Review: Suzanne O'Sullivan, It's All in Your Head

This is another book picked up by chance in Waterstone's and a most unusual one too. It's quite easy to find books which narrate the case histories of patients seen by private psychotherapists (Stephen Grosz's The Examined Life is a recent example, reviewed on this site 3 February 2014) or, in the case of Adam Phillips, by a former NHS child psychologist. But this book is by a consultant neurologist with a special interest in epilepsy who in the course of her work (both NHS and, I assume, private) encounters patients whose symptoms have no identifiable organic base and are thus, sooner or later, classified as psychological in origin.

The symptoms are major and disabling - seizures, convulsions, paralysis, blindness. They are symptoms which have led to ambulances being called, A and E working flat out, consultants being telephoned, provisional diagnoses and medication being prescribed - and to no avail. 

For the most part, they are symptoms which if not organically caused, would once have been assigned to the category of hysteria. Dr O'Sullivan devotes some pages to the history of hysteria within modern clinical medicine, starting with Charcot and Janet and continuing to Breuer and Freud. But - perhaps on editorial advice - she gives no bibliographic references at all, not even a Further Reading list. This is a pity since part of the interest of this book lies in the fact that it is written from the perspective of a neurologist with an orthodox medical training and wide experience of conventional clinical practice in Ireland and the UK. It thus gives an unusual insight into what hospital neurologists nowadays know and think about psychosomatic or psychogenic disorders.

But the book uses case histories rather than theoretical argument or research review to guide our understanding. One of the first things to strike me about these case histories was the prominent position of the patient's parents, partners and other carers. Of course, if you are confined to a wheelchair you are going to have carers. But the carers are often present in the kinds of unhelpful way which R D Laing and A Esterson flagged up many years ago now in Sanity, Madness and the Family: the carers present themselves as authoritative in regard to the medical history and current feelings of the patient. They also have strong views on what will count as an acceptable diagnosis. O'Sullivan does not really engage with the facts she extensively reports and the patient is always referred as an individual to a psychiatrist and never everyone involved to family or marital therapy.

She frequently makes the point that the psychogenic illnesses she encounters are found in people who often have no conscious awareness of being anxious, depressed or stressed and who indeed often enough proclaim themselves happy and worry-free. You could say, this is why they have ended up in A and E rather than in the armchair of a private psychotherapist. At one point she remarks, "Perhaps those who deny stress do so because they do not feel stress, having converted it to something else" (p 243) - that "something else" being a somatic symptom. But this is not an incidental "Perhaps" feature. It seems to be the heart of the matter - the patients she is seeing suffer from conversion disorders in which the body expresses (in a terrifying manner) what the conscious mind, the tongue cannot.

This is a very interesting, quite brave book. It is consistently humane, even towards the occasional malingerer who makes it all the way to the neurologist's telemetry suite - in the final chapter, there is a charming, warm portrait of just such a person. We know a lot about the world of those who can be articulate on the analyst's couch, much less about those whose body takes the brunt of their illness.

Essay: Portnoy's Complaint meets the Creative Writing Class

It was Carmen Callil who made me go out and buy a Philip Roth. When she resigned as a judge for the Man Booker International Prize, just awarded to Philip Roth, she complained that all his books were the same. Well, I thought, then I only have to read one.

I bought The Human Stain, on table display locally, and thereby plugged a gap in my reading. I had now read all of Philip Roth. I could see Carmen Callil's real issue. He's an all-American Male Writer. He's not doing polite fiction, he's doing a bar room brawl.

Unfortunately, I did enjoy the book, even when it punched me in the gut: there's a scene where, as part of his rehab, a traumatised Vietnam veteran - one of the principal characters - is taken to a Chinese restaurant to sit down and eat a meal. It's a long, drawn-out passage and reading it is like watching a horror movie. In a Creative Writing class you could use it as a model of craftsmanship.

I went out and bought another Roth, Portnoy's Complaint, a book I could have read at any time in the past forty years but hadn't.

In the second half of my University career, I drifted into teaching Creative Writing. There was a demand for it, people would pay (if you gave them an MA), and I could do it well enough. The basic formula is that you sit around and people read excerpts from their work in progress - or they pre-circulate it - and everyone joins in to comment. It was certainly easier than the foundations of linguistics.

The main source of anxiety in the Creative Writing class is that some (male) student will produce his equivalent of Portnoy's Complaint. And though I can sit and laugh heartily here at home, my toes would curl if someone did it (as they occasionally did) in a CW class. The atmosphere is just too polite, too politically correct and too feminine. At worst, it's Sunday School.

