Guest Post: Sheila Hamilton – Response from The Cassel Hospital

I’d just like to share a few thoughts about this letter from Dr Skogstad, who is the consultant psychiatrist at the Cassel Hospital. (NB. He wasn’t the man in charge when I was there all those years ago; I have never met Dr Skogstad.)

 One of my feelings when I read and then re-read this letter was: this isn’t really a proper response to what I have written. Another feeling was: the tone is ostensibly polite but actually rather patronizing.

The most troubling aspect of it is: there is no acknowledgement that what I experienced at home was abuse. This is where I get the impression that the Cassel (and by extension, a lot of psychoanalytical psychotherapy) is actually lagging behind societal attitudes. I haven’t shown this letter to anyone except Melissa and the readers of this blog but my hunch would be, most people nowadays would recognize what I describe as abusive.

Linked up with this is the doctor’s failure to recognize that health professionals themselves can contribute to someone’s difficulties. By labelling very distressed teenagers in his care as having “personality disorder” while not giving that description to the parents who have abused them, he is basically saying that responses to abuse such as depression, anxiety, low self-esteem are pathological (i.e. abnormal) but that abuse itself is not pathological or abnormal. He is still operating a hospital where parents of teenagers are given a forum, as they were in my day, a forum that the more disturbed parents used in order to justify themselves and to manipulate the hospital staff. In short, the focus is still on Keeping the Family Together. (A family where the teenagers are this distressed, have attempted suicide often more than once, etc. is a family that has already fallen apart. If it was ever, in any real sense, “together”.)

His suggestion that the term “personality disorder” is not denigratory or pejorative in any way also marks this man  and his hospital as out of touch. He should speak to a few more GPs if he thinks it’s seen as just another diagnostic term, and while he’s at it he should check what social workers, probation officers, the police think when they hear the term. The way the term is generally used it is taken to mean “untreatable” and, in many cases, “not to be trusted” and also “violent.” I don’t care for the insinuation in this part of the letter that I have somehow got this wrong: I have known plenty of people who are burdened with this often very unhelpful label. (And why is it unhelpful? Crucially, because it locates someone’s difficulties within them, as if that person is somehow fatally flawed; it pays no heed to the external factors involved. And abuse is a very important external factor.)

Freud famously decided that all the accounts of abuse he was hearing couldn’t possibly be true, that they were fantasies.  It seems that some of his heirs are still swayed by him.

  I have decided not to respond to the doctor’s letter personally.

*****

23rd January 2013

 Dear Ms Hamilton,

Thank you for your letter to my secretary and my sincere apologies again for responding only so late and only after your prompting. It seems that the Cassel has made a lasting impression on you, as you are thinking about it and making contact with us after such a long time. I hope that your time here helped you and gave you capacities and strengths that you could use in your life since. I also hope the reason you are thinking so much of the Cassel again now is a good one rather than another particularly difficult period in your life.

Since the early 1980s, when you were here, there have been numerous changes to the Cassel to respond to our research and to adapt to changes in the NHS and its increasingly harsher financial realities. However, the hospital is still there to help people with severe emotional difficulties and has retained many of its old principles. We are now much smaller than when you were here, but we do still treat adolescents, as long as they are over 16, together with (mostly young) adults. Structures have also changed and so we don’t have the particular meeting anymore that you describe, but we do regular family work with adolescents or young adults as part of their treatment and sometimes offer forums for parents or carers.

Like you describe about yourself, all our patients had a troubled and often very traumatic upbringing, which has formed them and has often made it difficult for them to get on with themselves and their own lives. When we call what our patients suffer from “personality disorder”, we are not using this in any denigrating way, as it is sometimes perceived and you seem to hear it. For me and my colleagues, it is a way of describing as a short hand deep rooted emotional difficulties that need understanding and appropriate treatment, usually through psychotherapy and other support. In fact, the term has in recent years also helped to instigate developments in different parts of the country to establish services for such people.

Thank you for your good wishes to the Cassel.

 With best wishes,

                          Dr. W. Skogstad

14 thoughts on “Guest Post: Sheila Hamilton – Response from The Cassel Hospital

  1. You are quite right; this does not respond to your letter at all. I particularly don’t get this:

    ‘In fact, the term has in recent years also helped to instigate developments in different parts of the country to establish services for such people.’

