CHAPTER THIRTEEN
PROBLEMS WITH PARENTS
As psychologists, we were often victimised by the patients and their families. A common defence is always that 'we were just obeying orders' or 'implementing policy', and we were very limited in the extent to which we could make arrangements to help people other than helping them to find the personality resources within themselves to adjust to the situations. We weren't so hot on arranging practical help.
Many patients didn't want to adjust - they wanted a transfer to the unit closest to their home, and a sleep out pass, and they knew that if they adjusted, their chances of achieving their objectives would diminish.
The army saw it as our job to help people to adjust, and we were aware that ours was the gentle approach, and that the army was quite capable of using harsh 'discipline' to enforce conformity.
A problem for us would happen where parents would decide to intervene of their son's behalf. They were not part of the military system, and so felt that they could throw their weight around, and sometimes were successful in this regard. I was often amazed at what privileges some senior officers arranged for soldiers whose parents threatened to make trouble.
We were unable to make such arrangement ourselves, and so parents often had the satisfaction of saying "Where can I get hold of someone who is worth talking to?", and almost stick their tongues out at us with contempt when they had got what they wanted from some senior officer.
In dealing with such problem parents, it was easiest to hide behind "permission" and "authority" to avoid parents. (Ryan & Thomas, 1980, p 73.) Some parents would phone up wanting to know what the results of 'the tests' were - often things that I couldn't understand. You could waste a lot of time talking to parents that way, though this would be seen as part of offering a quality service. If the patient was over 18, we could say that he was an adult, and we could not release any information without his permission, and suggest that they speak directly to him.
Something that might not be widely known about the SADF is the fact that national servicemen were allowed to get second opinions from their own doctors (and psychologists), providing that this consultation took place within the patient's own time, and at his own expense.
I was often amazed how 'negotiable' some parents seemed to think National Service was, and in some cases their assumption proved correct.
I assessed an apparently very immature Afrikaans lad, from 'the sticks' - some remote rural farming area. His presentation, apart from misery was that he had severe allergies to dust, and just about everything else, which drew some sympathies as square bashing in the Transvaal always seems to result in clouds of dust everywhere.
The lad was given 'recovery leave', and went home where he spent his time ploughing fields on his family's Transvaal farm, from dawn to dusk. No problems with allergies now. Watch the sympathy evaporate!
His mother was a dominating sort of person, - no wonder he was immature - who thought that all she would need to get him to be exempted from National Service would be to come and talk to us and point out to us that, while he must not shirk his 'duty', doing military service would not be good for him. He was needed on the farm. Annette O. had a long mother-to-mother chat to her, after which he continued with his National Service.
ASK AND IT SHALL BE GIVEN?
A story of frustration in trying to organise things in the army; I have a sixteen year old girl for a patient who comes from a disgusting social background - incest - mother now going out with teenage lover who beats her up - you get the idea! But the girl is very pleasant, and we think that we can try to help her overcome the handicap of her origins. At the beginning of the year, someone told the mother that it would be a good idea to send her daughter to boarding school at a place called Bronkhorstspruit, a one-horse-town about 80 km. from Pretoria, which the mother then did.
Daughter then had what was at first diagnosed as meningitis, and then as gastroenteritis, and finally as psychosomatic, at which time she was referred to the 'Psychiatric Consultation Service'. We had her discharged, but decided that I would follow her up for weekly therapy sessions.
Mother then said 'Thank you very much but who's going to organise transport?'. Like an idiot, I said that I would try to organise it. Our hospital's transport service was so helpful as to tell me that if I wanted to find out which busses came into Pretoria, my best bet would be to drive out to Bronkhorstspruit, wait at a bus stop, and watch to see which busses passed. Unimpressed, I phoned around in the military (She is the dependant of a PF member - part of the problem explained), and I was referred from pillar to post, and told to wait for people not to return my calls, and eventually I was told by a Colonel that it could not be arranged because (a) the military transport is full, and (b) that there is a directive out that dependent children are not allowed to ride on military transport, even for medical treatment. No-one is prepared to take the risk, for if they are discovered, the vehicle being used could be confiscated! What sort of organisation am I working for?
