Ann Butts was my patient from June 1969 until my departure for America on September 10, 1978. She suffered from Tourette's syndrome, a neuropsychiatric disorder characterized by recurrent muscle tics and involuntary vocalizations. It was an inherited condition from her mother who had a complex form of the disorder, which manifested itself as coprolalia, a compulsion to utter obscenities. Ann, who cared for her mother for many years until her death in 1968, had a good understanding of Tourette's syndrome and had learned to manage her own condition successfully. Ann's most noticeable symptoms were 1) motor tics in the face and shoulders; 2) a compulsion to talk to herself; and 3) obsessive behavior, particularly in relation to home and personal security.
I referred her in December 1969 to Dr. Randreth Patel (Middlesex Hospital), who took a particular interest in Ann and was sympathetic toward her firmly held views against the taking of psychoactive drugs, which she felt had worsened her mother's condition rather than improved it. While no one has yet discovered a cure for Tourette's syndrome, the disorder tends to improve with age and Ann was no exception to this. My understanding is that her tics were a great deal more pronounced when she was a teenager (DOB-12.3.36). As a result, she suffered considerable teasing and unkindness from her peers and had few social skills following an early withdrawal from formal education. In recent years Ann's symptoms had been comparatively mild although she was inclined to exacerbate them from time to time through an overindulgence in alcohol. She had an average IQ and had no difficulty leading an independent life, although her obsession with home and personal security meant she shunned the company of others. I made a point of visiting her every six to eight weeks and on my last visit-September 8, 1978-she was in good health, both physical and mental.
Sheila Arnold
Sheila Arnold GP, FRCP
TWENTY YEARS LATER
Family correspondence prior
to the Ranelaghs' return to England-dated 1999
CURRAN HOUSE
Whitehay Road
Torquay
Devon
Thursday, May 27, 1999
Darling,
I don't know why you always have to get so angry when someone questions your decisions. It's most unladylike to scream like a fishwife down the telephone, particularly when you're three thousand miles away. Of course Daddy and I will be pleased to have you home but you can't expect us to be thrilled about this silly idea to rent a farmhouse in Dorchester. It's over Two hours' drive away, and your father will never be able to manage the double journey in a day. Also, it's hurtful. We've only seen our grandchildren twice in twenty years-each time on very expensive holidays-and we always hoped you'd bring them to live near us when you finally came back.
I can't help feeling it's not too late for me to find you something in Devon. We have a very good real estate agent here who has a list of reasonable properties to rent. Have you taken the trouble to have this farmhouse vetted? The description you gave was very vague, and frankly Ł650 a month sounds very expensive for a house in the middle of nowhere. You do realize, I suppose, that there are a lot of charlatans about and it's very easy to put an advertisement in the "Sunday Times" in the hopes of attracting foreigners to summer lets.
You know I hate to be critical, but I do wonder if Sam and the boys have been consulted about this move. As usual, I fear you have made a unilateral decision and totally ignored the wishes of everyone else. You say you're only renting the farmhouse for three or four months, but do please explain why Dorset is preferable to Devon. It's absurd to say you want to revisit the place where you spent your honeymoon. I thought you had more sense than to pursue holiday memories from 1976.
We 're glad to hear that Sam is on the mend although we found Luke and Tom's flippant references to his "dodgy ticker" somewhat inappropriate, particularly as Sam was clearly listening to the phone call. I find it difficult to believe that they're now eighteen and nineteen. Frankly I'd have expected a little more maturity from boys of their age, and 1 fear you've been spoiling them.
I shall wail to hear re the real estate agent.
All my love, Ma
PS Dear M. personally, thought the "dodgy ticker" was wonderful and loved to hear Sam laugh at the other end. What a marvelous relationship you and he have with your boys and what a blessing they've been these last few months. I'm much looking forward to sharing some of the Ranelagh Jr. fun, even if it means driving two hours to experience it! Tell Luke I have every intention of having at least one go on a surfboard even if I do go "arse over tit" in the process. I may be an old codger, but I'm not in my grave yet.
Dad
XXX
Cape Town
5 June
Dear Mother,
Written in haste. Sorry about the screaming but the line was bad. I enclose a photocopy of the farmhouse details. I have taken up references and am reliably informed that Ł650 is a good price. It would be considerably more, apparently, if it weren't a property of "character," which appears to be real estate-agent shorthand for "somewhat dilapidated." However, Sam and the boys are looking forward to slumming it as much as I am. All being well we should be there by the first week in July and will expect you and Dad at the end of the month. I'll ring to confirm a weekend as soon as we're installed.
We're all fine and send our love to you both.
N
Dorchester: 18th century stone
farmhouse for short or long let. Character
property in idyllic rural setting, 2 mis
from town center, 5 bedrooms, 3
reception rooms, 2 bathrooms,
large quarry-tiled kitchen. 1 acre garden,
adjacent paddocks. Fully furnished,
oil-fired c/h, Aga, garage.
Ł650p.c.m. Teclass="underline" 01305 231494
*2*
I recognized Dr. Arnold as soon as I opened the door to her, although there was no answering smile of recognition from her. I wasn't surprised. We were both twenty years older, and I had changed a great deal more than she had after two decades abroad. She was silver-haired and thinner, late fifties, I judged, but she still had the same rather searching gray eyes and air of unassailable competence. On the only other occasion I'd met her, I'd found her thoroughly intimidating, but today she gave me a sisterly pat on the arm when I told her my husband was complaining of chest pains."He says it's a pulled muscle," I said, leading the way up the stairs of our rented farmhouse, "but he had a coronary six months ago and I'm worried he's about to have another one."
In the event, Sam was right-it was a pulled muscle from too much digging in the garden the day before-and I concealed my total lack of surprise behind an apologetic smile. Dr. Arnold reproved him for scoffing at my concern. "You can't take chances," she told him, folding her stethoscope, "not when you've had one close shave already."
Sam, whose memory for faces was almost as bad as his memory for names, buttoned his shirt and cast an irritable glance in my direction. "It's a ridiculous fuss about nothing." he complained. "I said I'd go to the surgery but she wouldn't let me ... just takes it into her head to start treating me like a blasted invalid."