CHAPTER FOUR
The front entrance to the old 1 Military Hospital at about the time these events took place.
WARD TWENTY FOUR
Ward 24 was one of the three psychiatric wards of 1 Military Hospital, Voortrekkerhoogte, Pretoria. It was situated in the original Military Hospital building which had been in use during the Second World War. (Mention of this is made in Gordon Vorster's 'Textures of Silence', pp. 142-164)
The old hospital was used mostly for long stay, low 'maintenance' patients; including people recovering from amputations. There were also a number of patients concerning whom the authorities wished to keep a low profile. These were black men, probably soldiers recovering from various injuries. They were presumed to be UNITA soldiers, but no explanation was ever given about who they were.
The Psychiatry Department was based at the Old Hospital, but clung to keeping a foothold in the New Hospital, with Ward 9 and part of Ward 5. Ward 24 was old, and rather dilapidated, as was the whole of the Old Hospital, but it was on the ground floor, which the psychiatric wards in the New Hospital were not, and subsequently had its own garden in which the patients could go and sit. Most of them had unrestricted access to the canteen, a public telephone, and various courtyards, with tables and chairs at which they could sit.
Ward 24 was used mostly for National Servicemen, most of whom were aged between nineteen and twenty two. Occasionally Permanent Force people were admitted, and these were usually alcoholics.
National Servicemen were usually referred to psychiatry by the doctor serving at the unit sick bay, but referrals were also received from Social Workers, Chaplains and various other sources from time to time. Some patients also referred themselves, but this was often because they were in some kind of trouble.
There were two psychiatric 'firms' or 'panels' at the old hospital, and they would be on 'intake' on alternate days.
Patients referred to psychiatry would be seen usually by a doctor, but sometimes a psychologist, who would then conduct a standard psychiatric intake interview (see Kaplan & Saddock, 1985). Following this interview, a doctor would decide whether to admit the patient to the ward, or to tell him to report back to be seen at the next psychiatric panel, which usually took place first thing the next morning. Only doctors could admit or discharge patients from the ward.
If a patient was admitted to the ward, he would have to declare any cuts and bruises he had, so that he could not afterwards claim to have been mistreated. Patients would also be given, and made to sign for a copy of the rules of the ward, one of which was that patients had to write down their destination on the blackboard if they were leaving the ward.
Psychiatric Panels were held the day after the particular 'firm' had been on intake, and was a multi-disciplinary team conducting a mini case conference of the patients who had been seen the previous day. The panels were chaired by the Psychiatrist, and other members of the team were Medical Doctors, Psychologists, Social Workers, and occasionally Occupational Therapists or Chaplains. The Doctor who had done the intake interview would read out his notes to the panel. There might then be a brief discussion, after which the patient would be brought in to the room- unless this was considered to be too stressful for him - and another member of the team would conduct a brief interview with them, usually focussing on the suspected pathology, to give the other members of the panel a 'feel' for the patient and his problems.
After this, the patient would be thanked, and asked to return to the waiting room while his problem was discussed. The panel would then formulate a DSM III diagnosis (Spitzer, 1980) of the patient's problem, and a management plan would be agreed on.
The management plan would depend on the individual and his problem. It might be decided that no 'treatment' was needed, and the patient would then be sent back to his unit with a letter stating this. It might be decided that the patient should be offered therapy, either individual or in a group, by the psychologists, but need not be admitted to the ward. He would then be returned to his unit with a card for an 'out-patient' appointment.
It might be decided that the patient should be admitted to the ward for observation, or for intensive psychological treatment (daily) or if the patient was being given medication, like anti depressants or anxiolytic medication, to give the person time to stabilise on his medication. The patient could be reclassified (see below) which would reduce the amount of stress to which he could be subjected at his unit, and thereby help him to cope.
