I have tried to tell some of the more upbeat stories, and indeed I know for certain that our service had many positive results. But I would not be honest if I didn’t tell how often we despaired at the way it was impossible to get the recognition, funding and cooperation from above that we so desperately needed. It was always a dilemma whether to start, knowing you might do more harm than good if treatment was stopped abruptly and inexplicably for the child. It didn’t even help if you went to all the case conferences and had a good relationship with the social worker—some of whom were excellent.
I have been at case conferences where we would solemnly work out a care plan, covering all eventualities and specifying the long-term treatment we were undertaking—only to find a couple of weeks later that the higher echelons of the Social Services Department had totally ignored it and sent the child somewhere faraway, impervious to my ranting and raving on the phone or even more measured letters of complaint.
I cannot get this across better than by this true story from my early days in child psychiatry—but these things never truly changed through all the years.
A boy in care, let’s call him Wayne, came several times to explore his aggressive behaviour. We worked well together, he was bright, and although inarticulate he showed by sand and water play what he had suffered and what he needed. His behaviour improved dramatically, but we had far to go still. I gathered things were also improving in the care home.
On what became his last attendance—though of course I did not know or intend that it would be—he cleared a great valley in the sand tray and put himself as a small toy animal in the centre. He surrounded this with larger animals, all looking over the rim from a distance: lions, tigers, cows, giraffes. He told me that these were his social workers and carers.
I asked if I was there. He shook his head and after a moment’s thought, he added a small, frail-looking model gazelle on the slope, between him and the pack of animals. Sadly, his estimate of his situation and my inability to help him was confirmed. He was moved out of county without explanation before his next appointment and I couldn’t find out anything more about his fate!
This use of objects such as toys and a sand/water area was a luxury I didn’t have in most clinics. So I learnt to compromise by encouraging my own and the child’s imaginations with storytelling. Although I regard my work with children as a branch of medicine, based as far as possible on medical principles and ethics, the actual practice, particularly with children and families can be very different. I learnt as much from good practices by teaching staff as by research and textbooks. So my ‘taking a history’ often involved getting children at any age to tell me a story—definitely that way round, not me telling them. Even very young children could be nudged into this and it opened up a dialogue telling me much of what I needed to know in order to help them.
As a broad generalisation, younger children would talk readily in fairy tale metaphors—stories which I have always adored and within much ancient wisdom is stored. Older teenagers were more likely to talk of action films, horror stories and soaps.
In fact, in all those years I never found a child who didn’t watch Neighbours, the Australian soap! As it happened, I liked that soap and followed it every day for years with my daughter Amanda, a nice bonding thing for us after work and school. I grew to admire the way it was done. I noticed that episodes didn’t end on a cliffhanger, leaving children anxious overnight. The storylines too held a basic decency, alarmingly missing from many soaps and in stark contrast to EastEnders, which I hardly ever watched and detested when I had to because of its cynical world view. There has never been any character in it who isn’t greedy, vindictive and corrupt, except the occasional religious ones who are just silly.
Neighbours indeed did well for one young teenager. He sat down in the chair in my clinic and opened with “can you hypnotise me so I can go out again and play cricket?” I enquired about this—very unusual—opening request. Apparently a storyline in Neighbours that week, which I had missed, was about a boy who couldn’t leave the house and so couldn’t play cricket, but ‘the doc’ hypnotised him and he could go out and play again. The youngster revealed that he was housebound with classical features of a phobia. Me being therefore cast as ‘the doc’, I gravely suggested that hypnosis could be very helpful in these instances but we would need to talk to his father about this. Also, I said that though I was sure that I would be able to help with his fear of going out, it wouldn’t necessarily help him play cricket! His father was brought in, I discussed with them my practice in hypnotherapy, he gave consent and they returned weekly for a couple of months, very successfully.
I should say here that my practice with hypnotherapy was quite extensive but was always ‘auto-hypnosis’, in other words, teaching the recipients to put themselves into a light trance state and emphasising that they would not be under the power of myself or anyone else. Reputable practitioners will all tell you that we are regularly going into light trance states of our own accord—such as when concentrating on a book or the tv—so it is harnessing a useful normal characteristic, not trying to replicate a showman’s dramas.
I learnt it first for my own benefit in childbirth, with good effect, and still use it almost daily for pain relief and relaxation, like mindfulness. In fact, a colleague with an interest in hypnosis taught me in the easiest possible way—by putting me in a trance state. Later on, he taught me how to do it to myself, with obvious advantages. He then told me that I would be able to follow it up by helping others in the same way and I therefore found it came very readily. Hypnosis has been shown not only to facilitate pain relief in labour but to shorten the first stage and other benefits. It certainly helped me and I think the advantages of it in medicine should make it far more widely used. But it must be used very ethically and is far away from the ‘magical tricks’ attitude to it as a nightclub or theatrical presentation.
Anyone is welcome to ask me more about it. I always, of course, got parental permission for youngsters. It had quite dramatic effects with asthma sufferers, reducing hospital visits, even their steroid drug usage and improving school attendance, The paediatricians and I wanted to explore it further with controlled trials, but we never managed to make the time.