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