The patient could also be referred for further investigations, from the clinical psychologists on the team, who might test suspected borderline intellectual functioning; (An IQ score below seventy would result in the person automatically being given a medical discharge; and usually a state disability grant.) Other psychological tests might be used to gain clarity about the person's personality, or mental state ('ego boundaries'). Social Workers might gather family background information. Medical tests might be undertaken; blood tests for endogenous depression, EEGs for epilepsy and possibly CAT scans if brain lesions or tumours were suspected.
In some cases it would be decided that the person's psychiatric problem was so severe that they would not be able to cope with National Service, and a recommendation would be made that the person should be given a medical discharge on psychiatric grounds. This would always have to be approved by administrators higher within the organisation, most of whom had no psychological or psychiatric awareness whatsoever, and sometimes these recommendations were queried. (See below) In some such cases, patients would be kept in the 'safe' environment of the ward until their medical discharge had been approved.
MEDICAL CLASSIFICATIONS
The SADF has different medical classifications which can be given to soldiers; there are a 'G' and 'K' status. 'G' refers to the person's medical condition, and 'K' refers to the person's medical mobility; A 'G1 K1' is soldier who can be expected to do anything (or have anything done to him!) and who go anywhere, like the opperational area, or which every neighbouring country we happen to be invading at the time. A 'G4 K4' is someone who is not allowed to do any physical work whatsoever (supposedly), and who must stay in the close vicinity of a large military hospital. (A 'G5' is someone who is considered to medically unfit for military service, and is discharged.)
People can be given these classifications by Psychiatry as well as the other medical disciplines, and G3's and G4's can be people who are highly strung and anxious. A 'GT' is a temporary discharge, where the person is allowed out of the army, but with the knowledge that they will be called up again at some specified time, at which they will have to start basic training from scratch.
THE WARD 24 PROGRAMME
Although standing orders probably said that all patients must be up and about at six, this was blatantly ignored, and patients might still be getting dressed when the staff arrived for the daily ward rounds at 7.45 am.
A 'ward round' was conducted each morning. The staff would follow the psychiatrist around, and speak to each patient for whom that firm was responsible, asking them how they were getting on. It was a chance for patients to air any complaints they might have had.
Each patient was required to be seen daily by the key worker responsible for them, either a Doctor or Psychologist. This was why they were required to state their destination when they were leaving the ward, so that their key worker could track them down between other commitments; such as conducting new intake interviews, running groups, or seeing out- patients.
Various groups were run for the 'in patients', including art therapy which was organised by the Occupational Therapist.
TAKING THE PATIENTS RUNNING
Psychiatric research has shown that patients benefit from physical exercise. Commandant P. decided that he wanted the staff to become more involved in the ward programme, which is aimed to keep the ward patients busy or entertained during the day. Glenn and I decided to organise a running group, early on three mornings a week. We had to made it compulsory for the ward patients, with promises of weekend passes to reward co-operation, which they previously were granted routinely.
"The last time we went running we had six members of staff running and only one patient. We are working on that, but one wonders; all the staff have to get up an hour earlier to come to work to go running - ostensibly for the patients' benefit, and the patients try their best to find excuses not to go running, so that they can go back to bed until its time for breakfast. And we have the audacity to say that they are the ones with problems! It makes one think - I think!"
As will be mentioned later, the patients seemed to think that they were 'in den' when they were on the ward, and that they should be left alone, lie around and smoke themselves into oblivion.
Many patients would claim leg injuries, which we could not dispute. We would ask the admitting doctors to clear those patients fit for running when they admitted them, but this system broke down.
Others would dash off out of sight immediately, and hide or sneak back to the ward as soon as we had passed them. It wasn't the greatest success story I have been involved in.
I continued to lead this group for the first half of 1987, even though I was then based at the new hospital. Having to move around the column of runners, which seemed to spread itself out the length of the route we followed, I found the exercise unsatisfying, so I started to take myself jogging in the evenings to compensate. It did me a lot of good.
