AFTER MY RETURN FROM THE BORDER ...
I returned to work after my Border Duty (see 'Grensvegter?') about ten days into October. At that stage I was still very wound up after having been on the Border, and it certainly influenced my work. I was inclined to be aggressive towards patients who were clearly malingering; aiming to get themselves all sorts of privileges. This seemed very unfair to me, while there were people in danger - in the perceived danger that I had been exposed to - who would have no chance of a transfer close to home, and a 'sleep out pass'. I think part of the problem was anger at the self-pity of people whom I thought had little or nothing to complain about.
As I have mentioned elsewhere, ('Grensvegter?'; Chapter 10) my unusual mood and behaviour shown when I returned from the Border. I have mentioned elsewhere of being irritable and aggressive, but from the documents quoted later in this document, (And towards the end of Chapter Thirteen) and the fact that I kept them, that I was rather paranoid as well.
It makes sense, I suppose. On the Border I had been a big fish in a little pool, and there was a great sense of relevance and the idea of impending danger. No matter how inadequate I felt in trying to help them, I had no doubts of the genuine need for help that people I debriefed to try to prevent them from developing Post Traumatic Stress Disorder.
Back at 1 Mil, I was much more aware of people malingering, and 'having us on', and I saw our 'giving them the benefit of the doubt' as being 'accessories to the crime', and betraying the conscripts 'doing their duty' on the Border.
I 'identified' very strongly with life on the Border, and still have vivid imagery of it now three years later.
My increased AGGRESSION was demonstrated at a psychiatric panel I attended, filling in at someone else, I asked a patient "How dare you demand to be taken off guard duty?" This amused my colleagues on the panel, though they shared my diagnosis that the person was a 'manipulative little shit!' but didn't feel moved to express it as strongly as I did.
Captain Koos E. suggested presenting another patient to "... let Barry growl at him." ["Laat ou Barry vir hulle knor!"]
One of the first patients I saw when I returned to 1 Mil after a week's bush leave was a young medics corporal I knew vaguely from the sickbay at Oshakati. I remembered vaguely that Charl, who had apparently seen him as a patient, had helped him to get a flight down to South Africa to sort out his relationship with a girl he had made pregnant.
He returned to find that she had been unfaithful to him, and that the child was not necessarily his. Within a week he had another girlfriend. He was admitted to the psychiatric ward after allegedly raping his younger sister and making a suicide attempt.
"Patient says it would not have been a problem for him to have shot himself if he had wanted to kill himself. Patient is scheduled to return to the Border tomorrow or the next day. Patient demands discharge this morning."
"Collateral: District Surgeon says sister was raped. Criminal charges are to be laid against the patient. Patient wrote a 'Thank You ' note to mother saying 'Thank you for everything, and that he will sort the problem out himself'. Possible suicidal ideas but these have not been admitted by the patient. Mother requests that patient be returned to the Border to continue therapy with Captain D.."
"Mother reports that patient's father committed suicide while the patient was an infant. He is just like his father - says patient has ? sexual impulse control problems."
"PARADOXICAL MANAGEMENT?"(Written at the time)
One patient was treated with what might loosely be called 'paradoxical management'. The patient was admitted to the ward with an alcohol problem three months ago. It is against policy to admit substance abusers, and to keep any patients so long in our acute wards, but he was thought to have a good prognosis, and that he would be 'a good influence' on the ward. A psychologist, Rene' V., saw him almost daily, and cured him of his drinking problem - except once when he went AWOL from the ward, and got drunk. This meant that he should have been automatically discharged to the ward, but Rene' pleaded that he should be given a second chance, and this was granted. It was observed that Rene' seemed to need him almost as much as he needed her.
Then came the time when Rene' was to go overseas for six weeks, after which she is leaving the army. The patient had been cured of his alcoholism, but had become addicted to her instead. He was incredibly manipulative - one of the doctors described him as 'a two year old who throws a tantrum whenever he doesn't get his own way'. An accurate description!
In the week before Rene' left, the patient developed what looked like a serious depression. He had the night staff call Rene' out because he was threatening to commit suicide. He told her that "he probably would kill himself, but she shouldn't let this knowledge spoil her holiday." This seemed to be his way of punishing her for going away.
We had to change his management, and Dave suggested that we use paradoxical treatment. We would agree with him that, yes, he was very sick (which he was not), and as such, he needed special treatment. This included limiting him to a room in which he ate all his meals, and had bathroom facilities. He shared the room with a 'Pioneer' - protected employment in the army for people of sub-normal intelligence. He was not allowed to mix with the other patients, or to speak with them. He was not allowed to make telephone calls, nor to receive them. And he definitely was not allowed to watch television - all this was because he was so sick! We gave him big colourful placebo tablets, which contain flour or sugar, and warned them that we would have to keep him isolated until he stabilised on this medication.
