launch into the makings of a reluctant analyst.

My father was a country GP who became interested in psychiatry when he helped shell-shocked world war veterans by using hypnosis. He decided to study psychiatry abroad and sailed to the UK as a ship’s doctor when I was ten. He gained his DPM and a fatal coronary in the same week.

As you can expect, his death had a powerful effect on me. I was sent to his old school where he shared Dux of the School with Hugh Cairns, who was to become one of the best known brain surgeons of his day. My unconscious must have equated learning with death because I refused to learn, instead putting all my energy into sport: as the stroke of the school rowing Eight, as member of the Gym squad, and First Hockey, Second Football and Cricket teams - and the tennis team. I left school at sixteen and became a jackeroo on a sheep station.

On my seventeenth birthday, I enlisted in the Navy as an Ordinary seaman and eventually was sent to an Officers Training school and became a Midshipman serving on a Landing Ship which saw active service in the Pacific as a member of Admiral Halsley's Fifth Amphibious Fleet and we took part in six landings and experienced a fear of the Kamikazi. We were a lucky ship and witnessed others who were not so lucky including our own HMAS Australia being hit a number of times.

When the war was over, we took troops into Ambon and came face to face with the Japanese and the men they starved and enslaved. Not long afterwards, I left the ship and friends I had known for three years and felt a great sense of loss, which was amplified when I was discharged. Quite out of the blue, a friend of mine encouraged me to enroll as a student with the “CRTS” (Commonwealth Reconstruction Training Scheme), studying with a group of ex-service people with whom we could identify.

Eventually, matriculating for medicine, the next six years were spent in wonderful company and camaraderie, which carried on in house surgeon years. While an RMO at the Children's Hospital, I was offered a share in my father's old country practice.

When I arrived there ,I was greeted by some of his old patients, singing the same refrain: "If you are half as good as your old man you'll do me". It soon became apparent to me that he was a much loved doctor.

In 1954 a country GP was expected to be a man of many skills including veterinary. It was a very busy practice. After watching a lady developing a psychosis following the death of her husband and her subsequent recovery after psychiatric treatment, I became interested in psychiatry. So I followed in my father's footsteps and sailed to London as a ship's surgeon.

Australians had a good reputation in London and junior jobs were easy to obtain. Lectures were being held at the Maudesly Hospital twice a week concentrating on the different schools and approaches to psychiatry with a leaning towards the medical model and a bias against Psychoanalysis.

My first experience of Clinical practice was as a Senior House Officer at St Clements Bow. This was a small clearing house for Acute Psychiatry attached to the London Hospital. It was run by three Australians, one Englishman and two consultants. I was given the women’s ward and learnt most of my psychiatry from a Senior Nursing Sister, who had been in charge of the ward for some time. Patients were kept for not more than two weeks and passed on to one of the outer ring of mental hospitals. This experience gave me an exposure to most acute types of mental illness and we were able to keep some patients longer if we thought they would benefit.

After a year there, I went to Claybury Hospital, a two thousand three hundred patient unit, which had just become the second open door experiment in the UK. It was there I met two analysts. A Dr. Jetmalini from India and Dr Ron Brookes from Sydney, who were both running, an acute women's admission ward. Very soon after I arrived, they both left and I was told to carry on alone, to be the group therapist as well as other duties. This meant conducting – without training - a large group of women of diverse diagnoses. Eventually a consultant arrived. A lady who was predictably late.

They were still doing leucotomies in those days and ECT was the effective antidepressant. Largactil and Tofranil had only just made their appearance and we were sitting in a group of women including a couple of borderlines who behaved appropriately for a hour without any major medication.

Because of an interest in schizophrenia mainly from the experience of a Cambridge undergraduate who had a catatonic illness and recovered after a short course of ECT and relapsed when sent home and recovered again after ECT, and the experience of working with a group of psychotic women, I approached the British Psychoanalytical Society for guidance. Someone referred me to Ronnie Laing who invited me to join his study group. At that time they were interested in existentialism and Satre in particular. Laing encouraged me to read Harry Stack Sullivan rather than Freud whose Totem and Taboo I had just been reading and found that he quoted my grandfather's book," The Native Tribes of Central Australia "

Confused from the advice I was being given, I decided to put all my energies into passing the DPM and returning home. I was lucky enough to land a job as a paediatrician on a migrant ship, the S.S.Fairsea. I looked after 650 children. To prevent an epidemic on board we injected all of them with gamma globulin. My time was spent as a GP again, trying to help their parents cope with their anxieties about the unknown country they had chosen to live in.