I told the mother that we couldn't arrange transport, and her suggestion was that I should see her daughter on Saturdays - this is not on! Mother says she is dissatisfied, and threatens to complain to the Surgeon General. She asks me for his phone number, which I have, so I give it to her. I know that I have done more than is expected of me, so I make sure that she gets my name right, if she does get through to the Surgeon General. The SG's a busy man. Surely he'll tell her to get lost? So I tell her that I'm Captain Fowler (which she knows); F-O-W-L-E-R! ("I'm not afraid of you, you unpleasant person!") Two hours later a Commandant phoned me, all very friendly, and told me that the Surgeon General has taken a personal interest in the case. The Director of Logistics has - At His Request - given special permission for this girl to ride on military transport, but they can only get her so far - 'could we arrange transport from there?'
We got the mother to fetch the daughter from there, but that wasn't the point. We were undercut by our superiors! (Score: Pleasant patient's obnoxious mother 1, Good-guy medical professionals 0!)
We, who have to do the work, have channels blocked, but going over us gets results. We get the message! Next time we should just refer such patients straight to the office of the Surgeon General.
A MOTHER WHO WELCOMED THE ARMY AS A BREAK FROM HER SON
Aviel's mother was not on his side. She contacted the psychiatry department when she learned that her son had arrived at our door, and requested; "Whatever you do with him, don't send him home."
"He states that he will never be any use to the army so they might just as well exempt him. Everyone thinks that he has an attitude problem while he believes that he has a psychological problem. I got him to write out a description of his psychological problem. Nothing new. Notes kept in patients personal file."
His mother exerted influence, and managed to get him transferred to Kimberley when we had recommended that he be transferred to Witwatersrand command.
"I negotiated with his mother, who eventually decided that she would be prepared to have him over weekends, but he immediately started manipulating to go home every night as he says that he wants to study. I am sure that arrangements could be made for him to study at his unit. Mother accepts no responsibility for her son and wants the army to sort him out for her."
Eventually we got him transferred to Wits Command where he immediately started manipulating again. Wits apparently didn't have kosher facilities, which he now insisted on, in the hope of getting a sleep out pass. Kimberley had apparently had a kosher mess.
"Aviel is making a nuisance of himself and has apparently gone on AWOL three times in the last week. We discussed giving Aviel a choice - either Aviel stays in Wits with a weekend pass only and no kosher, or he comes back to Pretoria where he can have kosher, and I can supervise his management. He does have psychological problems, but he uses them to manipulate and get what he wants, and he continues to terrorise his mother."
One 18 year old was making a nuisance of himself. He was immature enough for him to be offered a temporary exemption; 'Come back and do a complete to years when you are more grown up'. He accepted this, and it was put in motion. His father wasn't happy with this idea, and came a considerable distance to try to have this revoked and have his son continue with his military service, but at that stage it was too late.
FOLLOWING MY RETURN FROM THE BORDER:
My PARANOIA was possibly understandable in view of the number of people who suddenly seemed to start trying to get me into trouble. This prompted me to document each potentially hostile situation, (Psychology practise involves keeping notes on each session with each patient for use should legal problems arise). Policy at 1 Mil was that the Officer Commanding should be informed in advance of patients that might make complaints to him, so that he would have the facts at his finger- tips.
I think I overdid it a bit, in retrospect, and his secretary, Myrtle ('The Turtle'; collector of ornamental frogs) was probably quite amused; "Ah, its Captain Fowler with another defensive note for the OC!" and she filed it in her drawer!
There were occasions when we were supported by our superiors - above the Psychiatry Department that was:
Dr. Les G. had spent a three month Border Duty at one of the most remote and isolated Border bases - and was still rather shaken by the experience. He and I saw a youngster who decided that he 'had had enough of the Border.' He was in the Air Force and based at Rundu; a very quiet part of the Border. He used his position to get on board an aircraft and fly down to South Africa. In South Africa, he was arrested, threatened suicide, and was referred to 1 Mil for evaluation where we met him.
The man's father decided to intervene, him having been a sergeant or something when he had been in the army ('When men were men') and he was expecting to use the 'old boy network' to get his son out of trouble. This involved giving us a hard time.
"Why were we treating him as a criminal," the father demanded of me.
"Jou seun is 'n krimineel," ['Your son is a criminal.'] I told him, to Les's amusement. The lad was! He had gone AWOL from the Operational Area. He could be charged for "desertion, attempting to evade military service, behaviour contrary to the maintenance of discipline and good order."
The father decided that he was wasting his time with us, and demanded to speak to the OC of the hospital. The real OC, a reasonable man, was away, and his deputy was Brigadier Scholtz, who was known to be a very unpleasant person - especially towards national servicemen.
