Gay Life, Straight Work

by Donald West

  A Failed Project in Lebanon

  Expecting a short period of sabbatical leave in the autumn of 1966, and having to plan something worthwhile to do, I welcomed a suggestion from Dr David Clark, head of Fulbourn, the local psychiatric hospital. He was a long-time acquaintance of Dr Manugian, Director of Asfouriyeh, a psychiatric hospital in Beirut, founded at the turn of the eighteenth century by a Quaker missionary and supported by contributions from Europe and America. It had developed into a major hospital for the region. The hospital property was currently owned by a London-based trust that appointed the senior staff. Jean Ferguson, a friend of mine, and one of David’s psychiatric social workers, was already on temporary secondment there. One section of the hospital, Webster House, was designated as a secure facility, treating drug addicts and mentally disordered offenders transferred from prison. My proposed task was to study the therapeutic system being provided for these offenders.

  Considerable delay occurred between receipt of encouraging letters from Dr Manugian and the receipt of final confirmation of arrangements for the visit. This should have aroused suspicion. Had I seen in advance reports by Dr Haikal, the psychiatrist in charge of Webster House, copies of which I acquired subsequently, I might have been discouraged. In the event, Dr Manugian received me most politely, but explained that Dr Haikal was not at the hospital at the moment, but was to arrive shortly, and I should wait for him. As days went by Dr Manugian continued to promise that Dr Haikal was coming and, in my presence, he had a telephone conversation in his native language, purportedly with Dr Haikal, to the same effect. Disillusionment set in when I discovered, through talking with other staff, that Dr Haikal had in fact been to the hospital several times without sending for me. I heard that these two doctors were on such bad terms that Dr Manugian had limited control of matters pertaining to Webster House. Chronic political unrest in Lebanon, between the substantial proportion of the population belonging to Christian sects and the various Muslim factions, was coming to a head. Power struggles were spilling over into professional organisations.

  From gossipy conversations with various staff, and by reading Dr Haikal’s reports, I gained some impression of the work at Webster House. It seemed that a majority of Lebanese addicts were men aged 30–35, usually from the poorest sections of the community and that the drugs involved were nearly always opiates, mostly heroin, vigorously peddled by traffickers. The legal system provided that arrested offenders seen in prison could be examined there, and cases considered suitable on grounds of addiction might be ordered a year of detention in Webster House, subject to review after six months, when they might be freed, if given a certificate of ‘guerison’ (cure). Despite these formal regulations, many cases served their detention time in prison, where treatment was minimal. Certificates of recovery after six months, whilst correctly noting absence of withdrawal symptoms and other physical problems, took no account of absence of psychological and social rehabilitation. The court decisions to accept these recommendations appeared based on criminal rather than medical history. Due to delays between arrest and examination in prison, and the paucity of information available to psychiatrists, adequate assessment was often impossible. Consequently, malingerers, drug traffickers and untreatable recidivists, keen to evade long prison sentences, were gaining admission to the hospital. Dr Haikal argued that, in view of these deficiencies, the recidivism rate of over 90% among discharged addicts was an unfair measure of the efficacy of therapy.

  A brief clandestine view inside Webster House was achieved when I was hustled through the entrance in the protective company of the forthright British matron, who could not be refused. The young addicts were kept as far as practicable apart from the psychotics, whom they were apt to bully. Homicidal psychotics were under sentences of indeterminate detention and could only be released on the unanimous recommendation of a panel of three doctors. In the absence of a system of release under supervision, positive recommendations were virtually non-existent, so these patients, with little prospect of regaining their liberty, were becoming an increasingly conspicuous group of much older men. Perimeter security was exercised by a separate police force supervising all entering or leaving, but they were supposed to come into the building only at the invitation of the medical staff. The strictness of application of the rules was dependent upon the leadership of the commander in charge. There had been a tradition of patients having unofficial outings with relatives; a change to a stricter commander led to much unrest.

  One harmless elderly schizophrenic woman, following release from the civil section of the hospital, had set fire to something in her home and been returned under judicial order to the secure unit. Now she was housed in isolation, watched constantly by an attendant, who received a bonus for officially dangerous work, an arrangement more to the benefit of the guards than to the public.

  An appeal to Dr Manugian to allow me to interview some English or French-speaking patients in Webster House was met with a bland but unconvincing assertion that there were no such cases. Immediately following my brief peek inside Webster House, patient unrest boiled over into a serious riot that put paid to any prospect of further observation. I concluded that it was not going to be possible to acquire beneficial lessons from the treatment of offender patients at Asfouriyeh. It is easy to be critical, but the well-trained psychiatrists working there, who were perfectly familiar with Anglo-American standards, were contending with situations far removed from my British experience. Aside from the ambiguities of an undeveloped mental health law for offender patients, the local culture was still antagonistic towards the mentally ill, families considering it a disgrace to have a member so affected. Sick women were kept secluded at home, while relatives would agitate for the committal to hospital of sick men, who were more difficult to control. Hence there was a great excess of males in the civil section of the hospital as well as among the offenders.

