If you want to have joy, do

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bully from the mean streets of inner Belfast and he ... senior registrar up against a wall by the lapels of his .... with a small garden for the now adult dog) I woke.

MJA Dr Eric Dark Creative Writing Prize

If you want to have joy, do


efore I migrated to Australia, I had my darkest years working in a community mental health service, in a deprived area in the north-west of England. Our senior psychiatrist was a sociopathic bully from the mean streets of inner Belfast and he must have survived by trying to be one of the tough kids. He was rumoured to have once headbutted an aggressive patient in the emergency department when he was a medical student, and I did see him hold a senior registrar up against a wall by the lapels of his jacket and shake him for changing medications for one of “his” patients. Our clinic was situated on a busy road and the outside walls were covered in graffiti. The inside had peeling paintwork and worn carpets. At least half of the staff were taking antidepressants, and the ones with the most empathy were often taking more psychotropic medication than their clients. The surrounding suburbs were even worse, with five-storey flats connected by overhead walkways, with vomit and urine in the stairways. The flats had mouldy walls and damp carpets. Vicious Rottweilers roamed the streets, and only the local drug dealers weren’t frightened of them. The nearby psychiatric inpatient unit used to be a large asylum with 6000 beds, with grounds that were one mile across. Now it had only 600 beds, and the bureaucrats were hoping to close even those, and sell off the land for housing and a shopping centre. Ex-patients lived in abandoned wards, along with feral cats. And who could blame them — most had known little else as they had all been long-term inpatients. Hospital walkways usually had broken windows, which were never fi xed, as the hospital closure was always said to be 6 months away. Such was the bleakness of community mental health care after the promised bright new future when the asylums were closed. I was burnt out and losing myself, and relied on a steady stream of black humour from the other staff to keep going. I hadn’t even fi nished my specialist exams yet, and I wasn’t sure if I should. My patients were either melancholic women in their 30s or 40s who had been abused one way or another for most of their lives, and were often former opiate misusers who were taking methadone, or men who were angry and agitated, with psychotic disorders aggravated by ongoing polysubstance misuse. Both had some things in common though: dead eyes and a seeming need for chaos to enliven their daily lives. Helping someone recover and have a meaningful life of work and pleasurable relationships was a rare occurrence. Most of their families, including their children, were clients of various mental health services. I told myself that I would quit this work if I ever saw a patient’s grandchild at the clinic. I spent my workdays yearning for the harrowing tedium of the clinic to end, so I could spend an hour

Sandra F Armstrong Medical Advisor Health Professional Advisory Unit, Centrelink, Department of Human Services, Adelaide, SA.

sanarm@ optusnet.com.au doi: 10.5694/mja13.10393

At least half of the staff were taking antidepressants, and the ones with the most empathy were often taking more psychotropic medication than their clients

Highly commended Practising and retired doctors category

driving home through rush hour, often in the greyness of falling rain or snow, and then study, watch TV, and drink too much wine until I fell asleep on the sofa. Then I started all over again the following day until the relief of the weekend. Occasionally a patient woke me from this torpor and I can still recall most of these men and women, while everything else about that place and time has been walled off in my memory. Some of these episodes were tragicomic, like the manic, well spoken Oxford graduate who convinced passenger jet personnel that he was the copilot; fortunately, he was found out prior to take-off. Or the psychotic woman who persuaded a taxi driver to take her to London, so she could escape the aliens that were chasing her, and then refused to pay him. She was surprised when he called the police, as she said she was a diplomat who didn’t carry money and had immunity from this sort of petty matter. The majority of these situations were just tragic, like the 18-year-old with Asperger syndrome who overdosed on his father’s antidepressants after an argument. Four hours of resuscitation couldn’t save him. Another was a young man who had constant musical hallucinations due to schizophrenia, who despairingly told me that it was like a concert you could never leave, even when you were exhausted. My most haunting memories are of a crying woman who also had schizophrenia. She described all of the hurt and abuse in her life as a hole in her chest that she could really feel, and put her hands through. This somehow resonated with me and I wished I could comfort her, erase all of her past traumas. Then I saw her again and she was smiling, even her eyes were bright. She had been given a puppy, a chubby poodletype mongrel. I listened while she told me about the puppy’s naughtiness and foibles. She brought the puppy along to her next appointment and I went outside to see it. I watched the joy in her face as she held the puppy, and it licked her face. The other staff members were pessimistic, predicting it wouldn’t work out, that she wouldn’t be able to cope with the required ongoing care as “she had never coped with caring for anyone or anything, including herself, for any period of time”. But she and the puppy continued to thrive and I now looked forward to her appointments. The puppy always got fed and vaccinated, even if she could only afford cigarettes to smoke and toast to eat. She stopped drinking alcohol and I was able to reduce her medication. The puppy helped her make friends when she walked it to a local park and met the other dog owners. The day after our last encounter (she was moving to a unit with a small garden for the now adult dog) I woke with a panic attack, after a nightmare of being chased through interminable tunnels, and I realised that my life was an ongoing desolate ordeal with no joy of

MJA 199 (7) · 7 October 2013


Reflections my own. I realised that I deserved a life with more meaning, perhaps even happiness. By the end of that year I arranged to move to Australia and found a new career. Now I have my own moments of joy, sometimes even for days at a time. I have a house with a large garden, grow organic vegetables and have chooks in a coop. There are gum trees with kookaburras and multicoloured rosellas. I volunteer at the local school,


MJA 199 (7) · 7 October 2013

supervising children’s reading, and get a thrill every time I realise that a child has got the reading bug. And now my favourite time is coming home and being greeted at the gate by my own dog jumping with excitement at seeing me. Seeking joy in your life can be difficult, but luckily I realised it was essential before it was too late. 