I contacted him, and he told us to see him first. With Les being a Jewish national serviceman and me being an English speaking PF, we expected that we might have a rough time, but the man listened while we explained the situation, and then dismissed us. The father was accompanied by one of the nursing staff, who gleefully reported to us that the Brigadier had been very off hand with the father, who became 'meek as a lamb' before him. And the Brigadier finished by telling the father to stop abusing his (the Brigadier's) staff.
What a lovely surprise!
Les G. and I seemed to see several problem patients together. One was a 19-year-old lad called 'Greg' who claimed to be depressed and that he could not 'handle' work at his unit. His work turned out to be manning the unit's canteen (sweet and newspaper shop) for 2 hours a day. He seemed to have very poor social skills, yet it turned out that he played soccer for one of the better teams in Johannesburg, possibly even Wits University team. I saw this as a contradiction of the isolation he now showed. Football is a team game, and one has to be 'one of the boys' to get anywhere, doesn't one?
He was a weak and feeble, and he saw the solution to his problem as a transfer to the unit closest to his home and a sleep out pass. I didn't find much sympathy for him, especially having just returned from the Border, where people were constantly in potential danger, had to wait more than two weeks for their post, and were unlikely to get a weekend pass for months at a time. Why should this man, with a cushy job that most people on the Border would have given their eyeteeth for, get the further privilege of a sleep out pass?
The power in the family seemed to rest with two aunts, who came to visit us and tell us that we should let Greg 'out of the army'. As they were not immediate family members, I refused to see them after the first time.They threatened that they would just arrive there, and then I would have to see them.
"Oh, no I won't," I told them in more diplomatic terms. So they sent in Greg's father, to come and 'sort us out'. The man was quite pleasant, a loud man with little to say and a huge red nose. We could talk to him - Les and I sat him down and said that Greg needed to adapt, and that he was on a cushy number, and there was a chance to let him learn to stand on his own two feet, and wasn't it time the boy cut himself loose from the apron strings? The man responded well to this talk, agreed with us, and went home, where the aunts debriefed him, told him he had failed in his mission, and sent him back to us. We must have seen him for four or so meetings.
"87-11-20 Patient has invested no thought into how to help himself during the week he has been on the ward. Said he can cope with the ward, but he becomes tearful at the thought of returning to the unit. Admits he wants a G5 because he cannot handle the army. Says he wants help and that he is not getting it. Says his life is already a mess and that a G5 will not make it worse, i.e. unemployability. He has done nothing to help himself. Wants others to step in and save him."
In spite of all my efforts to get Greg to adjust to his 'cushy number' at his unit, a decision was made by his home unit to transfer Greg to that unit closer to home. Before then, Greg's father was instructed to ask for psychological support other than that offered by 1 Mil - my colleagues and immediate superiors agreed. I wrote the referral note, ending with the phrase: "I apologise for referring you such a patient."
{LATER NOTE: I met Marius M., Psychiatrist, at 5 SAI (Ladysmith) in February 1990. He commented that he had read my letter and that he got the feeling that the patient had really got under my skin. I don't know whether he was sympathising, or whether it was a mild rebuke.}
Les G. was to finish his national service at the end of that year, and he was heading to a surgery post at one of the Johannesburg hospitals. Greg's father heard about this, and said to Les that he was pleased about this because he would be around for them to consult.
"I'll be out of the army then," Les told him.
"We could see you for some friendly advice," the man countered.
I don't know what Les answered to that, but I know that he didn't see himself as a friend of Greg's family.
A PATIENT HITS BACK (WITH EVERYTHING)
The patient that was most troublesome for me at this time was Michael, a chap that I felt very positively towards at first. He was from the same unit as 'Greg' above, and the two of them knew each other. Let me just repeat my notes:
"1987-11-16 (DAVE'S NOTES) Narcissistic traits. Panel agree patient is faking bad, exaggerating symptoms - especially as knows other psychiatric patients on the ward. Normal duty. Recommend strict consistent management in terms out outpatient therapy. No manipulation (passes, transfers, boards) to be tolerated. Attempts will mean termination."
"1987-11-17 Psychometric work up. Nil of note. I told the patient of the employment risks associated with G5. Told him his symptoms lightly cover a variety of psychiatric conditions. We accept he has a problem, but he must please not add in other symptoms. Patient thinks we think he's 'gyppoing'. Patient says he has a problem and wants help. I asked if he will accept the help we offer, to adapt to being in his unit, and to leave his nightmare past behind him. Patient will not get what he wants - transfer closer to home and a sleep out pass so that he can keep an eye on his family - was this the secondary gain that the patient did not report to Dr. Dave S.. Patient to think over therapy on our terms. Patient reported back to Dr. Les G. that I told him that the panel thought he was faking although I clarified this with him before he left my office, banging doors after his session with me."
