by Ruth Skrine
But I still feel strongly about the subject. One of my clinic secretaries sent an appointment to a referred patient addressing her as Susan although the referral letter had called her Miss Blank. I was furious, and not a bit surprised when she did not arrive to see me. I learned from the letter that she was an unmarried teacher in her forties who had never been able to have sex. Of all people to patronise in that way!
After a couple of years Elizabeth retired and I took over her parttime lectureship. When she held the post it was called ‘lectureship in family planning’. I insisting on adding ‘and psychosexual medicine’ to try and raise the profile of the work. The job included a psychosexual clinic in gynaecology outpatients. By this time more men were being referred to me, which was very awkward as the electronic system of registration did not include ‘Mr’. A man often had to suffer the double embarrassment of being the only male in the waiting room and of being called over the Tannoy as ‘Ms’. I soon insisted that I would fetch each patient myself, whatever their sex.
I went on to lead several groups in various parts of the country, including one of obstetric and gynaecological physiotherapists. Despite the fact that their role requires them to give a lot of advice they were responsive to the idea that they could learn to listen in the consultation. Many of their patients were postnatal, with bladder and pelvic floor problems. The idea of ‘de-briefing’ is useful after childbirth. One definition of the word is ‘to relive an experience with someone else to make sense of it’. Feelings about the labour and delivery may take a few weeks to develop and the physiotherapist is ideally placed to listen to the woman’s story. I was sad to hear recently that no training in this aspect of their work has been included in their curriculum.
My life had become over-full and the time had come to give up my general practice work once again. I never regretted my short foray back into what I still thought of as the ‘real’ medical world, for it gave me more legitimacy to lead groups where an increasing number of the trainees were combining their family planning and psychosexual work with general practice or hospital medicine. These doctors were learning to integrate their psychosexual work into their healing role. However, I can’t help wondering if the deep understanding of emotional problems, unearthed by the detailed work of those who remained focused in family planning and psychosexual medicine, would be possible in today’s management-driven NHS.
16
Taking the Reins
After my father’s funeral Arthur and Sylvia went home. I stayed on for several days. During that strange interlude I became the adult to my mother for the first and only time in my life. I was the one to suggest we should take my father’s blankets to be cleaned, I chose what we would eat, and opened and listed the condolence letters for her to answer later. This position of power was surprisingly satisfying. My mother had always been the boss of the household, and of our lives, with no chink in her efficiency that would allow her children to provide genuine help. Now, in her grief, my mother truly relied on me and her need made me stronger. But my own grief demanded some outlet. Using my dog Bess as an excuse for a walk, I took an hour off every afternoon. Striding down gypsy lane and across the fields where we had walked so often as children I wept, not just for the loss of my father but for my departed childhood. The pond with the bullrushes at the end of the second field remained as I remembered it. The pill-box left from the war still smelt of stale urine. The path went over a tributary of the river Avon and down the side of the Nestlé factory as it always had done. I encouraged my tears, for they relieved the ache inside, but it was easy to stop them at will, in time to allow my eyes to recover before facing my mother again.
One day our friends Dilla and Alan Roberton, with whom we had spent holidays in Cornwall, arrived to take me out to a pub lunch. During that meal I learned something of the needs of the carer. Until then every fibre of my body had been concentrated on helping my mother survive, hour by hour. The warmth of their concern and the opportunity to talk about my own grief gave me the strength to go on.
After about ten days my mother seized back the reins of her life and I went home to Ralph. It was not long before she threw herself into converting the surgeries at Green Gables into a flat where she had a selection of different tenants. Then she built a smaller house in the grounds. A pleasant couple bought our family home, but they eventually sold it to a developer, who divided it into four flats and built seven houses in our lovely garden.
For me, the moment of parting from the house I loved so much came when all the furniture had been removed. I was standing at the nursery window looking out at the empty swimming pool with its cracked walls. I remembered the soggy leaves that always lurked at the bottom, full of worms, making me afraid to put my feet down. (My parents didn’t acquire a vacuum pump till many years after I had left home.) As I stood there, a single sob shook my body. One of Daisy’s nieces, who still helped in the house, was by my side. She laid a hand on my shoulder but said nothing. There was nothing to say.
My mother had always enjoyed planning houses and insisted on having the new house designed round her favourite furniture. This included her Globe Wernicke bookcases, bed, oak desk, and her ‘byme’, a small mahogany piece with shelves, a drawer and cupboard opening on both sides and made to stand between two beds. The resultant house was a plain building, light but utilitarian. Her architect, who had wanted an elegant house with windows in the shape of cabin portholes, lost every battle.
During my mother’s time in that house, my father’s cousin Sylvia Guthrie, who had been such a stalwart support when my father died, became very frail. I had always been in awe of her. Her husband had died early in her life but despite being a single woman she had been allowed to adopt two children. The rules were not so rigid in those days and the fact that she was a respected paediatrician in Manchester might have helped. My parents had chosen her as one of my Godmothers. After taking Arthur to be christened my mother had felt physically sick, so when it was my turn she had delegated the task to Sylvia. Biz was never christened and I often wondered if she felt a bit deprived.