It had been arranged that I would look after Dr Bill Dibden's practice while he was away for six months abroad. This locum work was an experience far different from anything I had experienced before. Work began with hospital rounds in two main private hospitals treating mainly very depressed and psychotic people with ECT giving the anaesthetic for the shock therapy ourselves. The demand for help in other areas was great and initially I worked a session in the repatriation department and in a alcoholic unit called Archway Port, as well as a session in a new teaching hospital as one of the first psychiatrists to work there as a visiting medical officer

In the beginning of 1961 I began analysis with Dr. Harry Southwood. He had had an analysis with Dr.Clara Geroe, who in turn had been analysed by Dr.Michael Balint. A couple of years after I began my analysis, Harry suggested that I might join a group he was forming to study analysis. He was analysing Dr.Jack Earl and Dr.Clive Kneebone as well and we three met at Harry's house once a week and began to try and understand what analysis was all about. As time went on he asked us if we would like to train as analysts and if so would we be vetted by an interstate analyst. It was suggested that I see Dr.Frank Graham and I got quite a shock when he greeted me with his big cheery welcoming smile to see that he was crippled by polio as a child and wearing steel calipers on his legs as a result. Later, our suitability was assessed by two visiting analysts, Dr. Adam Limentani and Dr. Leo Rangell, and we were accepted to train to be members of the Australian Psychoanalytical Society. This meant that our analyst was our supervisor and lecturer - a triad that has it's problems!

We met yearly with the rest of the Australian analysts, initially in Melbourne in Dr.Geroe’s waiting room, which, as time went on, became much too small for all of us and we moved on to other places. It was there we met Dr. Michael Balint and learnt to play "the Balint Game", a study we never continued - which I felt was a shame.

Later people began arriving back from the UK who had been analysed there. Dr.Rose Rothfield, Dr.Ron Brookes and Prof Reg Martin were some of the first to return. This influx of new blood caused tensions with members of the old guard. I had experienced supervision of my first case, a male bookseller, from Harry Southwood. Communication with students was not good in those days. We were left uncertain for months as to what was required of us. Eventually it was suggested by the new training committee that I seek supervision from a member in another State. It was my good fortune to be given Rose Rothfield as a supervisor. This meant flying to Melbourne every weekend for an hour’s supervision. It also created a conflict between what I had experienced in my own analysis and what I was expected to follow in my patient's analysis. Further supervision by Ms.Vera Roboz and discussion with others, suggested that I give up my analysis with Harry because we were thought not to be “a good fit”. There was no-one else in Adelaide and I was in no financial position to go to Melbourne for an analysis and it would mean losing my home State and beginning again in Melbourne - which would be a great loss for me and my family. Ian Martin offered me a partnership in his practice, but in the end I could not risk what had happened with Harry, as I was not impressed with the training analysts available in Melbourne at that time.

Dr.John Bowlby had come to town at the invitation of the Adelaide Psychiatrists and I was Chairman of the Branch then and was responsible for entertaining him. A friend of mine had a house boat on the Coorong and as Bowlby was a keen bird watcher, we showed him examples of some of our local species. He gave me signed copies of his books and his understanding of attachment and loss resonated with my general practice experiences of seeing anxious children clinging to their mothers.

Soon after this meeting I took on as an analytical second case, a depressed young woman who had recently lost her father to whom .she was very attached. The daughter of a doctor and studying for a BA degree, with an interest in psychology, I thought she was an ideal second case but as things turned out, we had a bizarre experience similar to working with a borderline patient until it was realised she was suffering from Disseminated Sclerosis. Later I read about the cellist, Jacqueline Du Pré and saw the film “Duet for One”. Attempting to treat this patient had a profound effect on my confidence and motivation to continue in psychoanalysis. I thought hard about continuing in general psychiatry.and avoiding psychoanalysis altogether, but the urge to learn more dominated my behaviour.

Such was my unconscious that I repeated the experience with another patient who soon showed me all the characteristics of Borderline pathology. A school teacher, she presented as a depression, self medicating with alcohol. She was able to come to all her sessions sober but tested every boundary. Her need for a negative therapeutic reaction was beyond my ability to analyse her so I continued to wonder whether I was a suitable candidate for analytic training.

At about this time time, I had some contact with Drs. Bill Blomfield , George Christie and Ian Martin who were interested in Group Analysis. I had been asked to see a couple of hysterical nuns and I decided to treat their nunnery as a group, seeing them weekly for three years. I presented my idea of the psychopathology of their institution to the members, and I was made a member of the Australian Group Psychotherapy Association. This complemented some work I was doing in a Public Hospital, running ward groups in the psychiatric ward to help contain acting out by very sick patients. I also had a small group of trainee psychiatrists and we were reading "An Introduction to Psychoanalysis” by Charles Brenner. None of them went on to show an interest in psychoanalysis but I received referrals from academics for psychotherapy patients.

One of these referrals I was able to convert to analysis and presenting my work with her to Dr.Bill Blomfield and Dr. Frank Graham secured my admission to membership of the Australian Psychoanalytical Society. I learnt more from this patient than any other experience during my career. She is the only patient I had, who demonstrated a transference psychosis. One day she caught sight of my black shoe and became extremely frightened. She believed that I was the priest who had had intercourse with her when she was a little girl, and ran out of the room, only to return crying, disheveled and terrified that I would abandon and reject her, as had happened so many times in her life before. This behaviour was never repeated but she had great difficulty feeling what she was feeling.

