We found these qualities in every professional contact we made there. I had noticed it in the busy school administrators who solved the transfer problems of my normal children; I noticed it again in the university official who found me a graduate to take home to replace Jill, who would be leaving us for college. We experienced in our scheduled appointments in the offices of English professionals all the openness and warmth-I might almost say affection — that Americans expend so lavishly in their private relations. Private relations in England are neither warm nor open — at least until the participants have known each other many more months than were at our disposal. An American can only wonder at the reversal of what he is used to. It is as if all the Englishman’s dammed-up potentiality for warmth overflowed into the practice of his profession. Perhaps one cannot have it both ways, though I cannot see why not. At any rate, nowhere in England did we come across that chill routinization of human contact which too often passes in this country for professionalism.
Too often, but not always. On our return, on the analyst’s suggestion, we sought out an extremely well-qualified psychiatrist who had newly moved into a near-by town. We went to him with our usual shyness, but he received us with the flexibility and welcome we knew from England. We thought that now Elly was settled in one place he would begin direct work with her. We were not entirely easy about it, from the point of view either of utility or of expense. But he did not. After three or four sessions, all dealing with Elly, he put me on my own once more. He even suggested — I lived on it for months — that I work with children professionally. He even said that Elly could have done no better in the best residential school for disturbed children than she had done at home with us.
I return with Elly once or twice a year, and he tells me how much Elly has improved since he last saw her. We could not do without him. He acts as a buffer between us and the world. He provides documents, classifications, terminology, and these reassure the bewildered administrators and teachers who have to work with Elly. What school would accept her if she had only her parents to speak for her? But she has her credentials; she has a psychiatrist. We luxuriate in his encouragement and support. It is he who suggested that I write this book.
One day he may feel that Elly can benefit from analytic therapy, but four years have passed and he has not suggested it yet. In the meantime, he is willing to accept that parents can be partners, even senior partners, in the treatment of their child. He does not consider that he presides over a privileged arcanum into which we are not qualified to set foot. What he knows that can help us, he imparts. What he can do, he does. It is both little and much.
When, smarting from our first encounter with professionalism, we took our disappointment to Dr Blank, he told us we had expected too much. Psychiatry, he said, was a gift, not a science. We agreed with him; it was not scientific knowledge we had been looking for. We had indeed expected too much, but it was something else that we had expected. What we had asked, and with incredible naivete thought to get, was nothing less than the counsel of someone loving, wise, and good. We had been hurt and disappointed when we had not received it. Yet we had no right to surprise. Few people are wise and good.
It is remarkable evidence of the American faith in the power of cash that a profession should arise that puts wisdom, goodness, and love on sale. Socrates did not. We had no right to be shocked that at our first attempt our money failed to buy us these commodities. Should we not rather be astonished and grateful that it is ever possible for money down to provide access to the rarest human virtues, that some psychiatrists are wise and good, true counsellors, whose love and wisdom, if not their science, can help heal?
12. The Amateurs
It is obvious enough why psychiatrists seldom welcome parents as co-workers. Even if they do not try to convert them into patients on the hypothesis that it is their pathology that has caused their child’s, professionals can find other reasons, some of them very good ones, for doubting the capacity of parents to work with their own offspring. Not only professionals, but any outsider may well wonder how father and mother can function as therapists under the handicaps inherent in their position.
Although detachment is necessary for wise action, parents are inextricably involved with their child, their natural emotional commitment intensified by constant physical proximity. Though they must be content to work from day to day, they cannot avoid the long perspective; they must think as heads of households, and the fruitless question ‘What is going to happen to him and to us?’ is one they learn with difficulty to suppress. Because much is at stake, they may be drawn to exert pressure on the child, and if they are, the opportunities afforded by family life are endless. If their involvement and concern does not produce a nervous and harmful overactivity, an opposite possibility presents more subtle dangers: loving their child, they may not be sufficiently armed against the slights and rebuffs that those who deal with troubled children must expect — against the rejection that seems deliberate even after one knows it is not. So many overtures repulsed, so many words unheard, smiles unseen, touches unresponded to — the danger is that they will be too bruised to mount another assault, for rejection does not cease to hurt when one has grown accustomed to it.
Even if they escape these inward pitfalls, a more straightforward one remains: how can untrained people know anything like enough to do what is there to be done?
No parent is likely to deny these handicaps, knowing them better than anyone else. But since we parents, in clinical literature, have found few eulogists, it is up to us to put our handicaps into perspective. Since we are conscious of them, we can go a long way towards overcoming even the severest. And we, and others, should realize that they may be counterbalanced by special advantages that even the most gifted psychiatrist cannot match.
The first of these advantages is a considerable one: total familiarity with the case since birth. Every child psychiatrist who concerns himself with his small patient’s past is dependent on what its parents tell him, however he may decide to discount it. Even if he manages to call out of the child’s consciousness some fugitive memory which he can use to enhance his understanding, he must go to the details of the child’s history to make sense of what he has found, and his source for these will almost certainly be the child’s parents. The younger the child, the truer this must be, especially if its dysfunction affects speech and the therapist must work at mind-reading. The parents of a psychotic child are quarries of information which no psychiatrist has time to work to the full. If the child is obsessed with an object or a place, who but they know where he has been or what he has clung to? Who else knows their baby’s characteristic approach to food, to sleep, to play? Who else can say what threatened him and what delighted? Yet how much of what they know, which might prove relevant if the psychiatrist knew it, finds its way from their minds to his? Psychiatrists and parents both explore an unknown country, but parents at least hold a map that shows the major landmarks. They may not know all they need to, but they know more than anybody else. As long as the child develops rightly and they have no need of all they know, they may not even realize that they know it. If the time comes, however, it is there to be used.
The second advantage is another version of the first: as well as a fuller knowledge of the child’s past than any doctor can have, parents have a fuller knowledge of its present. They can observe the child in the complete variety of situations to which it is exposed, not merely in the artificial situation of the therapy hour. Children’s conflicts and anxieties become evident to skilled therapists through their displacements on to things; sibling rivalry becomes visible through the doll family with which every therapy room is equipped, training problems through the miniature toilet in the dollhouse. The parent can learn to use toys too, but he needs them more for stimulation than diagnosis since he can observe these things directly. He knows how his child responds to each of his brothers and sisters, to grandparents, teachers, passing visitors. He (or, more probably, she) knows what the child is like at breakfast and in the bath, how it reacts to strain, how it behaves at a party, in a supermarket, at the circus. It is she who quicker than the best psychiatrist will notice the deviation from customary behaviour that may suggest a new explanation or initiate a new stage. She will not, of course, do this because she is cleverer than he, but merely because she is there when he is not. I have written in the previous chapter of the time when Elly suddenly ran towards a crowd of school children, and of what we made of it, mother and analyst together. That moment could not have come at all in the analyst’s office, in the daily hour.