  I resigned myself to making what use I could of the excessive leisure time available. An instructive incident came about through friendly conversations with one of the Asfouriyeh nurses, a Palestinian who invited me to visit his home and meet his family. Having had no reason to concern myself with the problem of refugees, I was unprepared for this shocking experience. Following the Arab-Israeli conflict of 1948 there was an influx into Lebanon of Palestinians driven from their homes. The Christian dominated government was reluctant to allow them to assimilate, the unrealistic official attitude being that they should return as soon as the Israeli occupation was overcome. Meantime, they were shut away in refugee camps. Only those with useful specialist qualifications, such as this nurse, were allowed to go out to work. The family were crowded into a two-roomed structure in a shanty town within a fenced enclosure. Dreary signs of poverty and helplessness were everywhere. In the sandy space between the dwellings idle adults and children swarmed around, many of the men in warlike garb. The whitewashed wall inside the room where the family were living displayed a painted map of Palestine with a cross marking the site of their former home to which they hoped – against all odds – that one day they would return. With nothing open to them but dreams of fighting back, one could not imagine a more effective school for terrorism.

  The situation left a lasting impression. Years afterwards I wondered how many of these people and their children must have met with violent deaths. Following my visit, there was a further influx of refugees into Lebanon from the 1967 Arab-Israeli war. From 1975 to 1990 Lebanon was ravaged by civil wars, during which, in 1982, there were reports of massacres of occupants of the Palestinian refugee camps by militant Christian Marinites. Former refugees have since participated in the never-ending conflicts on Lebanon’s southern border with Israel.

  It was inevitable that I should come across and sample a steam bath in Beirut. Much homosexual activity was going on and I met an agreeable young man whom I invited back to my quarters, a detached villa in the hospital grounds. Unfortunately, on arriving at the entrance gate, and recognising the hospital, he took
fright and could not be persuaded to enter.

  Asfouriyeh is on the road from Beirut to Damascus. Jean lent me her car and a couple of times I was able to drive along the curling mountain road across the border. I had expected something more romantic, but my clearest recollection of Damascus is of the dusty bus station and car park that was my arrival point, busy and smelly with diesel trucks and other traffic. The journeys were marred by the habit of local drivers to harass foreign cars by squeezing them off onto the edge of the road. More leisurely and enjoyable attempts at tourism were when Jean had days off and we were able to visit together some well-known sites, notably the nearby ruins of Byblos, the impressive Roman ruins of Palmyra, hidden away in the Syrian desert, and the less impressive remnants of the celebrated cedars of Lebanon. I have to thank Jean for another interesting experience. Years later, my partner Pietro and I were able to roam around and take tea in the fascinating medieval residence of the man she married, who became Bishop of Ely.

  A Major Project: The Cambridge Study

  Studying researches on delinquency for the book on The Young Offender proved helpful when carrying out what was to be my major criminological research. The project came about through the intervention of a medical officer from a nearby Dept. of Education. He had been impressed by the American delinquency researches carried out by the Harvard lawyer Sheldon Glueck and his wife, Eleanor, a social worker. He wrote suggesting that similar work in England would be a suitable task for the Institute of Criminology. Radzinowicz asked me to see him and report back.

  Working in the Forties and Fifties in the Boston area, and influenced by psycho-analytic theories, the Gluecks studied the progress of young delinquents over a span of years and compared their family and social circumstances during childhood to those of their non-delinquent contemporaries. They concluded that the development of delinquent behaviour was largely determined by, and highly predictable from, a few key factors at pre-school age – notably the quality of maternal supervision and discipline and the cohesiveness of the family. Being interested in these ideas, I endorsed enthusiastically the proposal to study the backgrounds of a sample of normal youngsters and then to follow their progress over years to see if the predictability of delinquency would be confirmed and found to hold true in England.

  It was 1960, the first year of the Institute’s operations, and Radzinowicz wanted quick results. He poured scorn on the idea, pointing out that before any conclusion could be reached we should all be grey-haired. (How right he was!) Disappointed, I told the proposer that perhaps the Home Office might be interested. They must have been, for soon after Radzinowicz received an intimation from them that the proposal seemed a good idea. Since the Home Office was the chief financial supporter of the Institute’s research at the time, Radzinowicz changed his mind and left it to me to devise the project, decide on the sample and organise a research team.

  Apart from doubts whether the Gluecks’ findings would apply to the different circumstances in England, their claims were being criticised as exaggerated. They had used samples of known delinquents, which meant that judgements about their past, inevitably somewhat subjective, might be prejudiced. Moreover, they compared extremes, well-established delinquents, many of them graduates from detention centres, with youngsters free from any delinquency whatsoever.