"1987-11-24Patient did not present for scheduled appointment.(Later the same day) Details of going on AWOL and suicide attempt. He was brought in to 1 Military hospital, where he was referred back to me. He says that he told his WO1 at the unit, SM Engelbrecht that he was not satisfied with the treatment he was getting at the new hospital and asked to be referred to the old hospital. He says that WO1 Engelbrecht told him to first report for his appointment at the new hospital. If this was unsatisfactory then alternative arrangements might be made. It must be pointed out that the patient complains that he is not receiving help, and yet, when he was told to wait in the hospital for his appointment, he went on AWOL and made a suicide attempt two hours before he was supposed to see his psychologist."
"1987-11-24 Interview with Michael's father, arranged by Dr. Dave S.. Father appeared to be concerned about his son. He was home over the weekend on a weekend pass, during which the parents sent him to see a private psychiatrist, who said that he appeared to be depressed at being in the army."
"Father says that the trouble all began when he was transferred to his present unit. Father says he will use his member of parliament to have the patient moved to another unit. Father says he knows how to contact minister Magnus Malan [Then minister of Defence], and that he has the telephone number of General Geldenhuys. Father visited son's unit and says he does not know how any of the NSM's cope there. Says he has been speaking to 'morons' all morning. Father's complaints are that people have told his son that he is worth nothing, and has no rights. Father has not done any military training himself. Father says he wants to know why his son was transferred away from his previous unit - says he believes it was because his son had an argument with the OC of the previous camp. Father has requested to be informed of the reasons for his son's transfer, but was told that it was the army's right to transfer its personnel, without explanations to parents. Father reports that a friend of his son saw his son's medical file in Kimberley in which it said that his son had had malaria, which was why he collapsed after his 'Vasbyt' in Kimberley (*). Father asked me to keep this information strictly between the two of us, but I informed him that all information received by me must be shared with the psychiatric panel, and must be included in the notes. Father asked me what type of psychotherapy I intended to offer his son and we discussed this. Interview ended on a cordial note, and I invited him to contact me if he felt he needed to."
"1987-11-26 A captain from the patient's unit contacted me. She said that the patient did not wish to see me again because he alleges that I had told him that there is no God. I told her that I still wished to see him at his scheduled appointment on Friday. I also asked them to make him make a statement about his accusation. The captain asked whether they could give him a weekend pass. I recommended that they do not give him a weekend pass. I recommended that they do not give him any leave to go home until further notice."
"1987-11-26 Received a telephone call from the patient's father. He complained that it had taken him 17 minutes to locate me. He told me that his son had said I had told him that there is no God in the army and demanded an explanation. I told him that I had said no such thing. (In an interview with myself and Dr. Dave S., the patient showed that he could not accurately repeat what was told to him. He told Dr. Dave S. and myself that I had said that he had a split personality, which is not a term I use.) His father then reframed this to indicate that his son was in an emotional and cognitive turmoil. Father then challenged me that I had recommended that his son not be allowed to go home. What was I hoping to achieve by this? I told him it was part of our psychiatric management of the patient. He asked me whether I intended to see the patient on Saturday and Sunday and if not, why could he not be allowed to go home? I repeated what I had said, and pointed out that the last time he was home, on Tuesday, he had made his suicide attempt. Father then said that he had thought that we had 'an understanding' following our interview but that my attitude had changed. He said that he was 'sorry that things would now become unpleasant' and put the phone down before I could say anything further. I wrote an account of this which I handed in to Mrs. B. (Mrs. Turtle), secretary of the OC of 1 Mil. I also contacted Lt. P. of the chaplains service to alert him of the allegations which are being made about me and to declare my willingness to co-operate with any investigation which the chaplains service might consider necessary. Lt. P. said that he was already aware of the case (**), and would be handing the whole case over to Padre C.."
(*) 'Vasbyt' - Michael was exaggerating here. Basic training, which was all that Michael had completed, did not include the awesome 'Vasbyt' route march.
(**) That Lieutenant P. had a wicked sense of humour. When I spoke to him on the telephone, I said that I was 'Captain Fowler.' "Oh, yes!" he said. "You're the chap who's telling the lads there is no God in the army. "He didn't seem to be taking the allegations all that seriously.