A particular patient I remember from 1987 declared that he was a certified drug addict, awaiting discharge, so 'Up yours, Captain. You can't touch me.' I would have loved to have asked him if he was proud of this, almost as much as I would have liked to have stomped his obnoxious little face in.
There were good times occasionally, especially with one of my patients who had been a 'Parabat', and who was super-fit anyway, and was willing to help organise the pathetic string of runners. I seem to remember some intimate moments of patients and staff patting each other on sweaty backs; a sort of 'we're all in it together' shared purpose feeling, which I enjoyed.
BILINGUALISM
"There is a pleasant and relaxed arrangement about which language to speak in the Department of Psychiatry - as I understand there is elsewhere - people generally speak in their own language and the person they are speaking to will reply in their language - it works well. Of course, to show off, I speak Afrikaans most of the time. Everyone assumes that one will speak to the patient in the patient's mother-tongue, but there is no attempt to refer English patients to English psychologists or vice versa. I have had several interviews and therapy sessions in Afrikaans and not found it to be particularly difficult."
"I've noticed something that interests me; when I'm speaking Afrikaans to someone and I want to quote an English phrase in the conversation, I find that I actually put on an Afrikaans accent for that phrase. I mentioned this to Fred, and he says that he has also noticed that people have the tendency to do this, but that he makes a conscious effort not to do it himself."
On occasion, I found myself on the phone to someone, speaking in Afrikaans, when some accent or slip suggests that they might actually be English speaking. Who asks first?
CONFLICT BETWEEN THE TWO PARTS OF THE HOSPITAL
Inevitably, with the Department of Psychiatry (Including Clinical Psychology) operating at the old and new hospital buildings, and given what I believe is part of the human condition; the belief that you are the only person who is doing any work, or that you are working the hardest, and poor communication between the different hospitals meant that conflicts developed.
We had a meeting to discuss this, and what to do about it. One of the suggestions as to how to improve relationships within the department was proposed by Retha E., what she called 'Spooking', ['Ghosting'? in English]. This involved putting all the names of the members of the department in a hat, and each person had to pick one out, and to anonymously do thoughtful little things for them; leave a chocolate bar for them on their desk, etc.
I drew Wimpie, who in 1986 I saw as being an irritating little psychiatrist at the new hospital. (I was later to work for the man!)I did nothing, but I hadn't liked the idea before drawing Wimpie. If I had drawn someone I liked, I might have put more effort into it.
The person who had drawn my name was a dedicated 'Spook'. I would return to my office to find little poems written to me in rather forced verse:
Barry the psychologist in blue
We all like you!
From Casper the Friendly Ghost
Barry my dear old friend
Without you this department would come to an end
Casper
Monday was a sad day
Because you were away
Missed you!
Casper
I strongly suspected that Coenraad G. was my 'spook', and turned out to be right. His final message, on the day that people who chose to could reveal who they had been 'Spooking' was:
"Coenraad, like Casper, also starts with a 'C',
so actually the ghost was me!
It was a pleasure being a ghost
for such a pleasant host."
(English was not his first language!)
Something that I thought was sweet; Estelle, the department's secretary drew Commandant P., with whom she had worked for many years, and for whom she had great respect and affection. She left a cake on his desk on one occasion.
WARGAMES
Another suggestion to enhance relationships within the department was that we should have a 'Spanbou'. I wrote down the story at the time.
"Our Department of Psychiatry recently held a 'spanbou' [team building exercise] for which we had a Friday afternoon off. We went to play "Mock Defence: Survival Games". This is apparently a developing craze in South Africa after having been imported from America. Where else?
Each person is issued with a gas operated pistol which shoots little capsules of glycerine, and you play variations of cowboys and crooks. It costs just under twenty rand [£5] for the afternoon, during which you feel entitled to act like three-year-olds. Our party consisted of two psychiatrists, five doctors, six psychologists and a social worker. For a kill, the glycerine capsule has to burst, and this is sore!! (On the next Monday, we were still comparing bruises and 'licking our wounds'.)