This is an accepted method of treatment, but it our case, I think the vindictiveness was only slightly disguised.
I took over as his 'primary therapist'. "Nobody could become dependent on Barry," Doctor Johan T. teased me, and then apologised. This patient certainly would not!
His 'depression' cleared fast, and after four days he was begging to be allowed out of the room. He said that the room was making him feel agitated, and that he was having concentration problems. I ascribed these symptoms to side effects of the medication, and he was to stay in his room until he stabilised.
The psychiatric team agreed that we could not allow him back on to the ordinary ward, or we would never get him out. He was to stay in his room until he accepted that he was being discharged back to his unit.
One night he told me that he was not going to stay in his room, and he didn't care what I said. He was going to go and talk to his friends. Of one friend, who was admitted at the same time as he was, he said "We've been through a lot together ..." - I use that phrase about people who were on the Border with me. I resented him using the phrase to gain sympathy. Ward 9 is not a bad place. He had been there for three months, and he certainly intended to stay longer - on his terms!
He threatened me that he was not going to stay in his room, and challenged me to do something about it. I did. It is a psychiatric ward. He was supposedly a suicide risk. I phoned the RSM of the hospital and asked him to send up a guard.
The RSM was impressed. Usually Psychiatry is regarded as being soft on undeservers. "Would you like the guard to be armed?" he asked. I savoured the thought.
At separate times before I went home, I briefed the RSM, the guard, the night staff and the patient that it he gave any trouble, he must be taken to DB immediately.
I apologised to the guard for taking up his night with this. He didn't mind. "Its better than standing beat out in the rain," he told me.
The patient decided to behave himself, and he stayed in his room until he was discharged back to his unit. He hated me by this time. He told one of the Doctors that talking to me was 'like talking to a brick wall' - he couldn't get his own way.
Being hard gets easier with practice. Co-incidentally, the unit to which he was discharged, 5 SAI falls under Natal Command, and I would like to see his face if he causes more trouble and ends up seeing me.
BETTER UNDER PRESSURE
I was asked to do a 'mental state examination' on one patient who was showing what might have been 'loosening of associations'. He had hinted that a transfer to Durban would help him to pull himself together. His doctor was a new national serviceman, still new to the department of psychiatry.
I was not convinced that he was genuine, and confident that I had the doctor there (To be the 'good guy' - not a usual practise in 'mental status examinations'), I put a little pressure on the patient, doing some cross-examination.
I made it clear that I wasn't convinced of the genuineness of his 'symptoms', which shocked him because no-one had challenged him before. "You don't believe me?" he asked. Had everyone said they believed him so far? I doubt it. That was why they had asked me to see him.
He handled the pressure I gave him well.(If he had started to struggle, I would have stopped!) The more I put him under, the more coherent he became. He started to defend himself with much more logic than he had shown so far - no longer was he vague; now he was angry and defensive. He justified himself, and arguing more assertively for the transfer he needed to help him to sort out his problem. The symptoms and credibility of which vanished before our eyes.
I was aware of the doctor watching me; his eyes were wide and he looked as though he could not believe the hard time I was giving to this patient. Aren't psychologists supposed to be nice people?
We were soon convinced that the lad wasn't as bad as he had made out, but we arranged support for him in his present unit.
ONE MAN AND HIS TEDDY BEAR
We had a very intriguing case where two youngsters were brought to Ward 9 by the MPs and there were heavy security implications. They claimed to have been kidnapped and interrogated by some mysterious (white) men in a remote house, from which they had eventually escaped. One of them wandered around the ward, clutching a teddy bear, which he indicated pathetically was a sort of 'security blanket' ('transitional object' in psychoanalytic jargon).
The Military Police were apparently not convinced by their story, and soon the decision was taken to separate the two of them so that they could not communicate with each other as the debriefings continued. One chap was taken to Ward 24, and the other remained on Ward 9, with Wimpie as the consultant in charge. Wimpie loved this, and seized on the opportunity to try to order me to do a Rorschach (Ink Blot Test) on the chap - I always resisted this unless I thought it was indicated, because it would take anything up to three hours to interpret the results. I continued to resist this, and I was eventually successful.
