CHAPTER NINE
DETENTION BARRACKS
'Detention Barracks', abbreviated to 'DB', was the military prison, where soldiers were sent for military or disciplinary offences. Is was deliberately made to be unpleasant, with continuous physical training, and everything being done 'on the double'.
As has been mentioned in Chapter 8, many people looked to 'psychiatry' as a way out of basic training. Many people either in DB or on their way there would try to get a psychiatric label instead. Time spent on the wards while they were 'being assessed' counted as time that they would otherwise have spent in DB. It was known to inmates of DB that life would be much more comfortable for them if they managed to spend as much of their sentences in hospital as possible. Consequently, referrals to psychiatry from DB were treated with great suspicion.
Early in my work at 1 Mil, I met a man who had been on AWOL for two and a half years. It was his second time that he had gone on AWOL for a considerable period of time. The army's way of dealing with this, instead of sending him to DB for long periods of time, was to call him up again, and make him start all over again. He had been living with a 'Coloured' girl, and he wanted to return to her. In South Africa at that time, it was possible for people to be reclassified into different racial groups, often on the basis of what racial group the person most commonly associated - one of the most ludicrous aspects of Apartheid. The thought occurred to me that he could apply to be reclassified as a 'Coloured Person', and as 'Coloured People' were not liable for conscription, the army would leave him in peace.
I lightheartedlty commented about this to Annette V.. She didn't approve of my attitude, and chided me at encouraging him to find ways out, instead of motivating him to complete National Service. "There must be something he can do to help the country, even if it is only pushing a broom," she told me. But the army employed many Black people to do the cleaning.
Because he was under arrest, he had two young national servicemen as his escorts, who had to take it in turns to watch him. He stayed on the ward for a couple of weeks, which did not seem to bother his guards, who happily played Trivial Pursuits to while away the time.
Eventually he was discharged back to his unit, and fairly typically, he attempted to slash his wrists in the bathroom on the morning he was to leave. He had been carefully assessed, seen to not be clinically depressed - and he was discharged with bandaged wrists.
"Patient was referred for suicidal and murderous thoughts. He is in DB at present following ? attempted murder. He is awaiting administrative discharge from SADF and six months in a civilian jail. Presently says he is 'cracking' in DB which is not convincing. He is impatient at the month he has already waited for his administrative discharge. Very manipulative in the session: "Dozens of psychologists have said they will help him, but no one has."
In the next extract from case notes, note the suggestion from a relative that he should try to avoid trouble by 'returning via psychiatry':
"Patient was on AWOL for 19 days from 10 Artillery (Potchefstroom). Second AWOL offence - has 21 Days DB suspended and twenty-one days added to his national service already. He was staying with a friend while on AWOL. He told me he was about to give himself up - he told Dr. Les G. that he was not going to give himself up. NCO from unit phoned his parents asking where he was - mother phoned around and traced him. They contacted the patient's brother in law, a Lieutenant, who suggested a return to unit via the department of psychiatry."
"Mild features of PTSD from explosion at 10 Art last year, not enough to make a diagnosis. Patient appears to be manipulative - says 'Maybe you'll trust me more if I go to DB'. Also tries to play medical staff off against each other. Patient has proved himself to be an unreliable historian, and has obvious secondary gain."
- 'unreliable historian' was a phrase coined by Dr. Dave S., which I liked and copied.
Worrying, but probably not surprising, was the savagery with which some patients hit back at us, in retaliation for us not aiding their avoidance of DB:
THE HERETIC I
"1986-11-07 Deon is coping well with DB. He says that he did not feel rejected by his mother when she remarried or when his brothers came home to live with them. He still wants to become 'straight' because he believes homosexuality is sinful. I referred him to Dominee Bester (Chaplain) to discuss this. We agreed to work on relationships when he is out of DB and has the opportunity to develop heterosexual relationships. Made follow up appointment.
1986-12-18 Deon did not present for scheduled appointment. Apparently he has expressed dissatisfaction with the therapy I offered him according to a dominee. I will leave him to contact me."