    What? The ‘name’ for something has helped developments? Not what it is, but the name of what it is? A name they gave to it? And therefore, thus and henceforth: it is correct? *befuddlement*

    I do not like ‘and you seem to hear it.’ That made me cross. I also do not like this:

    ‘Like you describe about yourself, all our patients had a troubled and often very traumatic upbringing, which has formed them and has often made it difficult for them to get on with themselves and their own lives.’

    It sounds like the upbringing happened to these children, as if by magic and not because of other people. This phrasing also implies that the upbringing has formed the child and the child cannot ‘get on with themselves and their own lives,’ so therefore this child is the problem – not what happened to the child, but the child his/herself. Ie. “these events have happened, so why haven’t you coped with them? It is your problem, and no one else’s.” It makes me rather angry.

    Thank you for sharing your experience of Cassel and the response that they sent to you. It’s been very illuminating. Sending lots of love. x

  2. Thanks, Jen for reading and sharing your thoughts. This letter made me angry too, and frustrated on Sheila’s behalf. It felt almost as though he were replying to another letter entirely at times! It was very patronizing. But I have to say, it’s more than a great many psychiatrists would bother to write, such is the arrogance of many of those that I’ve met. This is arrogance, but with a condescending politeness, as though Sheila should be very grateful that she came to the Cassel, with all her inherent problems and inner traumas. Why didn’t he say, I’m sorry you were abused, and I’m sorry we did nothing at all about it. I agree this has been very illuminating. I can imagine this doctor sitting back after writing this letter quite pleased with it, with himself. I think it’s very sad.

  3. Thank you Jen and Melissa.

    Jen, yes, he talks of “upbringing” as if it just somehow happens, just like that, a random event. Someone’s upbringing is never a random event.

    I will add that his response came a full 2 and a half months after I wrote the original letter. I know he’s a busy man etc (most of us are busy people!) but even so. . .And after I queried the non-answer, he actually got his secretary to email me with an assurance that he would write soon. Which implied, I felt, that he was giving some thought to the points I raised.

  4. I didn’t express myself very clearly above. What I meant to say was: I got the impression that the doctor was giving my letter some thought. When I actually received his letter, therefore, I was somewhat taken aback by the paucity of its contents.

    Have noticed before,, by the way, how doctors are always very busy. .. is if no-one else is. :)

  5. Thank you for this thoughtful and illuminating guest post, Sheila – and thank you to Melissa, too. I would agree that “the Cassel (and by extension, a lot of psychoanalytical psychotherapy) is actually lagging behind societal attitudes.” I was there as a patient for 11 months in the late 1970s, and while it is true that, as Dr Skogstad says, the hospital gave me much, I always felt that being with the other patients – including many my own age, in similar situations – was what helped me most. Individual sessions with another doctor (weekly or twice-weekly, I think) were the opposite of helpful, since I found him quite aggressive in his manner and intimidating. In my first session, he remarked that people often seemed to blame their parents for all their troubles; after that I felt my family was out of bounds as a topic of discussion, which looking back was really a pity, a huge missed opportunity to explore why I’d had the breakdown. In fact it’s only now, in my fifties, that I can say I really understand why! So thanks again – I’d love to see more discussions of this sort.

    • Frances, I missed you at the Cassel by a few years! Yes, I quite agree, this kind of psychotherapeutic thinking is lagging behind societal attitudes. What a bizarre thing for your shrink to say. . .even Freud, troubling in so many ways, acknowledged that family dynamics played a huge part in people’s troubles. . .Some of the praxis at the Cassel was cruel. Nurses saying to me on more than one occasion, for example, “You are a voluntary patient, you can leave whenever you want.” And where would I have gone exactly? 16/17 years old, no money, not well? Home?
      One of the things that I still feel angry about is that horrendous weekly parents’ meeting. My dad wanted any platform he could get to justify himself, twist the truth, put on a plausible face. . .and they gave it to him! I am disappointed that Dr Skogstad glided right over this in his response.
      Every now and then the Cassel faces closure. They campaign, do their best to get former patients to write to MPs etc on their behalf, extolling the place’s virtues. As long as they are still reluctant to use the word “abuse” (and what would it have cost the doctor to have acknowldged my experiences in his letter?) I won’t be part of any of those campaigns.
      It’s lovely to hear from you, Frances. best wishes

      • Hello Sheila! That awful parents’ meeting – a friend of mine used to tell me about it – how lucky i was to classify as ‘adult’ (by one month!). I also felt the Cassel’s ‘keep the family together’ policies accounted at least partly for the sad atmosphere on Ross – women who would really have benefited from a break from their husbands were denied this. It is so good to hear from you too. I agree that Dr Skogstad’s letter is a totally inadequate response!

