Doing Their Best

In the summer we spent hours together on the crags overlooking the valley. You loved to watch the birds spin crazily beneath your feet. Sometimes you would lie on your back in the warm sun, losing yourself in the vast sky. What were you thinking of? Then you would look down into dark pools, watching a dipper skim the surface. You were deeper than those pools, far deeper than any of us knew. Sometimes you would write, nothing much, a few notes, scraps perhaps. But later, when the autumn gales howled and night drew on, you would weave those notes and scraps into a web of words so fine that they lay gently on my soul, caressing me with that summer sun.

I have lost count of how many times I have made this journey, through the heart of Snowdonia to this house by the sea. Today it is a grey listless sea, frozen beneath the bleak sky as they gave me your suitcase. At home I opened it and beneath an old check flannel shirt with frayed cuffs I found the pen I bought you for your fiftieth birthday. You said you wanted to write. It was the first time you had shown any interest in writing for thirty years. They had just moved you to the sea side. A halfway house they called it. You had your own room there.

It was better than the old ward, thirty two beds standing to attention along drab dun walls. The move seemed to bring back a spark in you, at least for a few weeks. Before when you used to write, you crafted your poems with such care and love. The pen became a fuse, the physical act of holding it lit something within you, igniting your art. You wrote poems in the Old Language that were so full of life and light. I hoped that the pen might help rekindle the fire that drove you to write. But the devils returned and doused it.

Long ago now, I remember nurses in stiff uniforms and caps, doctors in white coats. In your first summer I took you to the carnival in the grounds. How strange, you said, that they should have this here.  But then it is a mad house, you added.

Doctor Griffiths didn’t want you to go to that place. Neither did we. He said it was unusual for anyone to leave once they were in, so it had to be a last resort. He tried, as did we all. We tried as long as we could to look after you at home. Your roots on that hill, in the woods overlooking the river. Doctor Griffiths was right. Perhaps if we had tried a bit longer you would have pulled through. Who knows?  Perhaps with mam’s strength, had she lived, we might have seen it through. The last thing we wanted was for you to be uprooted.

On your first day in the hospital I remember the nurse taking your clothes. She said you could have new ones after you had had a bath. You had to be clean to be examined. Then the doctor saw you. He spent an hour questioning you, checking you, examining you, writing about you. Then he spoke to me. He was kind. If I remember correctly he was English, from London. He told me it was an illness, schizophrenia I think. He was very excited because they had managed to get a supply of a new pill. It had been discovered in France a few years earlier. It was the first time that they had had something that could cure the illness. You would be cured completely. He filled our hearts with hope. He said

Patients who previously would have needed admission to a mental hospital can now be taken into the open wards of general hospitals, with the sense of freedom given by ready access to the coming and going in the corridors and in the street outside. It is particularly gratifying to be able to treat the young patients, with a sharp attack of illness and good chances of full recovery, in such a benign environment

It would bring you back too, he said. You started the pill; time passed. There was no change. You just got heavier by the day, drooling like an imbecile and shuffling like an old man. I wondered.

A couple of years later they said that you were a chronic case, incurable. They moved you to another ward, a dusty hall of men’s sweat and silence. It faced north towards the hills; no hope found its way in there. A new doctor took over your care. He told us that a different treatment would help. It was a well-established treatment that had been used many times before in similar cases with success. But there was pity in his eyes when he warned us not to build up our hopes.

The idea seemed bizarre, but it was found to work

he said, and he promised they would start carefully. They would begin with a very light form of the treatment, every day for weeks and weeks it continued, even on a Saturday when I visited. I remember seeing you lying on your bed. The therapy was draining something out of you; you would lie there still and quiet. You looked so pale afterwards, your skin sheathed in a fine sheen. So I gently patted your brow with my hankie; I wanted you to know I was there. Did you? Did you sense my presence? I hope you did.

Only if this proves insufficient is sopor or full coma treatment possibly required; and often additional light sopors will be sufficient

is what the new doctor told me, so they had to deepen your therapy. Everybody was concerned because you seemed not to be making any progress. Back home we were frightened, Tad, Dafydd, Anwen and me. Then the hospital phoned. Come immediately, they said. Mr. Roberts the minister took us in his new motor, across the moors at dawn. When we arrived, breathless, you were grey and close to death. In the stifling room you were alone. We feared that you were lost. The coma had gone too deep, the nurse whispered, and the treatment had damaged your brain. But even then your body pulled you through, and you recovered. You were made of granite; you were quarried, not born. Your strength carried you through it, but still you could not speak; the devils still assailed you. And when they sent you back to the old hospital they continued the therapy, gently this time, a modified coma they called it.