The referee told us how safe the whole thing was, and that they hadn't had a serious injury in the last two thousand games. We wore safety goggles to protect our eyes.
During the first game, the social worker was hit in the face at fairly close range, and her lips swelled up, and the doctors decided that she should go back to 1 Military Hospital casualty where they could fix her up - our revenge on 'casualty' for referring people to us unnecessarily.
A little while later, my boss, Pieter G., was seen hiding behind a bush, and two doctors took flight. One, Leon B., dived into a bush to escape, tripped, and split his chin open and knocked out a couple of teeth. He was taken along to 1 Military Hospital casualty as well. That was ironic. He has seven months of national service left; he spent three months in the operational area, and his only injury happened on a 'spanbou'.
We had to divide ourselves up into teams, and the first suggestion was that it be split 'Boer vs. Brit'. This came from one of the most Anglicised Afrikaners I have ever met, Franco C., and it surprised me. Why touch potentially sensitive areas like that? The English won of course!! Lekker! Next we had Doctors vs. Psychologists. Someone suggested we should have German against the rest, but Manfred B., the only German, didn't fancy the idea. The games were variations on Flag Raiding, and we were all dressed up in nutria and cammo and overalls, and the helicopters flying overhead made it seem quite realistic. We played in an area of about eight acres, which had a river, thick bush, ruined farmhouses and piles of rubble behind which one could hide.
It was an interesting way to spent an afternoon, but I won't be rushing back there again in a hurry. I get gun-shy and the capsules hurt. Andre G. put a note up on the departmental blackboard to announce the outcome of the spanbou; "Psychiatry 0, Casualty 2."
ACADEMIC ASPECTS OF THE DEPARTMENT
Commandant P. was very academically inclined, and the whole of the hospital was a training hospital.
In mid 1986, Commandant P. co-hosted an international conference on Post Traumatic Stress Disorder, which took place at a very 'upmarket' Johannesburg Hotel - was it the Carlton? The other co-host was one of the large drug companies.
As things turned out, it was not possible for the interns to attend this conference, which we felt a bit sore about, and we raised this complaint with Commandant P., who expressed his apologies. He probably had more important things on his mind.
Commandant P. requested that the psychologists arrange lectures and demonstrations for doctors new to the department on the different psychological tests that we used. This we did, and the doctors watched and listened with great interest. Then, using this new found knowledge, doctors would refer patients to us with the suggestion of which tests we should use, based on what we had told them, and we would then take offence that they were prescribing what we should do, which interfered with our professional autonomy.
We had weekly academic advancement lectures, either arranged by one of the staff, or on occasion by a guest speaker.
One such guest speaker was Pieter Spies, a man with some connections to the Dutch Reformed Church, who was seen as being an expert on how to help homosexuals to 'renounce their evil ways'. We invited him along to tell the department of psychiatry about his technique. He wasn't a hit with the department, as he was seen (my memory lets me down) as condemning homosexuality from a Christian point of view, which does against the 'Gay is Okay' philosophy of modern psychiatry and psychology. He was popular with the chaplains, who someone had invited. He arrived with a student who was writing a dissertation on his techniques.
After the lecture, he jumped a stop street, and was nailed by a traffic policeman. He approached the department asking that influence be used to quash his fine.
I was chatting about Humanism and Carl Rogers with Glenn in the tea room one day, and Commandant P. must have been listening. He suggested that I give a lecture to the department on Rogers. He suggested which text book I should base my lecture on. I didn't mind this, but others took offence on my behalf.