      • Ah yes, the families. I remember them. And what strikes me now as an overwhelming lack of privacy: couples being expected to discuss their misunderstandings in a group of maybe 30 people including teenagers. And one pair, a teenage (of age) girl on Ross who was having a perfectly consensual relationship with an adult patient being expected to discuss this both in the Ross group and in the dreaded parents’ meeting. The expectation that she would do so was creepy. Also, I suspect, counter-productive.

      • Have been thinking about your father in the parents’ meeting, Sheila – the hospital condoning/allowing an abusive experience – repeatedly – horrible :(

      • My father loved every minute of it, Frances. . .then went home and was very happy to drum up sympathy among others about how distressing it was for him. He was an arch-manipulator but boy, some people are very easily manipulated. I feel now, what I should have done is just boycott the meetings, all of them. But it wasn’t so clear then.

  6. An afterthought – I always thanked god that as a 20-year-old i was ranked as an adult (one year younger and I’d have been an ‘adolescent’), so I didn’t have to undergo the horrors (from all accounts) of the weekly parents group.

  7. Thank you for writing, Frances. I was an inpatient at a different hospital as a teenager, so I understand what you say about being with other patients and how it was that which helped you most. I have found a great many male psychiatrists (and let’s face it, the majority are male), to be intimidating, and sometimes quite aggressive. Your psychiatrist’s comment about the family is so unreasonably cruel and disguises so much, I am not surprised you felt you couldn’t discuss the range of issues that would have put you in their care in the first place. When a teenager is ill/has a breakdown, in my experience it is very rare that it is not just a personal issue but something within the family. When is a teenager having a breakdown NOT a family concern? Thank you again for writing, it is lovely to hear from you.

  8. I stumbled on your posts when I was googling “The Cassel”. I was a “patient” there a couple of years ago and wanted to see what they were saying about themselves these days, and also whether there had been any staff changes. The letter from Dr Skogstad that you have published does not surprise me at all. I too found him very patronising with an air of “I know best because I can think more clearly than you because I am not mentally ill”. He was very difficult to engage in any debate because of this attitude- he was aloof, arrogant and an old school psychiatrist. It’s a shame that he leads the service now as previously they had a much more down to earth and approachable overall lead who lost his job with the last round of cuts there.

    I do want to reassure you though that, generally, adolescents there are more supported to challenge their parents/carers, and are heard when they disclose abuse or difficult experiences to staff. Parents are not given an open forum to say what they want/ to whom they want, and certainly staff now are not easily manipulated by families.

    There is still a massive emphasis however on individual “pathology” and I found that incredibly difficult- as a mature adult it was not helpful or therapeutic to me to continually live in an environment where the medical model of mental health dominates and other perspectives are not represented in the staff group. The culture reinforces that patients are mentally ill, that they need to change their behaviour and that nothing else needs to change apart from that. It is especially sad that adolescents who have often spent years in the mental health system are further exposed to that perspective with no alternative thinking in play.

    Having said that, many of the young people who were there at the time I was, expressed great gratitude to the support they received- especially in managing self harm and suicidality.
    I think in those areas, the Cassel does do well, in helping people stop taking their pain out on themselves in a self destructive way. What the Cassel is still weak at though, is helping people find their own way through their experiences- there is a massive emphasis on fitting in with the perceived normality of society- the Cassel and psychodynamic view of “normality”. So some expressions of difficulty and pain are positively pathologised, and staff seek to engage in behaviour modification with their own agenda dominating, rather than recognising that their opinions should not dominate throughout the “treatment”. But they called us “patients” who were in “treatment”, so that kind of sums up and represents my point better than anything else!

    It was really interesting to read the posts on here- thankyou

    • Thank you, Flock, it’s very interesting to hear this. I’m pleased that the staff are more aware of manipulation by families these days. . .so they should be. Am not so happy (though not surprised) to hear that the place still leans towards the “mental illness” model. I was thinking the other day of a young woman there in my time, on the adolescent unit, she was 18 or 19. She was gay and, excruciatingly for her, in love with another adolescent who was straight, all this playing out very publicly within the hospital. Her gayness was clearly seen by “the authorities” as pathological. I wonder how they view homosexuality now? Their mindset still seems disturbingly authoritarian and patriarchal and yes, right-wing. Of course people are affected positively or negatively by external factors such as poverty and abuse, it seems truly mad that they are suggesting otherwise.

      Thank you again, and very best wishes on your own journey.

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