Maybe it was me. Maybe I didn't know how to make the setting into one which could accommodate masculine (or maybe male) rampage, masculine (or maybe male) tirade. Blogger can't accommodate it either, it seems - it refused to autosave the first draft of this Blog the moment I started to quote Roth Fucking and Cunting (I wouldn't even dare quote him Jewing).

But I don't think it was just me. Portnoy's Complaint could not come out of a nice CW class and that, I think, is probably Carmen Callil's problem with Roth. But if so, I think it is the CW class which has to go, not Roth or Roth's genre of writing.

Reblogged from www.trevorpatemanblog.com where it first appeared on 29 June 2011

Review: Andrew Morton, 17 Carnations: the Windsors, the Nazis and the Cover-Up

This is what you end up with if you place at the heart of your country’s constitution a struggling dysfunctional family, often enough just not up to the job or any job. There are plenty of occasions reading Andrew Morton’s book when I thought “Just like Prince Charles!” and “Just like Prince Harry”. The Windsors ( and their previous incarnation, the Saxe Coburg Gothas whose name they dropped in 1917 ) have only ever had much luck when their women have been in charge: Victoria, George VI’s wife Elizabeth Bowes-Lyon (the Queen Mother), Elizabeth II.

Unfortunately, this is not a good book. I find it hard to believe that the author read it cover to cover before signing it off:  two thirds of the way through, it is as if another (and inferior) writer takes over in Chapter 13 who then goes on to re-tell from a different perspective what has already been told in the first dozen chapters (and already more than once). So though I began reading with interest I ended up more than ready to put the book down.

It is not original research and in offering many quotations from a fair number of historians who have already written about Edward VIIIs sympathy for Hitler (and his own German aristocratic relatives who rallied to Hitler’s cause) it ends up without a clear verdict on the nature of his disloyalty to his country and his country’s various governments in the 1930s and 1940s. Morton has at least one excuse: though many important incriminating documents survive, others have surely been destroyed and more would have been if the House of Windsor and the Governments of the 1940s had had their way. (Just as nowadays, it is the Government which is fighting to keep Prince Charles' indiscreet political letters from becoming public)

The man who briefly became Edward VIII before abdicating to marry an American divorcee combined popular charisma with a deeply unpleasant private personality, his wife likewise. There are many examples in the book to make you think, “These people are complete shits”.

Like Prince Charles, Edward believed in an “active” monarchy which would not restrict itself to the constitutional duties of advising, encouraging and warning. But it’s unclear on what Edward felt his right to intervene to be based: he doesn’t appear to have studied much, read much or spent much time talking to anyone who wasn’t a crony or a crook – or a flatterer and spy. Perhaps then just Divine Right gave him the authority he assumed, after the Abdication, to conduct protracted freelance diplomacy with the Nazis and their allies.

Deeply self-centred and often childish, he had no notion of discretion and his careless talk in France in 1940 – where he had an active duty military posting - may have cost lives. On that Morton is reasonably decisive.That may have been one reason he was then posted to the Bahamas where he was made to sit out the war as Governor. Primarily, he was exiled from Europe to keep him a long way away from his Nazi chums.

The insecure George VI and the vindictive Queen Mary (George V's widow and Edward's mother) and Queen Elizabeth, later the Queen Mother ensured that after the war, there was no place for him in Britain. But in perpetuating the family feud as dysfunctional families are supposed to do, they may have done some good. Edward VIII got away with actions which in the case of lesser mortals might have led to war-time internment. He does not even appear to have been questioned under caution. After the war, he had little or no scope for any action. 

Review: Suki KIm, Without You, There is No Us

You couldn’t make it up. North Korea boasts one private university, the Pyongyang University of Science and Technology (PUST). It teaches  - in English and for free -  a couple of hundred male children of the North Korean elite, picked by the regime. The University is funded mainly by American Evangelical Christian groups and the teaching staff are mostly  Christian missionaries, who are however forbidden to proselytise. Go to Wikipedia to find out more about PUST (which you can do, unless you are in North Korea where Internet access is restricted to a very small group with usage monitored by guards).

Suki Kim, a Korean American born in Seoul, got herself a job at the University in 2011, shortly after it opened and at which time it was no more than a glorified English language school with its own new campus. She had her own agenda: not as a Christian, but as an investigative journalist and writer. This book is the product of teaching at PUST for two semesters. Her website contains a page defending the ethics of what she did.

