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Interview: Brice Avery, psychiatrist, psychotherapist, writer

by
11 January 2013

'I try to spot the folk who will cause the archdeacons sleepless nights'

I'm a child and adolescent psychiatrist in Edinburgh. I also practise as a psychoanalytic psychotherapist with adults. That's the one where you lie on a couch and I sit out of view listening and not saying very much.

I see folk with a wide variety of difficulties, from traumatised children, through psychotic teenagers, to grown-ups stuck in neurotic misery.

I rarely treat youngsters in isolation. The family, even if quite disturbed, is usually the developmental context for the child, and therefore the natural first-choice therapeutic system. This often involves enabling them to find a more nourishing space in relation to their carers, peers, and, sometimes, the authorities.

Generally, I don't "cure" people like some other doctors: it isn't always a realistic goal. Often I can improve things - sometimes quite a lot. One aims to understand what's going on for the young person and their context, and help them alleviate or manage the underlying problem causing the symptoms.

I don't think it's a sign of mental health to want to help people. Everyone in the caring business has a story that got them there. Perhaps you need to be admired, or were neglected and want to do a better job. It's important to know what your story is, to avoid feeding off people's vulnerability, or exposing yourself to manipulation.

People often ask: "How do you deal with all the pain and misery of your patients?" I use a blend of humour and relentless optimism to avoid getting emotionally silted up. I get a bit cross with those who think that emoting and empathising are, in themselves, either therapeutic or ennobling activities. I prefer to keep a clear head, and use my compassion as a motivator and sensing tool rather than an end in itself.

Of course, stuff gets under the wire. If something beastly is happening to a child who reminds me of my son or my younger self, then every utterance has to be double-checked for objectivity.

Freud said the analytic gaze must be "without memory and without desire". You have to be naïve and knowing at the same time in emotionally charged situations. The more one can resist the tendency to solve, categorise, sort, edit, and so on, the more chance there is of discovering the surprising thing in another person - and in yourself.

In child psychiatry we see quite a lot of Attention Deficit Hyperactivity Disorder (ADHD). It can be controversial. The only really effective intervention - if a youngster can't concentrate, is impulsive, always losing things, and fidgets the whole time - is medication. It's a big step to give children mind-altering tablets, however life-transforming and safe they may be.

We look hard for other explanations for ADHD-type behaviour, such as emotional trauma, learning difficulties, or attachment problems, before making a diagnosis.

People who distrust the "medical model" wonder where ADHD suddenly came from. I think it has always been around, but it's only over the last generation that we have developed the sort of compassionate insight required to join the dots. It's very important children aren't dismissed as naughty, badly parented, or thick if they have a developmental difficulty like ADHD. Without proper management they won't do well at school, and will miss out on things like learning social skills and self-control, which other children find more natural.

There is a saying in my business that we the therapists are the real patients. I think my childhood prepared me for a life of enquiry. Looking back, I see that the "examined life" attracted me. I grew up in a big family. Our mother had pretty fixed views. Our father was calm and liberal-minded. This, combined with a rigid, posh school, turned me into what I would call an "edge merchant". I can just about tolerate authority, and it just about tolerates me. I do institutions like the Church and the NHS, but generally choose to be the penguin on the outside of the huddle. It's colder, but the view is better and the air sweeter.

Like all children, if left to myself, I naturally wanted to think and play. When I was a teenager, my godfather, who was a brigadier straight out of Central Casting, used to summon me for tea and cake and a grilling. Everything I said had to be justified and built upon. He was like a cross between Torquemada and Socrates. But actually he was a master of advanced think-and-play, and he had faith in me. If I have any clarity of mind as an adult, these good-natured torture sessions were the first real rub with a soapy cloth.

I was eased out of school at 16, after one too many practical jokes and serial underachievement. After a year dossing about, I went to a college, got some A levels, and did a first degree in psychology. From there, further degrees in medicine and psychiatry, and training in analysis, followed.

What's it like to live with me? Obviously I can be maddening. There is a time for rigorous enquiry and a time to shut up and wait. I sometimes get these muddled.

So far, our son Laurence doesn't fit the stereotype of the deranged psychiatrist's child [see picture], but there's still time.

I met my wife, Tina, when she was studying architecture in Edinburgh. She now runs her own practice, and is a talented singer/songwriter. We have been together for nearly 20 years. As a couple, we waste very little life-energy bickering or misunderstanding each other. She is an extraordinary person.

How do we survive as a family with my psychoanalytic approach to life? If I was a chef, I'd taste nothing if I ruined every meal by analysing the sauce. Best just enjoy the food. The analysis is a background thing: I don't let it turn me into a spectator. The upside is that we have a vocabulary for our feelings and responses in relation to each other. We can explore/thrash out things quite well.

Psychoanalysts can become extraordinarily self-conscious and mannered. I insist on being messy me all over the place when I'm not being paid to be sensible.

What is my experience of God? This one is tricky. Any attempt to put things into words leads to distortion. I would say that "Love your neighbour as you love yourself" I have found to be a promise wrapped in a commandment.

Favourite Bible passage? Has to be the Prodigal Son. It's all there.

I pray for kindness.

Does being a Christian impact on my work? Probably not directly, but if there is a smudge of holiness in me, then it must come to bear upon what I do, because I try to deploy every part of my personality, intellect, and emotional inner world at one time or another. I need them to try and work out what is going on in a tricky emotional situation, and then change what I can and surrender to the rest.

I've been involved in clergy selection conferences for about 15 years. It's hard to assess someone's vocation and suitability for training. I try to help the archdeacons of the future by spotting the folk who will cause them sleepless nights in 15 years' time.

It's tough being clergy. I couldn't do it. Far too many leaky boundaries to patrol, and far too many seductive flesh-eating zombies hiding in the congregation.

Priests get thrown into other people's distress, and things can get muddled. I wrote The Pastoral Encounter for HarperCollins to help clergy look at a few key issues when dealing with other people and themselves. I also did Churches and How To Survive Them with Richard Holloway. I'm a post-Evangelical, I suppose, and he's, well, not; so there is an enjoyable undercurrent beneath the dialogue between a bishop and a shrink.

Over the past couple of decades I've done quite a bit of writing and broadcasting. I've had some books published - two children's books, two on psychotherapy - some poetry, stories for radio, and the usual expert-witness stuff on magazine shows. I'm working on some more fiction at the moment, and have recently sent off an interesting film idea to the BBC, which has got the initial thumbs-up; 2013 will be another busy year, I think.

My biggest regret? Life's too short.

If I'm remembered for anything, let it be for living an unfeasibly long time, with all my friends and family doing the same.

What has surprised me most? Just how much I go on missing my father, who died seven years ago. He set my moral compass, and nurtured my sense of self-worth, can-do, and wonder. I still haven't quite forgiven the sun for having the gall to rise the morning after he went.

Always the same thing makes me angry: the careless cruelty of selfish people. So that's all of us, then.

Holding and being held soothes me. So does the sound and feel of rain. Beautiful things like a Spitfire in flight, or a piece of decent writing make me cry.

Favourite writing? Novelist Rebecca West for The Fountain Overflows. She was a no-nonsense author with deep, deep, subtle insight. Anything by Donald Winnicott and Neville Symington for psychological theory. "Dover Beach" by Matthew Arnold: I still don't fully understand it, and I slightly hope I never do.

If I got locked in a church, I'd want it to be with my wife. No distractions. Be good, too, if she remembered her guitar and a decent claret. And possibly some hard ewe's-milk cheese, and a few crackers. . .

Dr Avery was talking to Terence Handley MacMath.

 

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