It was not until Sylvia was fading in body and mind, when I visited her in her home, that I appreciated the person she was. I found her sitting up in bed reading one of Enid Blyton’s ‘Famous Five’ adventures. She had been something of a legend in the paediatric world and the humility with which she accepted that she could no longer keep up with the latest medical advances, yet had found a book she could still read and enjoy, was impressive. She told me she had been close to Michael Balint in her youth but to my great disappointment was not willing or able to elaborate on one of the most important gurus in my life.
On moving back to Bath in 1980 I had found the local accent very evocative. My gardener and many of the girls who served in the shops spoke in Daisy’s voice, carrying me back to my earliest memories. Travelling to London, on what used to be the Great Western Railway, the first stop was Chippenham. For years I looked out of the window on every journey, searching the entrance where my father would stand, hat on his head and gloves in his hand, waiting for me to arrive home from school or university. He was always sent to fetch us, for my mother hated meetings and partings as much as I do.
During the last years of her life Daisy continued to live with another of her nieces in Chippenham. I only saw her occasionally, though she was an integral part of the person I am, present in the deeper recesses of my mind and my memory. Eventually she became very frail and was moved into a care home. The day before she died I took my mother to visit her. We were shocked to find her semi-conscious, but dressed and sitting outside. Protocol demanded that old people should be mobilised at all cost; but we were sad she had not been allowed to lie peacefully in her bed for her last few hours. My mother was upset that Daisy was dying first. In her will she had left all her tweed coats to this person who had given the most loyal service to the whole family over so many years. What would she do with the coats now?
Ever since Daisy first arrived at G
reen Gables, and I had peeped at her round the banisters, there had been a love–hate relationship between the two women. My mother was often irritated by her, especially when she insisted on continuing the story she was telling to the bitter end, never deterred by the interruptions that would have silenced others. But she was fond of her and was totally reliant on her practical help during the war. Daisy admired her employer’s intelligence and dedication to her work. Neither woman would have admitted how dependent they were on the other.
Needless to say, my mother would not consider going to her funeral. I had to represent the family, at the same crematorium where we had taken my father. In sharp contrast to his minimalist ceremony, Daisy’s service was well attended. I managed to get a seat by the wide window where my mind could escape over the rolling Somerset hills. All such sorrow-filled places should have an expansive vista. Despite my atheism – not as rabid as my mother’s for I am not anti-church, just not able to believe in an ‘out-there’ God – my favourite devotional line, based on the 121st psalm and set to music by Mendelssohn, is ‘Lift thine eyes to the mountains whence cometh help’. The hills, together with the intervening valleys and their rivers, hold for me that sense of mystery that others find in religious belief.
That day of Daisy’s funeral I again witnessed the tradition of placing the flowers from the top of the coffin on the ground in the courtyard, in the shape of a body. Her pile lay as one of a row with those of others who had been cremated during the day. The custom was for the mourners to linger, reading the messages of condolence while talking, at times with some animation. When Arthur and I had scuttled away from my father’s dispatch there had been no such niceties, for we had no flowers and no mourners other than ourselves.
As I stood awkwardly among Daisy’s friends and relations a middle-aged man approached me. ‘I think you are Ruth, aren’t you? I remember your house and parents so well.’ He was one of Daisy’s many cousins and told me the following story with glee. Remembering seemed to give him as much pleasure and amusement as listening gave me.
‘During the war, when I was about seven, I was walking up your surgery path. You remember, it was a long path used by your father’s patients to get to the surgery entrance. We always went that way when we visited Daisy.’
I nodded, enjoying his memory of the path that I had used so often on the obligatory afternoon walk as a child.
‘I had a friend with me, young Jack, he’s dead now, rode his motorbike into a wall. As we were going up the slope, kicking the leaves, he saw something at the side of the path. It was like a round tube. We knew it must be an unexploded bomb.’ He paused for effect. In the solemn surroundings I had to suppress a giggle.
‘We looked at it from all angles, then prodded it with a stick. It didn’t move. Should we go on and tell Mrs Hickson? Or just run home? In the end we decided the right thing to do was to take it to the police station. I had a piece of string in my pocket so we tied it to the end of a stick to keep it as far away as possible in case it exploded.’
The vision of these two small boys, solemnly walking through Chippenham High Street, arms outstretched with what was probably some sort of empty cartridge case tied at the end of a stick, was a good story to take back to my mother.