She would often regress and curl up into the foetal position and describe feelings as “like being a baby” and wanting to be cuddled. Outside of the analysis this would enable her to feel separate from others. Before this, she would be unable to think differently in conversation with other people. However she beleived she could only be her true self in analysis. The problem I still have is understanding why the recovery did not last long before she reverted to her old habit of fusion. I found it a great help presenting her to visiting analysts from abroad. She also taught me about the difficulty extremely traumatised children have in re-experiencing the feelings they experienced in the past that were internalised as psychosomatic symptoms.

In 1978, there came to our town, a British trained psychoanalyst , a South African called Sam Stein. So at last I thought I can have another analysis. Or at least find out why I found analysis such as Janet Malcolm said "an impossible profession." So every morning I drove what was then for an Adeladian a long distance to his home in the foot hills. One day after four years of analysis I experienced the gastritis like pain of angina, walking up the incline of his driveway.

Shortly afterwards, in 1983 during a heat wave, having dinner with some members of my family, I had a coronary thrombosis which I believed to be indigestion. The next morning, arriving at the hospital, my registrar thought I was not looking well. I had walked up a few floors, attempting to make a differential diagnosis as to whether I had suffered from acute indigestion or a coronary thrombosis. He suggested that I see a cardiologist, who put me into intensive care. Soon I was to find myself in a group of six patients lining up for a coronary by-pass operation.

After a few months, my analyst and I began again to try and make sense of what had happened. Needless to say I was pretty traumatised from both the experience of the coronary and the even more difficult experience of the by-pass.

Luckily I had three analytical patients at that time who wanted to continue their analyses so I went back to work as soon as I could. They thought I was more compassionate and understanding than previously and that I had gained a lot from my experience of hospitalization. I decided to limit my practice to analysis and a few psychotherapy cases and gave up hospital visiting. Post-operatively, for some reason my analysis became much more difficult for me. I thought my analyst and I were on different wave lengths. What that was all about has been lost in a resistance to remember anything at all about that period. So I once again gave it up and found myself concentrating on Institute affairs.

By then we had managed to have some students. Our South Australian Institute had been formed after Harry Southward and Clive Kneebone against all odds brought it to fruition.

This meant that there were more people involved in analysis in Adelaide and we met more often to discuss training, trying to avoid the problems we had with our own training. We felt our work improved supervising students as well as the introduction of visiting analysts - when we ourselves were able to be supervised by analysts from abroad. Our students were being supervised by interstate colleagues and our confidence as analysts improved.

When the time came for students from the various states to meet and present their work to us in Adelaide over a weekend every year by listening to the interstate people it became an additional learning experience. It gave us an opportunity to compare the standard of our students and ourselves,

At the same time I was supervising students for psychotherapy training. As part of their experience for the College of Psychiatry training, students were allowed forty sessions of supervision of their psychotherapy I. am still seeing two students weekly. An Indian and a Kenyan, who are a delight to work with - as are the various groups I take for Infant Observation.

In the nineties, I was given the opportunity to join the Excutive and learn how a modern society works. This was made more pleasant because of the personalities of the members involved who all gave the impression they wanted the Society to work. It also gave me an opportunity to see how other students were faring from interstate. Being asked to decide some budding analyst's fate was a new experience.

Being a member of the executive required telephone link ups between the States quite often and I got to know other people much better .I was fortunate in having intelligent and balanced people to work with. Eventually I became President but did not seek my third term. During the night before the executive meeting at the last conference when I was President, I had a vivid nightmare.Waking up in a sweat I began to realise that I was furious and I thought one way to handle my dilemma was to resign from the Executive and avoid the stress.

It always surprised me that the yearly meeting of analysts in whatever capital city or special retreat, generated a tension that was rarely ventilated. It seemed that our conferences were always the containers of bizarre objects, collected from our work and internalised. Rarely were they externalised. Of course I was reminded of the British experience of the three schools and wondered at the problem of some people exposing elements of their narcissm.

After another by-pass operation and another for a carcinoma, my interest in analysis was maintained by joining a small study group of Drs Robin Chester, Rick Curnow and Elizabeth Heath, presenting an on-going case once a month. We trust each other enough to be frank. I wish this could have happened earlier in my career as I learn a lot from these discussions about cases. The support and help I received, as I struggled with a case of Anorexia Nervosa, made the whole journey a learning experience I had longed for much earlier.

A couple of years ago I noticed an increasing difficulty reading. My ophthalmologist, a young man, told me without much emotion after coming away from his slit lamp that I had a wet macular degeneration in my right eye and that I would be legally blind in about six months. Giving me a few minutes to digest that statement he went on to say they were doing some clinical trials on a drug used to treat carcinoma of the colon. He could inject this into my eye at regular intervals and it might stop the progression of the disease. So I decided to give it a go because I had been told by other opthalmologists that my left eye was useless due to trauma. The injection into my right eye halted the progress of the disease but made it difficult to read without a magnifying glass, so I decided to give up practice and retired, feeling the loss keenly. About six months ago I pleaded with my ophthalmologist to remove the cataract from my left eye and, lo and behold, I could see better than my other eye and now I can drive to the golf course where my mates still have to tell me where my ball goes!