My public speaking improved during my time at 1 Mil, and my lecture on Rogers must have been my worst. I was nervous, and got myself tongue tied. "Rogers saw people as being developing orgasms ..." I said, making the mistake I had hoped to avoid, which I had seen a student friend make. I should have said 'organisms'. In discussing 'Conditions of Worth', I wanted to give the example of a mother saying to her child, "Mommy will love you if you eat your carrots." I fumbled that, and suggested "Love your carrots". My lecture, or rather my embarrassment, seemed to be well received.
BITS AND PIECES
A patient 'escaped' from Ward 24 and fled towards Northern Transvaal Medical Command, which is right next door, where five sentries tackled him, beat him up and sent him back. He doesn't want to escape anymore!
One of the beds in Ward 24 had the surname 'Fowler' written on it in block capitals. This gave rise to some rumours amongst the patients that at one time I had been a patient on the ward. I never did find out the story behind that, though I assume than some other Fowler had been a patient. Interesting!
In the SADF, sport was encouraged, and people who were registered as playing a sport, which would mean that they would have to attend a 'sports parade' (even if this occurred on a civilian golf course), were excused from working on Wednesday afternoons. There must have been a great many people playing sport on Wednesday afternoons, as it was almost impossible to get hold of anyone, anywhere. Everything seemed to close down.
The department of psychiatry contained many doctors. On occasion, Doctors prescribe medication. Various drug companies courted the doctors, peddling various products, and they would arrive at morning tea times, usually bearing cakes and other edible goodies, which the non medical people would tuck into while the doctors had to listen to the sales patter.
The SADF has been seen by many people as being the guardians of the Apartheid Regime. We had black cleaning ladies in the department, and when members of our department were leaving, they would get together and sing a couple of songs for us, which was great! They had excellent voices. ("They have such a good sense of rhythm" is a comment often made patronisingly by 'liberal' whites in reference to blacks.)
PUBLIC RELATIONS
I had a couple of calls from Officers Commanding, asking about why a particular soldier from their unit was still in hospital, and "Didn't we realise that the man was just bullshitting?"
Be diplomatic! "That's not quite the way we see it," seemed a polite way to fob them off.
One infantry camp commandant put all the loonies identified from his camp on a truck and sent them to 1 Mil - I think it was from Palaborwa. You have to admire the man's style. Maybe he was hoping for a bulk discount?
RELIGION
Psychology and psychiatry on occasions come into conflict with Christian ministers - especially with some of the 'happy clappy' ('Born Again' charismatic) ministers who rush in where even fools dare to tread. We had cases where such ministers would tell a patient that he was cured and that he should throw away his anti-psychotic medication. Then they would wonder why the guy was a raving lunatic again two weeks later. No, obviously 'his faith was not strong enough.'50 m of Faith, PRN please doctor!
MY OFFICE AT THE OLD HOSPITAL
I had a decent office in a prefab with a phone, and a bed instead of a Freudian couch. I didn't have a powerpoint at first, and it didn't seem to be possible to arrange one, so Annette V. got one of her contacts in the maintenance staff to drill a little hole in my wall, and I bought an extension lead, and we were in business.
DUNGEONS AT THE OLD HOSPITAL
The old hospital where I worked last year, is used mainly for psychology, psychiatry and rehabilitation departments, and many old operating theatres and other odd rooms left over from before the new hospital was opened are sealed off. We're short of space in the department at the moment, and I was walking past when I saw the Head of Department with the janitor, about to open one of these doors that until then had always been sealed.
We opened the door, into the old abandoned maternity theatre, and walked in to look around. It was dark and cavernous and dusty inside there, with large rooms, from which little rooms full of old what looked like iron torture instruments lay where they had been left, disused for many years. It was an amazing experience, like a medieval torture chamber. It was tempting to become poetic, and to describe the experience as being like therapy, exploring old torture chambers with a patient within himself. Words can't describe the experience, but it had quite an effect on me.
The place had been cleaned up now, and an old theatre has been furnished as a group rooms, which means 'swept out', and a circle of chairs put under the old theatre lights. I can't use it as a group room - its too eerie!
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