When I complained that evening to a close friend, he backed me up. "Of course there's no God in the army," he pointed out. "He's everlasting. They could never give the [deity] an army number ..." (I knew I was safe.)
"1987-12-01 Lt. K. investigates. Michael was given a weekend pass by his unit CMDT against my advice. Says his father still intends 'to take things further'. I explained to Michael why, of the psychologists available (I was the only qualified one) I think I should follow him up. Explained to him why we had decided against referring him to Dr. Clive W. (I think he had asked to see Clive, which interested us).I explained the therapeutic process and management I envisaged for him."
THE HERETIC II
Michael was in trouble, possibly on his way to DB, and he wants to get out of it by making out that everyone he sees is incompetent, or biased against him. The context was he had told me about a friend of his who had died in the army, and how the people in the unit had only said "His parents won't get any money". He thought they should have prayed for him instead. I said something to him about people not always acting as Christians when they profess to be Christians, and he managed to distort it fairly well.
The senior people in the Chaplain's service have it in for Psychologists - so the junior Chaplains admit - but all the Chaplains that I work with have assured me that they will stand up for me, and that nothing will come of it anyway.
The patient, who has 'strong traits of Histrionic and Narcissistic Personality Types', arrived for an appointment with me, to be told that I was delayed, and he was asked to hang around until three o'clock when I would be able to see him. His time belongs to the army, so we can do this to patients. Instead of waiting, he went home to Johannesburg on AWOL, where he made a very dramatic, but harmless suicide attempt. Now he is being charged with AWOL and 'damage to state property'. What he wants is a transfer to Johannesburg and a sleep out pass. He is stationed in Pretoria at the moment, half an hour's drive away. There are soldiers fighting in Angola. I don't have much time for such manipulative patients. I went out of my way to try and help him, and he 'bit' me. I find myself feeling vindictive, and hoping to be called to testify at his court marshall.
Dave S. wrote a note to me concerning this patient. Elsewhere on the paper was the word 'prejudiced' in Dave's elegant handwriting. Had he been testing the spelling, or was he having a jibe at me?
ANOTHER BORING SELF-DEFENSIVE LETTER SUBMITTED BY A PARANOID PSYCHOLOGIST CAPTAIN TO A SECRETARY WITH THE NICKNAME 'MYRTLE THE TURTLE'.
On 19 November 1987 I accepted a psychiatric referral from casualty department at approximately 13H45. The patient was K. [identity]. The patient had made a vague suicide attempt the previous day.
2. The referring doctor told me that he had been instructed to refer the patient by Dr. W. of the hand clinic. The doctor said that the patient had been unco-operative.
3. Before I could see the patient, the patient's mother took me aside, told me that she was worried that her son had a serious problem, but that we would not take him seriously.
4. I took the patient to my office on ward 5 to conduct an evaluation. I asked the patient's mother to wait at casualty, rather than to accompany us. I did not envisage interviewing the patient's mother. I did not tell her that I would be seeing her.
5.I evaluated the patient, writing full notes.
6. I decided that the patient was not a suicide risk. I gave him an appointment card to appear before a psychiatric panel on 20 November 1987. I told the patient that any disciplinary problems he caused between when I saw him and the panel would prejudice our ability to help him.
7.I allowed the patient to return to casualty unescorted.
8. I phoned the doctor at casualty to inform him of my evaluation and provisional management.
9.Arriving at work on 20 November I was told that a Mrs. K. had phoned to complain about my management of her son. Her complaints were that he had not been admitted, and that no follow up had been arranged. She said that her son was lying at home in a daze, and said she did not know what to do with him. She did not leave a number at which I could return her call.
10. I phoned the patient's unit to determine the patient's whereabouts. The adjutant officer said that the patient had not been at work for the last month. He had seen the patient, accompanied by his father, with the RSM the previous day. The adjutant officer could not tell me whether the patient was AWOL. The adjutant officer gave me two telephone numbers at which I could contact the patient at home.
11.The patient was not known at either of those numbers.
12. Until the present 09H37 20 Nov 1987 the mother has not contacted me again.
13. I anticipate that this mother may attempt to complain to higher authority, especially if her son is on AWOL. I wish to draw your attention to this matter.
On the patient's computer file, I found notes indicating that he had been seen by Pieter G., who described him as being 'unmotivated' and attempting to achieve "secondary gain from his sore hand ... "
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