The two lads could not keep up the pretence for more than a few days, especially when the MPs could 'debrief' each of them separately. It seemed that details of their 'escape' differed, and they contradicted themselves and each other as they identified where they had run along a river bank, and then they could not account for why or how they were suddenly running along the other bank.
The final story turned out to be that they had gone AWOL with a military vehicle, which they had crashed. They decided that they 'might as well hang for a sheep as a lamb', picked up some girls and lots of booze and boozed and screwed themselves into oblivion for a couple of days before deciding to concoct their story in the hope of escaping being charged. The story broke a while before they were removed.
Probation Officers have told me of the informal discrimination shown by prison officers to sex offenders and other undesirables. This takes the form of issuing such people with trousers which are too small or too big, or without zips, to further humiliate the people.
I can confess now that I contributed to such treatment of the con man. After discussion with the other ward staff, we decided to take his teddy bear off him. I think I asked him to hand it over as it had to be sent down for X-rays. (At least we did it with a sense of irony!) This action did give us a sense of satisfaction, after all the trouble he had caused. And I was glad I didn't waste my time doing a Rorschach on him!
AUTHOR'S NOTE: More material relating to cases seen during my 'aggressive/paranoid' re-adjustment period can be found in Chapter 13.
DOCTOR IN DISTRESS
There was a qualified medical doctor on Ward 9 who could not cope with basic training. He was kept in the psychiatric ward for the duration of basics, with the idea that he would be discharged to coincide with the end of basics. I think he was eventually G5-ed. Rene V. said that he was 'too fascinated with the idea of death' not to try it out - or at least make a suicide attempt!
Captain Fred S., OC of the Military Veterinary Clinic at Onderstepoort had a small number of soldiers under his command, most of whom were dog handlers. I had met some of them when I had 'helped' Fred with some minor surgery.
Fred phoned me one day while I was at work on the Psychiatric Consultation team to ask about one of his soldiers who had been admitted to Ward 9. He had apparently shot dead one of the other soldiers at the clinic. Fred said that this chap had always been quiet, but on the day of the incident, one of the other lads had irritated him.
"If you do that again, I'll shoot you," he told the other person.
Either deliberately, to call the man's bluff, or else accidentally the irritating behaviour was repeated.
The patient had then shot the person who irritated him, killing him.
The man was not my patient, and I don't know what happened to him. Fred, who did not allow himself to become emotional ever, was quite upset about this.
That must mean something about the dangers of giving youngsters lethal weapons. They might just use them without being told who to kill.
I WAS GUILTY OF NEPOTISM (HELPING PEOPLE YOU CARE ABOUT)
Out of the blue, I received a message that a lady I knew as the mother of one of the youngsters who used to come camping with me in Sasolburg, my legendary hometown, wanted me to contact her. I returned her call to be told that her son Alan, whom I didn't even know was in the army was in one of the other military hospitals (I think it was 2 Mil - Cape Town) with a leg injury. Where he was, he was too far away for her to visit, and she asked me if there was any way, or any influence I could bring to bear to get him transferred to 1 Mil, which was much closer to his home. I said I would do what I could, and asked Mariaan, my social worker friend what she might be able to arrange.
She said the Afrikaans equivalent of 'I'll see what I can do', and within a day or two I was visiting Alan, who was able to hobble about, at the orthopaedic ward at 1 Mil. I saw him before he went home for a couple of days' recovery leave.
He had been on the School of Infantry Junior Leadership Course, and was a corporal at the time. He had been on the Border at the time of his injury, doing further training, presumable at Oshivello. I think he had been running carrying sandbags, or something similar (vital to the defence of the country!) when his knees packed in on him.
Mariaan said that she did not have to work particularly hard to arrange it, and she said that the mechanism existed for such patient transfers. I think she was being rather modest. I will always be grateful to her for that. Thanks Mariaan!
I was glad to see Alan again. It was good to help someone you cared about.
"BATTING AND TURFING"
Samuel Shem's (1978) "The House of God" introduced the notions of 'batting and turfing', specific medical variations of what used to be called 'passing the buck'. Below is a referral which I would have gone to Natal to avoid. Actually, I think that's what happened ...
(NOTE: I NEVER DID SEE THIS PATIENT!!!)
"1987-08-24 Mrs. J. fell off a bus last November. She has since found that her back is sore when she runs. Then married and became our patient. On X-ray severe OSTEOARTHRITIS - which distresses her as she says she is very active. Does yoga and running. What exercises are now appropriate for her? Can you please help. She has been to physiotherapy for treatment.