This book is her strange diary of teaching in a strange land among strange teachers: the kind of fundamentalist teachers who won’t enter a Buddhist temple (page 211) or entertain the idea of letting students watch Harry Potter. (“filth” page 275).

Presumably, the North Korean authorities feel that they have something in common with American evangelical Christians and I guess they do: “mad” comes to mind quite frequently as you read this book. Both groups are intellectually isolated. Google to find out how many Americans believe that the sun goes round the earth or that human beings are the product of special creation.

North Korea is a country where over ninety percent of the population is kept hidden from outside eyes. They are impoverished, hungry,sick and afraid. They are at permanent risk of brutal punishment. They are –  Suki Kim uses the word – slaves. They do not appear in photographs.

What outsiders are allowed to see is a theatre – Potemkin churches (“Freedom of Religion”), Potemkin farms, Potemkin crowds – against a stage set of endless monuments to the Kim dynasty and endless socialist realist exhortations.

What Suki Kim encounters is a small group of elite students who know next to nothing about the world outside Pyongyang, but who are clever enough to know that they don’t know. They are naïve, sexually frustrated, and very very fearful. They operate exclusively in groups (though that is common enough among young men – think English football fans). They look alike and act alike. They are at least half mad.

It is difficult to see how North Korea can change. Except for the blanket of ideology which stifles everything, the relationship of the capital to the rest of the country is not so different to that found in mineral-rich African states, where the capital city’s wealth stands in total contrast to rural impoverishment. Except that North Korea has little by way of natural resources. The regime is propped up by the proceeds of crime, the proceeds of slave labour, foreign aid, and - as I now discover - Christian missionaries. There is no economy to speak of. What money there is goes into the military programme.

This is a troubling, very emotional (and probably flawed) book. It contains very little to comfort and a lot to disturb.

Review: Owen Jones, The Establishment

This is a straightforward Them (the 1%) and Us (the 99%) book. It's lucid, well-documented, compelling and sometimes - as in the chapter on the police - scary. Rather than concentrate on its many strengths, I will focus on my doubts.

(1) Trade Unions. It's true that the assault on Trade Union power, led initially by Mrs Thatcher and continued ever since, has helped produce a much more casualised, readily exploitable, and lower paid labour force than existed for many industries - but not all - in the 1960s and 70s. But that assault was possible because the old Trade Unions pissed off a lot of people and not just the bosses.

There has always been some tension between the goals of trade unions and the aims of socialist or social democratic political parties. The former are designed to advance the interests of sections of the labour force; the latter to advance the interests of all workers. Those aims can conflict. In the UK the miners, for example, got into the habit of expecting everyone to stand up for their pay claims - partly playing on other people's guilt when they didn't themselves do such dirty or dangerous work - until a point was reached (for me, in 1984) when people no longer wanted to jump when the miners said Jump! Oh, the miners might get sentimental about the nurses, but that's not the same as a proper discussion about who should be paid what and why. 

Look at France, which retains strong unions ever-ready to strike, and what you see, partly as a long-term consequence of unions pursuing sectional interests is, on the one hand, large groups (notably in the public sector) with very good terms and conditions of employment and, in stark contrast, two big, overlapping, excluded groups: young workers ( or would-be workers) and migrants from France's former colonies, mostly blacks and mostly Muslims. Whatever the rhetoric - and there's an awful lot of it in France - the effect of sectionalism has not been favourable either to equality or fraternity. 

(2) The Big State. Around the world, more egalitarian societies have bigger states, taking a larger share of GDP. This is a bit depressing because in the UK at least, the state has a poor record for efficiency and transparency. To this day, the National Audit Office churns out report after report documenting the waste of billions. Transfer activities have an inherent inefficiency because when you take from A to give to B, there are always administrative costs and, on top of that, there is often bungling. It would be nice if we could cut out the middleman.

Apparently, there is just one major state - Japan - which scores well on equality but has a relatively small state (for details, see Wilkinson and Pickett, The Spirit Level). 

How could you achieve both a lot of equality and a smaller state? It could be done, for example, by legislating high minimum wages and capping top wages. If that is combined with the use of inheritance tax as a major source of state revenues, you can dramatically level the playing field. The last thing I can get enthusiastic about are systems which make heavy use of indirect taxes (VAT) and subsidies such as tax credits and housing benefit. On the other hand, when you legislate for equality then if you are way out of line with market forces, you just end up with black markets, dual systems, evasion and so on. That is, unless people are satisfied with their situation - Owen Jones, for example, points out that nowhere else in Europe do bankers expect to be paid such huge amounts as those in London. And in Germany, at least,corporate greed seems much less common - big companies are kept in the family, not asset stripped and bankrupted by their bosses. So there are cultural issues - and I suspect they include such things as the culture of stag parties and men-only football (In Germany at the time of the World Cup, I was amazed to find the streets full of painted, flag-waving but mixed-sex and sober groups).