  We set out to study a sample representative of the general population of children, with a normal distribution of the well and badly behaved, and to recruit them at age nine to ten, before appearances at juvenile courts began, and to follow their progress as long as possible. The aim was to collect information about their personal characteristics and family circumstances up to the age of ten and to see what features recorded then would prove most closely correlated with becoming delinquents. If we were to have personal contact with all of them, and also interview their parents, the sample size had to be limited. We restricted the research to boys, in order to obtain a reasonable proportion of delinquents, and instead of attempting national coverage, we recruited them from a neighbourhood of Camberwell in London that was considered typical of a stable, working-class urban environment. We obtained a sample of 411 boys that included all of the male pupils enrolled in the fourth year classes at six local state primary schools in proximity to the Cambridge University Settlement in Camberwell, where we were able to secure office accommodation.

  The project has involved several generations of research workers, continuing far beyond my retirement under the direction of Professor David Farrington. I will proffer a few recollections, mainly from the beginnings of the project, and venture some opinions about cohort studies, that have become an established branch of academic criminology. The enterprise can be said to have succeeded beyond all expectations. Interviews with the sample have been conducted at ages eight, ten, fourteen, sixteen, eighteen, twenty-one, twenty-five, thirty-two and finally at forty-eight, when 93% of the 394 still alive were successfully interviewed. Until they reached age fifty, the names of all 411, and also those of their parents and siblings, were repeatedly searched in criminal records for any convictions. Their scholastic and work careers, their social successes and failures and their involvements in anti-social activity have all been systematically recorded. The data have been used to assess the influence on criminality of early upbringing and parental family situations, and also the influence of subsequent ife events, such as marriage. Results have been presented in over 150 publications, including two convenient summaries that put the findings in the context of other researches and present day criminological theories(1).

  Initially, the research team consisted of two female psychiatric social workers, who visited the boys’ homes, a clinical psychologist who saw the boys at their schools, and a secretary, all resident in London, with me shuttling from Cambridge. Fortunately the Hampstead flat was still available, permitting regular contact with the research office and a continuance of private life in the big city. The prospects for pursuing the research to a conclusion, however, were precarious. Home Office grants were not guaranteed from one year to the next; they depended upon competing demands and upon the receipt of satisfactory progress reports. This meant that the researchers, other than me, and later David Farrington, were all employed on short-term contracts. The first hurdle was gaining access to the sample. The Dept. of Education insisted that the heads of each school should ask parental permission on our behalf. Since many families, and particularly the sort of families we were most interested in, were not necessarily on good terms with the teachers, this proved a non-starter. After further negotiations we were finally allowed to approach parents directly, when the tact and persuasiveness of our interviewers secured the co-operation of the great majority of families. Our psychologist was permitted to see the boys at their schools and administer tests and questionnaires to them all, on the understanding that personal questions about their homes and parents would be avoided. Most importantly, the Home Office allowed our secretary access to the Criminal Record office to search the records of the boys and their family members without prior consent from the individuals themselves. Their privacy has been well protected and nobody has been damaged by leakage of information confided to us, but with increased concern about ethics and privacy, researchers today would have difficulty securing permission to obtain and secure so much sensitive data. We were lucky to have colleagues in contact with persons working within the relevant authorities.

  We were all new to this kind of project and Radzinowicz was keen for us to justify our existence as soon as possible. This meant a minimum of pilot work on interviewing techniques and schedules. Topics to be covered had to be decided on the basis of what at the time was believed relevant. We were much influenced by what the Gluecks had considered important. The social workers disliked questionnaires and, although they had lists of topics to ask about, the interviews with parents were not tightly structured. The late Tony Gibson, our first psychologist, trained in what he considered much more objective methods, was critical of impressionistic i
nterviews and spent much time comparing, for example, the differing proportions of mothers considered ‘neglectful’ according to which interviewer questioned them. A similar difficulty emerged when classroom teachers were asked to rate pupils’ behaviours, some having stricter standards than others. Ratings were therefore ranked and those falling into the worst quarter of their school class or interviewer’s sample were contrasted with the remaining three quarters. As the research progressed the interviews became more structured, with the wording of questions predetermined, and some standardised questionnaires and tests were introduced. Pilot interviews were conducted to establish consistency of evaluation by different interviewers. We still made our comparisons, as far as possible, between the worst rated quarter and the rest of the sample on all the different assessments and combinations of assessments that were used.

  In the early stages of the research our interest centred on prediction. We were keen to find out how closely family background features and measures of childhood behaviour, evaluated before age ten, would relate to risk of acquiring a delinquency record as a juvenile (age ten to sixteen inclusive). Three background features found very relevant were (1) A parent (usually father) having had a criminal conviction. (2) Parenting of the boy rated unsatisfactory by social workers. (3) Reared in a low income family. Of those ranked in the worst quarter of the sample on each of these adversities, a third acquired a juvenile delinquency record, compared with a fifth among the sample as a whole, and only an eighth among those free from any of the three adversities. Another two adversity measures, coming from a large family and having a below average IQ, were found to have a similarly significant association with future delinquency. Having more than one adversity much increased the likelihood of delinquency. For instance, of 34 boys rated as having had poor parenting, and also having come from a low income family, over a half became juvenile delinquents. As many as 63 boys were assessed as having at least three of these five adversities and a half of them became juvenile delinquents compared with only 15% among the remainder of the sample.