By the time Daisy died my mother had moved into the rooms she had added to the back of our house in Bath. It had been built in the late 1950s of imitation Bath stone and is a plain rectangle with two projections on the back. The cupboard under the stairs has been extended to make a study in which I still write at my computer with a view of the garden, enclosed on two sides by an ancient wall. I was told that it had been part of an orchard belonging to an old monastery. In the corner where the two walls join, a shed contains a small stone grate. Half the floor of the shed is raised a few inches above the rest. Could it have been a bakery, or was a fire used to heat one of the walls, which shows the remains of coping-stones and whitewash, suggesting greenhouses? The ground is full of broken glass and clinker. When we first viewed the house its simple style combined with the site’s long history made it irresistible.
The other addition at the back was a large playroom. With some trepidation we had invited my mother to join us. She turned the playroom into her living room and built on a bedroom with a kitchen and bathroom beyond, creating a ‘granny annexe’. She applied the same principle of building it round her furniture. In her eighties she continued to be in charge of her own affairs. But she was living in my house and I had a growing sense of responsibility for her wellbeing. She had given up her car and although she could, for several years, get to the town on the bus, I drove her to visit friends and family who lived further away. From the passenger seat in my car she could see the rev counter, hovering between 30 and 40, which she mistook for the speedometer. I never enlightened her for she would have been horrified by my speed. Adjusting to the faster speed of all traffic was as difficult for her as getting used to the rising cost of everything as the years passed.
My mother matured with age, like a good wine, becoming less tart. To my surprise we were able to live together in peace. Sometimes I could even share some of my inner feelings without fear of being shattered by her temper in the way I had been as a child. On one calm day in June, when lupins and delphiniums were flowering against the backdrop of grey stone, I told her that the garden felt like a space where I could face whatever life threw at me. So far that has proved to be true – though I have not been required to suffer the devastation of untimely death or serious illness among my younger loved ones. The loss of a child or grandchild must be the ultimate horror.
During that time, when my mother was living with us, I edited my first psychosexual book. For several years the proceedings of the IPM leaders’ workshop were recorded and transcribed. I was no longer editing the family planning journal and I missed the task of trying to sort ideas. I began to pick out themes and to choose extracts as examples. In those days I worked with a pair of scissors, cutting out relevant pieces, stapling them onto plain paper and then photocopying them at the local paper shop. After a few months I sent a sample to Tom Main, fearful of the scathing comments I expected. His reply included the following: ‘. . . I had no enthusiasm for the idea when you first mooted it. . . but your headings make the discussions punchy and even exciting reading. . . if the fumbling is plain and the occasional errors or superficialities also plain these accounts have one virtue – They have an authenticity, unpolished and even crude, that makes them a model of reportage.’
His letter lives in that envelope marked ‘Some of my most precious things’. This package contains a number of other messages of appreciation, including a postcard of a stylised cat and kitten with the words:
Dear Mum
One kitten safely weaned! Thank you for a wonderful wedding.
Lot and lots of love
Helen
Although I do not often take out these small tokens I still value them. The need for appreciation never dies.
I discussed the edited transcripts with Jimmy Matthews, Ralph’s longstanding friend, who worked as a small-time publisher producing a directory of legal businesses. He became intrigued and we decide to continue the project that eventually became the book Psychosexual Training and the Doctor/Patient Relationship.
The text was divided into three main sections: the individual doctor and psychosexual training, the group and psychosexual work, the leader and the group in psychosexual training. To my great delight Marshall Marinker agreed to write the forward to the book. He described the three levels in the following terms. ‘In the distance we may catch a glimpse of a man and a woman locked in some personal unhappiness. . . Nearer and less muffled we hear the voices of doctors talking in their training seminars. . . Closer to hand is the Workshop where the leaders meet to discuss their leadership of these seminars. . .’
I have been surprised at how much I learned about group behaviour and the technique of helping the group to work. Many years later I was on a course at Schumacher Colle
ge in Devon, sited in the grounds of Dartington Hall, where they run courses relating to the environment and sustainable living. All sorts of different people attend, including those from abroad and businessmen who want to conduct their affairs in a more ethical way.
The particular course I joined lasted for three weeks. The experience was not a happy one for me. The emphasis on a holistic approach to life’s problems was set in opposition to ‘relativism’ where things were divided into small pieces in order to study them. The members of the group seemed to equate that word with scientific method, in which I believe with passion. I became the token ‘bad’ scientist, castigated for not knowing all the details of the sheep dip that poisoned farmers back in the 1970s. However, towards the end of the time we were broken into smaller groups to work on some project. Our discussion was becoming heated and going nowhere when one member left the room. The others immediately started attacking her. We had no leader but without thinking I suggested we should wait until she returned and try to find a way of airing these views in her presence. When we did, she was able to put her points more clearly and we produced a result of sorts.
I experienced a very badly led group on a weekend course at the Tavistock Clinic, where I had expected them to be experts. My small group had only one man. When the discussion turned to sexual abuse he was attacked and, not surprisingly, became defensively aggressive. Tom was not in favour of making group interpretations and always took the discussion back to the doctor and the patient, the work task. Perhaps the trouble with the Tavistock group was that we did not have a well-focused task – I don’t even remember what it was.