(3) Profit. Owen Jones spends a lot of time denouncing the selling off and outsourcing of public services for private profit. Leave aside that there exists some support for this because people got fed up with crap public services. Concentrate on the issue of Profit.

Suppose it cost the public sector £150 to provide some identifiable chunk of a service - like issuing a TV licence or producing a chest X ray. Now suppose a private firm comes along and offers to do it for £100 plus a whacking £25 profit. It's still better value for money than the public service. Why not let them have their profit?

Since there may be important reasons to keep a service public, the first response to this situation should be to ask why the public service is more expensive and whether it can be made more competitive. Frequently, it can indeed be made more competitive - and Owen Jones is quite right to point to the purely ideological commitment to private provision which characterises our recent governments and which led, for example, to the selling off of the one public service rail franchise (the East Coast mainline) which just happened to be more efficient and more profitable than any of the heavily subsided private sector rail rackets. 

To make Profit the enemy is a dangerous oversimplication (as in "People not Profit"). People can benefit from Profit - but not from ideologies of Profit which is what we are currently offered.

Review: William Waldegrave, A Different Kind of Weather

I do not normally buy politicians' Memoirs - nor do many people, it seems, since most Memoirs end up fairly rapidly remaindered. The cover and the title of this book are economical with the fact that it's a politician's Memoir. But I was not misled - I bought the book because I knew William Waldegrave a bit in the 1960s, through the Oxford Union, and liked him. But I did hesitate - I guessed that the book might make me think about things I would rather not think too much about. In this I was right.

Life isn't fair. I read Waldegrave's book immediately after re-reading Kazuo Ishiguro's The Remains of the Day, as fine a book now as when I first read it on publication in 1989. It's a wonderful book in part because it deals with things we all have to face - or find elaborate ways of evading: life not turning out the way we hoped or imagined, realisation of our own past mistakes as a cause of present unhappiness, life's unfairness striking us when we least expected or deserved it.

In the way it tries to engage with those things, Waldegrave's book is rather brave. The author is still an active paid-up member of the Establishment: member of the Privy Council and the House of Lords, Fellow of All Souls, Provost of Eton ... and he has a family and many friends and colleagues in public life who will read his book. But he tries to focus on aspects of a public career which would often enough be kept off the page. True, there are silences - you can't have the Provost of Eton going on too much about youthful sex, drugs and rock 'n'roll. And he is quiet about God and the Queen - the latter, not because of Doubts, but because his family has long been closely connected to the Windsors. As President of the Oxford Union in 1968, Waldegrave was well-placed to achieve the coup of bringing The Queen to a Union debate: there is a photo of the occasion in the book. I was one of the debaters, though perhaps in case I made Socialist trouble, I was put on in the second half, by which time Her Majesty would have left for home:

Click on Image to Enlarge

William Waldegrave was born in 1946, into a loving family which just happened to belong to that (small?) part of the English landed aristocracy which goes back centuries, is connected to everyone who matters, values culture and education, and has a very long tradition of public service. Life's unfairness: the unmerited advantage of a dozen silver spoons,even if of a now-obsolete minting:

Noblesse oblige is ridiculed now; but in the society we have created, which is even less equal than that of my childhood in terms of the distribution of wealth, no slogan exists to shame the rich into any semblance of solidarity with the poor (page 43)

So much for the "Big Society" of posh boys who don't know the price of a pint of milk. (Lord Waldegrave surely does know; his farms sell it).

There are other moments when Waldegrave rounds on something you would not expect:

Sentimentality about how the ultimate instruments of state power - soldiers, police - act in reality is a dangerous thing (page 84)

- this after being knocked unconscious by an American cop. And again, in relation to the episode which hit him most with life's unfairness:

It is wrong to commit the state to the support of the arms trade. It is wrong that the Ministry of Defence is a promotional arm of British Aerospace and other arms manufacturers, and that the Department of Trade backs up MoD in a perpetual joint campaign to promote the export of weapons (page 246)

Mr Blair? Mr Cameron?

