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
I see folk with a
wide variety of difficulties, from traumatised children,
through psychotic teenagers, to grown-ups stuck in neurotic
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.
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
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
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.
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.
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
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.
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.
passage? Has to be the Prodigal Son. It's all there.
I pray for
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
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
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
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.
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.
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.
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.