While I was on holiday in Pietermaritzburg, Dolf phoned to say that a complaint had been lodged against me from the Chaplain General; a patient said that I had interfered with his religious beliefs. Fortunately, I could remember the patient. He had been in Detention Barracks at the time; he was a military criminal. He had told me of some religious problems, and I had referred him on to one of the Chaplains that works with our department. I noted this all down in the patient's file, which Dolf had in front of him. Unfortunately, the Chaplain to whom I had referred the patient was on the Border at the time, and unavailable. My name was cleared, and the matter presumably forgotten.
The Chaplain's Service was very formidable, with much defensiveness against 'Godless' psychiatry. Getting into trouble with them was a very bad career move.
The Chaplain involved, a brave man, told me that the senior staff in the Chaplain service were not interested in practical help to patients, and advocated reading a verse from the bible and prayer instead of any practical involvement.
GENERAL PATIENTS
"We've got a long term Satanist on the ward who has permission to smoke dope to calm his nerves and he dishes it out to the other patients which is a bit of a problem. Obviously the whole situation is somewhat unacceptable (to the staff at any rate) but for some reason we can't do much about it at present."
Another chap who was referred to us was identified as a Satanist, which he did not deny. He had been working as a chaplain's assistant. Had a chaplain taken him on as a project? Was it just coincidence - or something more sinister?
46 year old PF WO2. Anxiety and depression when his wife left him, adultery on his part, but he now has no further interest in 'The other woman.' Two children. Ex-Rhodesian. Difficulty making decisions. She wanted the divorce to go through, but said he could start courting her again once the divorce was finalised.
"22-07-86 21 year old NSM Kobus wanted to discontinue the adjustment group as he feels that he is coping at the moment and he does not want to open up old wounds. I told him that the door was always open for him to return to the group if he should feel the need."
20 year old NSM. Secondary Enuresis [bedwetting] which started after he was run over aged seven. This lead to social withdrawal, feelings of rejection by others and feelings of inferiority. Symptom relief by medication. I taught him relaxation exercises.
JUNIOR LEADERS THAT DIDN'T MAKE IT
Johan was a 21 year old Afrikaans lad I saw who was on the Junior Leaders course when he cracked up. I saw him over a fairly long period of time, and I know that he was eventually given a G5, though I forget what the final diagnosis was. We certainly entertained a couple.
He seemed to have great difficulty adjusting to the ward, and would wait for me to arrive at work, begging and pleading to be discharged from the ward.
His father was some fairly senior police officer, who had been rather remote from Johan all his life, and the fact that Johan spent some time in a psychiatric ward seemed to improve their relationship.
"Johan improved markedly on the high doses of Serenace. Agitation down, feels happier, can concentrate to read magazine articles etc. He is still wanting to be discharged as soon as possible."
I find that there is little I can remember to tell about him, but he seemed to be a good wholesome lad, suffering from some illness that he could not begin to understand. I hope he's all right now!
Deon was another favourite patient, and again I can't remember what the final diagnosis was. He seemed to have strange experiences, sometimes of the future, which then happened. It didn't seem to be a typical hallucination, or a delusion. Unfortunately he told the people he mixed with about his strange experiences, and seemed taken aback when they thought he was a 'weirdo' and distanced themselves from him and started to make snide comments about him.
His history included that he had been unconscious for two days when he fell off his bicycle at around six years of age.
"Since standard six [13 years] he has had visual images in his head which repeat themselves over and over. First was of him and some school friends being chased by some man. Now he sees himself in the army with people that he recognises and two men rush out of the bush and collapse in front of him. He also has deja vu experiences and has had previews of things that come true. He is worried by these images which occur for several hours at a time, but he is able to continue with his functioning at his unit during these periods."
"Dr. Manfred B. reports that in his tense state last night he seemed to be somewhat hysterical and he phoned his father to ask him to come and fetch him, but Dr. B. said this would not be possible, and he calmed down. Patient denies any alcohol or drug use."
Psychometrics indicated that he had a high need for achievement, and possibly for recognition. He had a family tradition to follow; his older brothers had both been corporals, and he wanted to be one too - ambition? He was adamant that he wanted to stay on the Junior Leadership course, but eventually agreed that he couldn't cope with it.