How was it the doctor described you? Refractory? That’s it; a refractory case is what he said. I‘d never heard that word before. Can you say it in Welsh I asked?  But he didn’t speak Welsh. Later I found out that it meant stubborn, because you resisted their attempts to treat you. So they added a new treatment. The new doctor told me that

if insulin and ECT are combined in the early weeks of treatment, both types of symptoms, paranoid and depressive, will improve together, and better results will be obtained.

So they gave you the shock treatment as well as the insulin therapy. It was no use. They tried their best, but it served you no benefit. Still and silent you remained, deeply submerged in your pool. Stubborn? A strange kind of stubbornness that kept one so young away from life. With the new treatment your slowness increased. You became more distant. You used to hold your hand up for me to take, just as you did when you were a small boy and you wanted to go to the forest to hear the birds. But you lost the urge to cling to my hand when I visited. Each week as that new treatment progressed you slipped further away. Then one day I came and your hand was motionless, a thing of warm marble. Still, I sat there holding your mute limp hand.

I shall never forget that day. I want to hold your hand was on the radio when the doctor called me in. It was number one. He had something important he wanted to discuss. Have you spoken to him about it, I asked? There was little point, he said, because he never spoke to them. Besides, they thought that you were incapable of understanding it. They thought I might be able to get through to you. The doctor told me that

the point has now been reached where the swing towards conservatism has gone too far. The tranquillising drugs have not enabled many chronic patients to be brought out from the back wards of mental hospitals; too often they have succeeded only in muffling the cries for help coming from these wards, where the patients may now accept their chronic state more placidly.

He tried to explain what they wanted to do, but I found it difficult to follow. They wanted to remove some of the nerves from your brain. The operation was quite safe, and some people did remarkably well afterwards. He said that

over 30 per cent of all schizophrenics operated upon were able to leave their hospitals

I was told. Tad was against it. He didn’t think it was right, that it wasn’t natural interfering in things like that. Dafydd and Anwen thought the same as I; we were desperate to see you better. That night we prayed at home together, and at Chapel the next day. Mr. Roberts came to see us. He reminded us about the raising up of Lazarus. He said that we must put our faith in our Saviour and in the doctors’ skills. Then you would be delivered back to us. It’s miraculous the things they can do these days, he said; the doctors will have spent years perfecting this treatment. We must pray for guidance and have faith.  Dr. Griffiths wasn’t sure. It was the most difficult decision we have ever had to make. In the end we thought that if there was the slightest chance of some improvement for you then the doctors should go ahead. I could not have lived with myself knowing that there might have been a chance that it would have made you better. As things stand I have not been able to live with myself anyway.

In the early weeks after the operation we held our breaths. We dared not to hope; we could not even speak about it for it seemed that you had turned a corner. You started to speak, and you greeted us for the first time in years when we visited. It seemed to me, though, that the devils – for that remains the only way I can talk of them – still visited you. But you were less perturbed; your worries had eased. How is Mam, you asked one day? You had forgotten that she had died the year before you came into hospital. Never mind, you said without a glimmer of sadness, did you bring chocolate? And you left the room; you ran out and did something that you had never done before. Oh dear God, I shall never forgive myself for allowing them do this, this awful thing to you. You went into the town, to the Hope and Anchor halfway down the hill, and you drank. The phone was ringing when we got home. We can’t control him; he’s raging about the ward, they said; we’ll have to put the jacket on him, put him in the cell. I was ashamed of myself for allowing them do this awful thing to you. They were doing their best; they did this thing to you because they really believed that it would help you. But how can you ever forgive me for allowing it to happen?

After operation these paranoid patients are much more amenable to taking maintenance drug therapy, and are much more willing to continue under follow-up care, so that for the first time they can be kept under control outside hospital. Those who at this date are content to leave permanently ‘tranquillised’ in the back wards of their hospitals, patients who are capable of recovery with a modified leucotomy, should remember the principle that we should always treat our patients as we would wish to be treated ourselves, if we were so placed.

And now your case is empty. Your pen I shall keep, and the anthology I bought you for your twenty first birthday. It was at the bottom, and must have lain there unopened for years. But on the title page you had written

When spring wakens the hearts
Of the young children to sing, what song shall be theirs?


Reproduced from Bracken and Thomas, Postpsychiatry, pp. 23-6 © 2005, Oxford University Press, with permission.

I am also grateful to Orion for their permission to quote two lines from ‘The Old Language’, by R.S. Thomas, and published in his Collected Poems.