1987-09-03 50 year old woman. Six months ago married a man of 24 years. Experiences problems communicating with other women as the result of an event which happened before the marriage. She was physically assaulted by another woman. Presents with phobic symptoms. Follow up arranged.
1987-09-17 V. shows good improvement. She revealed what is really worrying her. She is worried about her physical health and feels that her body has let her down. (Psychologist Johan A.)
87-10-19 Patient presented distressed because Dr. R. is not here to help her. Dr. R. understands her emotional condition - that she wants to stay young and pretty, again able to do head-over heels, etc. She says she has no need for medication, but a psychologist. But when she was with a psychologist who could not relate to her at all. She saw Dr. Van D. who shouted at her so that she (Dr. van D.) needed psychological help herself. I explained to the patient that we are only human and that it would be good for her to come and see Dr. R. again. She also complains of a lump on her right buttock, which is cosmetically unacceptable to her. I explained that I would refer her to surgery, but I could not guarantee that the surgeon would operate. The army doctor is just 'buggering' her around. Very unpleasant patient. Burst into tears, sprang up and stormed out of the door. Patient slammed the door with great aggression. I will not consult the above patient again.
Johan A. tried to dump a patient on to psychiatry - cleared it with Elfrieda (who would always say 'Yes' to please someone as long as it did not involve any work for her!)
"Please not again for Johan A.. See consultation please."
Capt. Johan A. feels that psychologist at psychiatry could deal with this case better."
"Department of Psychology please."
"Psychiatry gives back." - 'marital problems'
THE DEPARTMENT TO WHICH I RETURNED(October - December 1987)
When I returned from the Border, Commandant P. was serving as an expert witness in a court case where a white member of 'Koevoet' (SWAPOLTIN) was charged with murdering a local Owambo by beating him to death with a pole. These were apparently many witnesses to this event, but none who were impartial. They were either family or tribal members who said that the man was murdered, or else members of the defendant's Koevoet squad, who denied that the incident had taken place.
We saw Commandant P. once or twice when he returned home from Windhoek, where the trial was taking place. He told us of the great publicity which the trial was attracting in Namibia, and how he would see himself of the SWA-TV every evening. If there was any coverage in the South African media of the trial, I missed it. The commandant's impression was that while the man was guilty, he was - for a Koevoet member - a relatively decent chap, and much less deserving of conviction than many of his former comrades, who were now distancing themselves from him in his hour of need. The lasting impression I have of Koevoet was that they were a bunch of murderous bastards. I believe that the defendant was convicted, but at present I do not have the details.
Marius became fed up with Commandant P. for his continual absences, and he felt that P. should have arranged for someone to fill in for him, instead of putting the remaining Psychiatrists under the stress of having to cover for him.
"ARE WE IN ANGOLA?"
At this time, there was a great deal of evidence that South Africa was involved in fairly extensive military operations in Angola. Captain Coenraad G. disappeared on a top secret mission for a couple of months, but I didn't ask him much about it.
Major Coetzee B. was up there, and a soldier he was working with was referred down to 1 Mil against his wishes. The chap had been in a Ratel (Armoured Combat Vehicle) which had been bombed by a Mig fighter-bomber. (That sounds like a war to me.)
Then there was an outbreak of cerebral malaria amongst soldiers who returned from Angola, and ward space had to be made for them at 1 Military Hospital. Imagine the irony of surviving the Angolan Campaign of 1987 only to die later, after having 'klaared' out of the army, of cerebral malaria. The army implied that those who contracted malaria had not taken their pills as they had been instructed to - shifting the blame back on to them, and saying, 'Its all your own fault'.
I think at this time the SADF admitted that something was happening in Angola, as a statement was issued warning such soldiers to report for medical treatment if the started to show any of the earliest signs of malaria.
I believe that between seven and twenty-two soldiers died of malaria during that epidemic.
I ACTED AS THE HEAD OF THE CLINICAL PSYCHOLOGY DEPARTMENT
"We are losing many psychologists from our department; who are either leaving the army, or being promoted away from the hospital. Of the four psychologists who selected me for my Clinical Psychology Internship, only one still works at 1 Mil."
"The head of the Department of Clinical Psychology has been promoted [Dolf], and the 2IC [Elfrieda] has taken over. She is notorious for delegating all her work, so that she saves all her energy for her private practise which she has in the evenings."
"She was up on the Border for a couple of days, and attended an open party about a kilometre from where I was staying, but she made no effort to contact me. I'm not worried about not having seen her personally, but I would have enjoyed being brought up to date on all the latest gossip from the department, especially with the spate of resignations. She can't expect very much loyalty from me."