"He is prepared to be taken off the JLs course. He still has confusing thoughts of a car rolling down an embankment. He is going to the bush but will be brought back if his problems get too bad."
"Deon started to talk about parts of him that he has repressed in order to present a false but pleasant image. He is capable of rages but he has been rigidly keeping these under control."
"Deon presented to say that he had a premonition last night that he would be driving his car for the last time and some half an hour later he was forced off the road and his car was written off. He did not appear to be particularly upset; he was just telling me to keep me informed."
"Deon was waiting from early in the morning. He is still succumbing to pressure at his unit and just walked out for the weekend. He was tearful throughout the interview. Paranoia about people in the unit."
BORDERLINE PERSONALITY DISORDERS
Fairly early on, I treated a lad of German extraction who had a borderline personality disorder; sometimes seen as close to being psychotic, or else people with existential difficulties who continuously need to prove to themselves that they exist. What clinched it was towards the end of the time I saw him, to told me that one day he decided that he was going to kill himself, and he was going to do this by driving his motorbike at full speed into an oncoming car. He said that he was about to do this when he saw children in the back of the car, and he decided that it was not fair to take them with him.
ANXIETY CONDITIONS
I saw one patient with an anxiety problem; Kenneth. He went to see the movie, 'The Hitcher' which had such an effect on him that he had to be rushed to hospital with a severe anxiety attack. He didn't learn, and went to see it again three days later, but he survived that okay. It takes all sorts, I suppose.
NON WHITE PATIENTS - THE RUNNING MADNESS
A Bushman was referred to us from the SWA Border with what the referring doctor described as 'the running madness'. The letter was addressed to the 'Honourable Psychiatrist' which had us wondering whether we shouldn't be seeing the doctor instead. The 'running madness' turns out to be the result of eating some indigenous herb which has the effect of making them hyperactive - I wonder where I can get some? Through the interpreter we asked him why he believed that he had been sent to see us.
"Because I want to have two wives," he replied. Fair enough!
Marius, the psychiatrist, said that it would be a nice idea if the Bushman could see something of Pretoria while he was here. His idea of civilisation so far extended only as far as a double story building. We didn't arrange anything, but it was suggested that Marius might like to take him for a spin on the back of his motorbike. This is why we are not permitted to take cameras into military installations. Too many reputations would be irreparably damaged.
For a while we had a black patient on our ward, a chap called 'Solly'. One of our paranoid patients was sure that he was a SWAPO spy, and he was amazed that we - the staff - didn't recognise him for what he was, and have him shot.
FROM THE BORDER
A manipulative little psychopath had so confused the sickbay at Rundu that they had flown him down to 1 Mil. He wanted an indefinite pass to go down to Durban to sort out his problems. He could not be specific about the nature of his problems, but was not interested in receiving professional help to deal with them. The only problem that he was prepared to disclose was that he was a pathological liar, and this kept getting him into trouble.
All he wanted was time off in Durban, and we became impatient with him. We needed to have a presenting problem before we could consider giving him recovery leave, not that any of us were thinking about this seriously.
"Would you like us to help you to lie more effectively?" I offered, an offer mirthfully debated in the tearoom. The patient was put on the next flight back to Rundu.
A patient we saw went deaf after being assaulted on the Border. He started to become worried about this when he was nearly run over by a truck that he didn't hear. He reported to the sickbay, who referred him to a psychologist, who reportedly saw him for ten minutes before having him casevaced down to 1 Mil. Shortly afterwards, the patient reported that he fell in the bathroom, and that this blow to his head restored his hearing.
Now the ENT specialist, Brigadier Scholtz, who holds an administrative position within the hospital, considers this patient to have been malingering, has reportedly shouted and sworn at him, and wants to lay formal charges of malingering against him.
The poor patient never even asked to leave the Border, and he is now up to his neck in trouble that he doesn't deserve.