Elsewhere, there is some partiality - he blusters about the sleaze and incompetence of the Labour Party, as if they invented the selling of peerages and the family silver (the latter Harold Macmillan's phrase for state assets -  Waldegrave admired Macmillan but worked for Thatcher). Though there are plaudits for the Civil Service, there is never a mention of the National Audit Office which has spent decades documenting the waste of public money by governments of both colours.

He blusters about Communism, not that what he says is untrue but that it feels a bit forced. And it made me recall a fine example of the freedom of action which comes with being patrician and not merely posh.

In the summer of 1968, I stood as the left wing candidate for the Presidency of the Oxford Union, opposing the liberal-with-a-small-c Ian Glick. We debated the motion, "That the Politics of Karl Marx should be consigned to Highgate Cemetery". The voting after the debate was a dead heat, leaving Waldegrave - the then President and also a recent President of the Oxford University Conservative Association- with the casting vote. He plumped for Marx, which I thought generous of him. Of course, there was still the actual ballot for President to come and I lost that.

I never regretted losing. Though I had been five times an elected member of the Standing Committee of the Union my candidature was half-hearted - I didn't canvas - and I wouldn't have done a good job. It was a Prize I was relieved to miss out on.

As the youngest of seven children, Waldegrave had the inevitable experience of always trying to catch up with older siblings. Why can't I win the prizes? is almost a smallest child's lament. His precociousness helped him to do so, both at Eton and later. He got a Congratulatory First from Oxford -  the Examiners wrote you a brief letter of congratulation, something they did for the three or four with the best marks out of the hundreds of candidates; he won University academic prizes. I did both of those things too, but as an only child escaping an awful background.

His party political career spanned the years 1979 - 1997; I settled into a University post at Sussex for exactly the same period. He was turfed out by the electors of Bristol and - after the harrowing experience of the Arms for Iraq affair, which sabotaged his career and has clearly deeply troubled him - decided to change course. Dissatisfied with university life, and knocked back by a bad divorce, I took early retirement at the earliest possible date, my 50th birthday.

My sense of him is that though he desperately wanted to climb to the top of the greasy pole of politics, his character was wrong for it. I have no sense of a killer instinct, of ruthlessness, of the kind of roughness which, say, Norman Tebbit shows here (page 203). There is charisma but not machismo. He's a decent, kind and thoughtful person who would - as he himself says - like to find a compromise if one can be found. Unlike Ted Heath or, say, David Miliband,  he isn't a bad loser. This book is an honest exploration, an unusual exploration, trying to make sense of the kind of man he was and is and ending up finding the answer in T S Eliot -  it's the Shadow falling between thought and deed (the quote is at page 267)

Last word to Kazuo Ishiguro: his lead character - Lord Darlington's butler, Stevens - speaking as the lights go on at Weymouth Pier:

...for a great many people, the evening is the most enjoyable part of the day. Perhaps, then, there is something to [ my companion's] advice that I should cease looking back so much, that I should adopt a more positive outlook and try to make the best of what remains of my day. After all, what can we gain in forever looking back and blaming ourselves if our lives have not turned out quite as we might have wished?

Review: Jean Rhys, Voyage in the Dark

Twenty or thirty years ago in England, the Arts Council put up a prize for a literary work written under the influence of drugs. It was rather spoilt by people claiming "Aspirin". Anyway, that occurred to me when I read (page vii of the Introduction) that this novel was written in 1933 on "two bottles of wine per day" which is quite a lot even for the hardened drinker Jean Rhys had become - she was in her early forties when she wrote this book.

You can see how the alcohol may have been effective. It's very hard to find good examples of Expressionism in literature, whereas in art it's very easy to compare and contrast Impressionist and Expressionist works. But this novel is an expressionist work, using (for example) colour imagery like splashes of colour and deploying dialogue in strong and bold strokes. Almost inevitably, it's short (152 pages) - expressionism is not about fine details.

And the alcohol was surely indispensable in overcoming fear of the censor and - perhaps more important - self-censorship. It cannot have been easy to write in 1930s England and in the first person about having sex for money or having an abortion when it was illegal. 

The work still reads as very fresh - one might say, vibrant. It's an impressive novel. 

Jean Rhys published several works in the 1920s and 1930s, none of them really successful. Then she disappeared from English literary consciousness until at the age of 76 she had great success with Wide Sargasso Sea (1966). Apparently, there were people who were surprised by the novel because they thought she was dead - something which I suppose was possible in the days before Google and probably reflects the fact that she did not attend London literary parties but instead was "living reclusively in Cornwall", which is no way for a living novelist to behave.