I am now a retired renal physician. The Medicine Stories Project struck me as a fantastic idea. I have always thought that one of the important things that was missing in medicine was the narrative. This story reflected the fluid nature of how important it is to make decisions on the basis of one’s own experiences. Louis Pasteur said “Chance favours the prepared mind” On reflection I think in my own discursive fashion this is what I think my thoughts were at the time.
Woody Guthrie’s role in my not being a psychiatrist
Convention has it that the Sixties began in 1960. But take it from me, the Sixties began on the morning of October 5th 1962 when the Beatles released “Love me do.” In response, popular music experienced a seismic shift from songs based on a saccharine sentimentality to music full of gutsy, hard edged, reality. Not long afterwards you needed to aggressively define yourself based on whether you worshipped the Rolling Stones or the Beatles.
The idealistic, love-in, drug hazed, fashion show that followed ended abruptly when the Union Nationale des Etudiants de France (UNEF) demonstrated in the streets of Paris in May 1968. The city came to a halt. There was a risk of an armed rebellion. De Gaulle called a general election. Ironically, he won a landslide victory but resigned at the end of 1969. The world was never the same again and the Sixties ended.
If there was any doubt that the Sixties were moribund, the stabbing death of Meredith Hunter at the Rolling Stones concert in Altamont in 1969 by the Hell’s Angels was an epitaph. For such a thing to happen four short months after Woodstock confirmed that the bubble had indeed burst.
So what’s this got to do with psychiatry? Well, taking a few steps back … It’s not widely known that the Sixties pretty much lasted the same time as I spent as a medical student in Edinburgh. I realised very early on that this flux of ideas the Sixties were throwing up was likely to be quite an interesting experience. My father had been a successful student in Edinburgh. He spent a total of ten years at university and won many academic prizes. I am sure nepotism must have played a part in my selection as a medical student. However, my achievements seemed to hold less relevance to me. I decided very early on that any mark over 50% meant that I had overdone things.
Instead I rapidly became interested in the Scottish Enlightenment. This was a movement that emphasised the fundamental importance of humanity and reason as powerful forces for the benefit of society. It preceded the better known French version by quite a number of years. I also dabbled in trying to understand Surrealism and liked the way that it could appear to free me from logical constraints such as rational and utilitarian values. I liked the rather vague idea that rumination and reflection were the key to a fuller reconciliation between the self, art and life. I read the seminal Sixties “must read” Jack Kerouac book, On the Road, and fell in love with America.
In 1966 I did an externship in Tucson, Arizona. I travelled over 10,000 kilometres on Greyhound buses. I loved the way that the bus drivers listed the places we were headed for: Chattanooga, Tuscaloosa, New Orleans, Cincinnati. It seemed like a sort of poetry. A Greyhound bus is a beautiful creation: sleek, smooth and silver. Seeing these machines gliding almost silently along the freeway inspired me and fed my idealistic peregrinations. There’s even a whole website devoted to poems about Greyhound buses. Three months in the U.S. finally freed my mind from any traditional thinking that I might have acquired in Edinburgh.
I started reading about Freud as well … and the way that there was something less than rational about us human beings. Dreams and their analysis enabled us to make sense of the unconscious. When I arrived back in Edinburgh in mid-1967 quite by chance I was on a psychiatric run. I realised that all that stuff I had had time to reflect on was beginning to make sense. I was lucky enough to meet two professors who were world leaders in psychoanalysis. I became star struck with their brilliance and their ability to dissect the sometimes barely intelligible things that patients would say. Cutting to the chase, I decided to become a psychiatrist and to go back to the U.S. I applied for an externship at a psychiatric centre in Ward’s Island Hospital, New York – and this was where my enlightenment would occur.
When I arrived in New York I found that Ward’s Island “hospital” was really a warehouse for mostly black patients. There was a tight security system to keep all the patients locked up at night. Ward’s Island had its own police system. I even had my own set of keys. I could visit patients when I wanted to. The most humorous person I have ever met was in solitary confinement. When I was with him I felt that in another life he could have been a talk show host to match Johnny Carson or Dick Cavett. I later found out that he had cut his wife into inch cubes and put them in his fridge.
Most patients there were on huge doses of phenothiazines. Most of them had Parkinsonian rigidity and moved very slowly with a distant reptilian stare. Everyone was scratching (due to a phenothiazine-induced photosensitivity).
By contrast, on the weekends I used to socialise with my fellow students in Manhattan. They introduced me to their friends and family. These two sets of experiences were like chalk and cheese. No one in Manhattan seemed to have anything wrong with them, as far as I could tell, other than a modest dose of narcissism. This was at a time when psychoanalysis was at its peak. It came as a great surprise to me when I discovered that a number of the students, their friends and their parents were undergoing psychoanalaysis at huge expense.
It was time to exercise the lesser known part of the Hippocratic Oath – reflection. I was confused, dazed, impressionable and thousands of miles from home. I had been reading about dreams and their interpretations – but this was one which didn’t really make any sense at all. Turmoil, chagrin, doggedness and a sense of pride combined to create a toxic mix in me. I’d invested a lot of time and energy getting to this point. This was not the time to quit.
And then I met Woody Guthrie … well, sort of. Throughout history singers such as Bob Dylan, Johnny Cash, Bruce Springsteen, Harry Chapin, Pete Seeger, Joe Strummer and Billy Bragg have all acknowledged him as a major influence. I was introduced to him by seeing his son, Arlo Guthrie, in concert. He was a hugely popular singer in his own right and was also one of the prime movers of the anti- Vietnam War movement. I knew that Woody had stopped performing a few years previously but I didn’t know why. He died on October 3, 1967. I read about it in the New York Times. He’d become progressively demented from Huntington’s disease. He had been locked up in The Creedmore Psychiatric Centre in Queens, New York. I felt I needed to make a “pilgrimage” to just have a look at the place and I was absolutely shocked. It was even worse than Ward’s Island. The building was crumbling. I stood outside and felt sad beyond belief. The patient abuse, inhumanity and neglect felt palpable. Later in life I found out that Woody’s name was actually Woodrow Wilson Guthrie – he was named after a former U.S. president.
I still feel sad when I recall these events in my life. I’d been young and idealistic. I felt a degree of bitterness that my idealism and sense of purpose had been shattered. Sometimes when the words “a heavy heart” are used, they can sound a bit clichéd. Even after all these years these are the words that come to mind when I recall these events.
The words of the old song say “Pick yourself up, take a deep breath, dust yourself off, and start all over again”. And in the end that’s what I did. At the time I’m not sure that I had fully figured out Woody’s role in helping me to walk away from psychiatry, but looking back it seems clear to me now.
Later in life I came across Louis Pasteur’s memorable quote, “Chance favours the prepared mind”. All this frantic self-examination can, I suppose, be summarised with these few words in mind.
Oddly enough, in 1968 I returned to the U.S. for my internship at King’s County Hospital, Brooklyn, New York. Here I met two amazing role models, both renal physicians. They were great teachers and they magically demystified fluid and electrolyte balance for me. I have to admit to a certain amount of pride when my colleagues would approach me to discuss acidosis and hyperosmolar coma. Being a doctor is indeed a happy home for an immensely wide spectrum of folk.
– Alistair Macdonald
I’ve worked in UK, USA, Canada, Vietnam, Iraq, East Timor and New Zealand. I’ve been a long time renal physician but I’ve also collected fruit flies. I’ve been a GP and a director of family planning. I’m now a clinical ethics advisor and I honestly think it’s about time I settled down to a stable career as a clinical ethics advisor … I think!