STRANGE BEHAVIOUR AT LAST
Psychiatric wards are where one expects strange behaviour. I haven't seen much, but its started. On a ward round, where all the staff follow the psychiatrist, while he speaks to each patient and discusses complaints with them, one of the patients snapped off a Nazi salute - not subtle. When Commandant P. asked him if he had any complaints, he said 'YES' - and that he was angry - "I hate this place," he shouted. "And I hate you."
Then he lunged at the Commandant, who dodged backwards, and there were about eight doctors, psychologists and social workers about to jump in and beat up the patient. That patient actually knew my rather eccentric cousin.
Glenn T. was walking along a corridor recently when he saw a patient with a broken arm coming towards him. There was nothing remarkable about this, until the patient jumped up and smashed out a window with the plaster cast, moved forward and jumped up to smash the next window. Glenn shouted at him, and moved forwards, at which the patient turned on Glenn. Glenn slipped on some glass, as did the patient. The patient stunned himself. Then the doctor was there to give him a 'knockout' injection. Where are all the big burly warders that one sees on T.V.? We could do with some!
One chap claimed to be an astral traveller, and to have witnessed a murder in Germany over the weekend. Eventually he backed down on this.
Three youngsters were referred to us after having eaten 'malpitte' ["Madness seeds"]. Part of their problem was that they didn't want to do their basic training at 2 SAI (Walvis Bay), remote in the desert surrounded by what is now Namibia. I remembered one of them particularly, because he looked similar to a friend of mine. I came across this chap's name later when he was charged with having been involved in an armed robbery. At that time he should still have been doing his national service.
Annette V. had a patient who was very screwed up (and I mean Borderline Psychotic) who came from a very rich family - so rich that they had an L-shaped swimming pool around their house. The pool was so big that they taught his little brother to water-ski on it. (But not towed behind a boat!)
A nineteen year old was referred to me with a problem of pulling out his hair. There is a special word for this; Trichotillomania. When he had leave, he stayed with his mother and father in law, who made him feel unwelcome. He also had communication difficulties. I started a behaviour modification approach with him, but he decided to keep his hair short, which reduced the problem considerably.
I saw a 24 year old chap who had been held in a civilian jail, presumably when arrested for AWOL, where he had been raped by eight men. He felt humiliated and was tearful and depressed. He insisted on, and was given, a solitary cell in DB.
I saw a Jewish Air Force lad who was referred with a bereavement reaction following the death of his father. His OC was sympathetic to the Jewish rituals that he had to observe. Eventually they felt that he had had enough time, and I felt that he would do better to get back to the structure of work. He turned on me then, saying that I did not want to understand how he felt, and his concerns for his mother, and that I "was just like the rest of them." I think that he was actually capitalising on his father's death, which I think was pretty 'low'.
I saw an engineering graduate who had not been selected for one of the officers' courses, and he was destined to do most of his two years doing menial clerical tasks, which he found very boring and frustrating. He also seemed to be on the lowest pay possible for a national serviceman. He found it very frustrating to be financially dependent on his parents again, when he knew what he could be earning in 'civvy street.' His tension was eased with relaxation exercises.
I also saw a tired old Colonel, whom Marius asked me to do psychometrics on to see if there was anything to suggest 'occupational burnout'. I found it strange, after the hordes of young national servicemen I had seen to see a much older man, who seemed to feel as out of his depth, though he was floundering in a different area.
One of my patients has a surname which looks very much like the German translation of "Easter bunny" although he is English speaking. Surely one of the most obvious things to do would be to change his name to 'Smith'?
KIDS GROW UP
I chatted to someone else's patient, who was about to be discharged. Conversation somehow turned to the fact that I come from Sasolburg.
'I know someone from Sasolburg,' he said, and then he went on to name someone whom I remember as being eleven or twelve, and who had come camping with me. After having enjoyed the first one and a half days of the camp, he developed homesickness and nothing we could do could get him to cheer up. Eventually we phoned his father and asked him to come and collect his son. We invited him on other camps, but he never accepted.
'Where do you know him from?' I asked.
'He did basic training with me at 1 SA Infantry Battalion in Bloemfontein last year,' he told me.
Boredom seemed to be a major problem for many youngsters; this was probably worst during four hours of night guard duty - especially during the early hours of the morning. Many others had difficulty keeping themselves amused during free time, and there was always plenty of that after the initial weeks of basics had passed.
