My thanks to Ian Gould whose
Saturday morning tweet brought back wonderful memories of the Coast to Coast
walk I did some 14 years ago. It’s funny how and what can trigger a memory. Here’s
another example. Last week I was reading about England’s only NHS Youth Gender Clinic
and their work on helping children and young people with gender identity issues
through the use of so-called ‘puberty blockers’. Children as young as 11 years
of age are being offered these hormone-blocking drugs. Now I have very limited
knowledge about gender identity issues, but 11 years old does feel relatively early
for a child to be questioning their gender. However, similar clinics across the
world are apparently now providing these drugs to young people. As with any
drug there are risks. In this case there are potential adverse effects on bone
strength, the development of sexual organs, body shape and or final height. The
report I read also detailed the outcome of a BBC Newsnight programme that
suggested another side effect was a high risk of self-harm and suicide.
The Health Research Authority,
which overseas medical studies, ensuring that they are ethical and well
designed, is evaluating this programme and the risks involved. Time will tell
as to what the risks versus benefits of such an intervention might be. The Youth
Gender Clinic is in the very famous Tavistock clinic, now part of the Tavistock
and Portman NHS Trust in London. It was in thinking about the Tavistock that
sparked off a whole series of other wonderful memories for me.
The Tavistock Clinic was founded
in 1920 by the brilliant therapist, Dr Hugh
Crichton-Miller. It was a clinic that set out to offer an alternative to the
traditional asylum-based psychiatry. Critchton-Miller was also medically
trained and combined this knowledge with psychoanalytical approaches to help
those experiencing Post Traumatic Stress Disorder (PTSD) after the Great War,
as well as ordinary folk with mental health problems. Their sister clinic, the
Portman Clinic, opened a little later in 1931. Both attracted some real leaders
from the field of psychotherapy and psychoanalysis, including Sigmund Freud, Carl
Jung, John Bowlby and Michael Balint. The work of these folk is still very
influential in contemporary health care. Both clinics joined forces in 1994 and
these days are seen as pioneers in the field of alternative psychologies. One
of the most influential contributors to the early work of the Tavistock Clinic
was Wilfred Bion who, along with fellow psychoanalyst John Rickman, developed
the pioneering concept of a therapeutic community.
This idea was adopted by those
working in the Tavistock and it changed the way the Clinic operated and was
managed. Senior posts were elected by staff, and clinical responsibility was
shared, rather than being the sole responsibility of the psychiatrist. Training
and learning were facilitated through exploration of real-life situations and
cases often presented in the form of peer seminars. Since that time research
and education have become an essential part of the work of the Tavistock and
Portman Trust. Both through publications and teaching, they have become
internationally renowned for their psychoanalytical and psychotherapeutic
educational and training programmes.
I came across the Tavistock
Clinic very early on in my career. In fact it was I when I was much younger, infinitely
more impressionable and undertaking my nurse education, I worked for a time on
a newly-opened medium secure unit in Swansea. It was an era where male student
nurses were issued with grey suits which you were expected to wear to work,
with white coats to be worn while on duty and where shirt and ties were de
rigueur. Despite there being some very troubled folk nursed on the unit, it was
a very safe and peaceful place for most of the time. As student nurses we were
mentored by one of two Charge Nurses, one of whom smoked a pipe for much of his
shift. I have fond memories of my time there and learnt a great deal about
engagement and interpersonal relationships, something I only realised was the case
much later on in my career.
There was a Staff Nurse working
on the unit who amazingly managed to get a paid 12 months’ secondment to the
Tavistock. Nobody knew why he would want to do so, but off he went. A year
later he returned. I happeed to be back on te unit and can remember his first shift back. On to the ward he
walked, blue shoes, no socks. Black jeans, open-necked shirt and no tie. If he
still had his white coats they were nowhere to be seen. His authentic self had
risen to the surface. Sadly, his life was made very difficult and after a few
months he moved to a local psychotherapy unit in the city. His authenticity
left a lasting impression on me, but again, it was only later on in my life
where I realised the liberating and empowering impact of staying authentic.
Much later in my career, I had
the privilege of managing the North West Regional Specialist Mental Health
Services, one of which was The Red House. The Red House is a psychotherapy
service, which at the time was located in a wonderful old Victorian house and
run as a therapeutic community. It was a very interesting place to manage,
particularly when it came to such activities as business planning, cost
improvement planning and so on. Usually discussion around these activities
involved meeting with the whole community, (staff and patents), often involving
a Jacob’s Feast meal. I learnt a lot about managing time (the analytic hour)
and the value of silence as a communication tool. Somewhat ironically perhaps,
this latter lesson was surprising, as like the Tavistock clinic, the Red House
was absolutely committed to ensuring that ‘talking’ therapies were available to
all. So thank you Ian for sparking off what for me has been a very pleasant trip
down my memory lane.
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