"I finished off working under [Wimpie] last Friday, as with the staff shortage, I have been moved [to the old hospital] to replace someone in a higher priority position. I haven't told [Wimpie], as he will take it as a personal rejection from me, so I will leave it to the new head of department to tell him, if she doesn't try to delegate it."
30/11 Coetzee B. & `Ollie' O. returned from Operational Area. Major Coetzee B. and Major `Ollie' O., the most senior psychologists at the Hospital after Dolf left, were tied up with working on a special Angola-related project for the Surgeon General until December.
This, together with people taking leave, left the day to day running of the department to junior personnel, and resulted in me acting as the Head of Clinical Psychology.
"Goal planning for the new year, although we only had acting heads of the departments; Elfrieda, the blond bombshell, had been on a course about such planning, but she had not taken notes and so could not give us much feedback, so her idea was to invite old Andries K. to come and give us a lecture on it - a few days before he was leaving for a much better paid civilian job. He came and lectured us on the Vision technique; 'This is where we have arrived - (Imagined in the future) - how did we get here.' He told us of a fantastic OHP/photocopier they had at 'Servamus' (SAMS headquarters building), which could make photocopies of what you wrote on the screen - apparently in one process, rather than photocopying the transparencies, and I could imagine the drivel which would be thus copied to demonstrate the self importance of the lecturers."
More mundane issues that we had to deal with was the problem that had been identified of patients breaking into psychologists offices to use the telephones to make personal calls, and arranging for Clinical Internships for two senior military personnel, a Commandant and a Major, who had apparently gained the necessary qualifications to make them eligible for the internship, which is the last year of Clinical Training prior to registration as Clinical Psychologists. They would significantly outrank the people who they would be supervised by. That could make for an interesting situation in a military environment.
COMING TO THE END OF A YEAR - FAREWELL PARTIES
It is coming to the end of the year, and we are having a whole barrage of end of year functions, most of which are supposedly compulsory. We have at least one per department, as well as numerous farewell parties, for people who are leaving or getting transferred.
I was at a Chinese 'braai' [barbecue] of the former head of psychiatry's house last night - a beautiful 'jet-set' house, that I know I will never be able to afford. The dominee who sees our patients, and who also attended the braai, told us over dinner the latest developments, accurate to the last couple of days, of any military situations which might or might not involve friendly forces in countries which might or might not be our own. ('Squatters' rights') (Careless talk costs lives!) [Angola] I found it surprising that the chaplains are so well informed, when other professional people in the armed forces - some of whom have served in the operational area - which he has not - have not been told. What happened to 'need to know only?'
When I was on the Border ... (popular opening to conversations in those days!) we only knew of military incidents that happened within our sector, and only heard about activities in other sectors when we read about them in three week old newspapers.
We had an end of year party for the general Department of Psychology. The suggestion was that we should dress as 'Boers', a suggestion not popular with the English speakers; Rene and me, but apart from moaning to each other, and Naas who was the other psychologist based at the New Hospital, we did not raise any formal objection.
The 'social committee' had send off for flags of the old Afrikaner Republics to use as decorations, and these arrived with an enclosed three-seven swastika of the AWB. (Neo-Nazi movement) Gee, fellas, thanks a lot!
Commandant P. wanted an outing for the staff of Ward 9, in which I was included. We had a lunch at a restaurant in Pretoria. At this, Commandant P. started a rather inappropriate conversation with Dr. Leslie G.. He asked Leslie if his marriage was a 'traditional marriage'. "What does he mean by a traditional marriage'?", Leslie asked incredulously in hushed tones. Did the Commandant actually mean 'an arranged marriage?' Surely not!
Dr. Dave S. hosted a party to celebrate his imminent 'klaaring out' of the army. This he made a wine-party, held at a friend's house in Johannesburg. Dave put a great deal of effort into this, and had a half sheep grilled on the spit - delicious! It was strange to see the way that men with Border experiences seemed to seek each other out and congregate, swapping Border stories. It was like an elite club of 'those who had been there'. Dave tried several times to get us to mix with the other guests, but that seemed difficult.
There was much discontent at the end of the year when collections were made for farewell presents for the Permanent Force members who were leaving. The National Servicemen doctors were asked to contribute, but they took a stand about this, saying "Why should they always contribute, when there were never collections for them?" Clive W. was most vocal in this, and he was also most opposed to the inner elite of the PF.
When I finally left 1 MIL, Marius quoted my comment that more people seemed to be leaving than those who were staying. That was quite sad really. The end of an era, in my life anyway!