Some patients were not happy at being seen in groups, and would insist on individual sessions in which to discuss issues which I think should have been discussed in the group.
GENERAL PATIENTS SEEN BY THE PSYCHIATRIC CONSULTATION TEAM
"IMPORTANT PEOPLE MUST BEHAVE"
Early in 1987 I was summoned to see the Officer Commanding 1 Military Hospital, Brigadier Coetzer, in connection with a patient I had assessed when she had been referred to the Psychiatric Consultation Team. Her problem related to stress from marital disharmony, and ideas that her husband was mistreating her and being unfaithful to her. Her husband was a high-ranking officer, at least a colonel, and I was later to find that his behaviour was disapproved of by his superiors.
I was not yet in uniform, which was the first issue the OC dealt with, and with one phone call he got my name added to the candidates for the next induction course.
Having got that out of the way, he asked me about the patient, and on our abilities to help. I advocated family therapy, and nominated a family therapist in the Psychology Department to whom I proposed to refer the patient.
The OC seemed satisfied with the arrangement, and instructed me to keep him informed of developments.
I liked Brigadier Coetzer. He was small and non-threatening, and seemed to be friendly from beyond the great divide of rank. On occasion, he would enter a lift in which I was travelling. I would brace, or salute him smartly if there was room. He would always acknowledge this militarily, but would usually seem to ask an informal; "You all right then?" Maybe that was just an impression, but he was certainly one of the most approachable officers of his rank I ever met. Not that I met that many.
After a couple of weeks, I thought back to that patient, and decided to check that he was being followed up. A phone call indicated that he had been offered an appointment, but that he had not arrived for it, and he had not contacted the psychologist who had offered it.
Aware that I was telling tales, I phoned the office of the OC and relayed this message. "Thank you," said Myrtle the Turtle. "The Brigadier will attend to this." I had done my duty, and I had enjoyed doing so!
DYSMORPHOPHOBIA
A rather amusing case concerned a young National Serviceman who was referred to us following his request to have his ears pinned back with plastic surgery. His ears - less prominent than mine - worried him so much that he would stick them to his head with super-glue every morning. The thought occurred to us that this might be a front for a glue-sniffing habit, but there was no other supporting evidence.
Selective surgery patients are often referred for psychological/psychiatric evaluation. We decided that he had worse problems than just his ears, and he spent some months in a psychiatric ward.
He became one of Commandant P.'s patients, and eventually had the plastic surgery at army expense. I wonder if I could have had my ears done?
THE OLD LADY WITH THE LUMP IN HER FOREHEAD
A tragic case was a sixty-year-old female army pensioner, with a massive brain tumour - which if left alone would kill her within a week. Someone had told her that if anyone attempted to remove it she would go blind, and she refused to sign permission for the tumour to be removed. She was sent to me to test whether she was mentally competent to sign consent for the operation (and if she was not, then her next of kin could sign, and her life could be saved).
She reminded me slightly of my favourite grandmother, and she was pleasant and sweet when I took her into a borrowed office to test her. I had to listen to all her World War II stories first before I could start the testing. If her accounts were reliable, she had served as a nurse in the North African desert, and had been on first name terms with Field Marshall Jan Smuts.
She battled with the tests, and again I heard more anecdotes than answers. Suddenly, she became enraged - accused me of implying that she was mad - cursed and swore at me, threatening me with the Surgeon-General, the Medical Board and 'Other Important People'. Then she stormed out of the office - as she was entitled to.
She thundered off down into the ward, passed the doctor, Leslie K.. I reached him, and we herded her back into the office. ("What did you do to her?" Les asked me suspiciously.)
She ranted and raved at both of us, and we were polite and professional, telling her that she could refuse to be tested if she wanted to, and that we were only trying to help. She threatened that if we came near to her (we were standing on the other side of the room with our arms folded) she would do us lethal harm with Ju Jitso; she aimed a few karate-type blows at us. There wasn't very much we could do to help her, and we had to let her go home - probably to die.
RIP VAN WINKLE - THE MAN WHO SLEPT
Another patient I saw faked being unconscious. He kept it up for three days, which was a good enough performance to warrant his admission to a psychiatric ward for "further observation" with pressure from the internal medicine to get him out of their beds. Apparently he eventually could keep it up no longer, and he 'woke up'.
I was asked to see a patient who had suffered a bad spinal injury - I forget how - but he would never walk again, and at best he would be restricted to a wheel chair, and he was unlikely to gain any control over his continence. The referral said that he was depressed, and that he showed the 'self injurious' behaviour of undoing his dressings etc., and he was unco-operative with those who tried to help him. He was uncooperative with me too. I identified with him. I think that if I was in his situation I would not want to live, and would be very frustrated at my lack of ability which would prevent me from killing myself. Wimpie explained to me that there were many things that could be done for him - of which I had been unaware. I didn't see the man again, but some other help was arranged for him.
I saw a big nineteen-year-old, John, who suffered with a severe speech impediment. His mother reported that his speech problem had started following a particularly severe beating from his father, when he was about eight years of age.
Prior to starting with National Service he had coped well with being an apprentice printer, where he didn't have to do much speaking. He had difficulty with basic training, where he was mocked by most of the other youngsters, which increased his isolation from them further. He was also big and lumbering, so he was conspicuous, which have subjected him to more attention than he would otherwise have.
I saw him after he had made a suicide attempt. Conversation with him was very painful as it took so long, and it distressed him. He was very tense, and would grind his teeth so hard that one felt that he must be at risk of ripping his teeth out of his gums. I overcame some of our communication problem by getting him to fill in questionnaires we had available, and I did a personality 'test' with him (The 'Thematic Apperception Test') getting him to write down his responses.
This indicated aspects to him which his speech impediment hid from most people - indications of intelligence (he played chess of a high standard), wide reading and a sense of humour. At the end of one of his stories, he added; "For more information see 'Of Mice and Men', by John Steinbeck."
I advocated that he be exempted from military service because his speech impediment would prevent him from developing the social support that most people need to survive national service. The recommendation was vetoed, on the basis of that we wanted to help him to feel that he had done his patriotic duty - a notion elsewhere seen as 'normalisation'.
We arranged for him to stay in Voortrekkerhoogte, and to see a speech therapist, and in spite of being a Consultation Team, with minimal therapeutic involvement, we kept tabs on him, and observed the minimal improvement he made in spite of intensive speech therapy input.
"87-11-03 John says things are building up at work and he feels unable to work. Accommodation-wise he has no privacy in which to do the exercises to stop himself from stuttering. He says that other people do include him in their social activities, but this is not convincing. Attended a week-long chess championship during his seven days and says his stuttering problem was then the best it has been for years. Following my enquiry, John says he will not feel that he is a failure if he does not complete his national service."
Things were worse at his unit than we realised, and a few days after the above session, someone actually killed themselves at his unit, and John was in a bad state. I again motivated to have him discharged. Marius was consulted, and while he felt that much could be done to help John, he accepted that we did not have the professional resources to offer this help. John was given a medical discharge.
"87-12-01 Told John about his G5 and the reasons for it. He accepts both arguments - give him a normal life in the army, and that the psycho-social stressors are too severe for us to expect him to adjust. He feels that he coped for almost a year, and I told him that the panel had been impressed with this."
DANGEROUS WHEN BORED
I saw a chap who had been a Parabat corporal who had been Court Marshalled following an incident on the Border when he had got bored and drunk, and 'blown up their own base', by throwing hand grenades around. [Further details of this incident appear 'Bad Guys: Friendly Fire'".]
He and one of the others involved had been given lengthy prison sentences, although no-one had actually been killed, but his father had appealed, and the sentence had been reduced to two years in detention barracks. (It often seems that parents have a great deal of influence ...)
After having spent about a year in DB, where he and the other chap had become 'trustees', the pressure started to take its toll, and they were assessed, first by the Consultation Team, and then on Ward 24.
Alas, as in so many of these cases, I don't know what the final outcome was. The man bore a passing resemblance to Mel Gibson.
Published:1 July 2000.
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