A lifetime in psychiatry Dr Harry Freeman reflects on his long career. In the 1970s my first year training in psychiatry was in a huge mental hospital in country New South Wales - there were ten such hospitals, all about 100 years old - sandstone, farm self-supporting, beautiful gardens - run by the nurses and only a couple of doctors. A hospital house for working wife and baby (and Grandma), pay rise from $4,000 per annum as a similar RMO to $7000 as a registrar, ignorant, grandiose, political activist, anti-Vietnam, anti dominant paradigm, cocktail pianist, energetic and not hesitating. I felt good. The hospital had four groups of patients, men and women in separate wards. So, as well as the mentally ill, there were alcoholics, dementia patients and those with intellectual and behavioural problems. Each group comprised about a quarter of the hospital population. These latter groups filled the state’s hospitals by the 1960s. Families no longer able to manage such people as the family dispersed and changed. Despite more buildings, the hospitals were deteriorating, overcrowded and a Royal Commission in the 1950s determined that they shouldn’t survive. A political and financial decision was made to do psychiatry in the community and in ordinary hospitals. Creating so-called community mental health is a nonsense, given how many different sorts of humans there are in the communities within which we exist. The dementia cases would be solved by creating subsidised and non-government nursing homes (predictably seriously problematic), the alcoholics got a few name changes and little else, and the handicap group are doing pretty well in “the community”. The mentally ill are homeless and the drugs which help them in hospital didn’t really solve their problems when out of it. That is now, but in the 1970s, only 50 years ago, we still had the “mental
8 | NorDocs
Long-time North Coast psychiatrist and accomplished pianist, Dr Harry Freeman. Photo: Jonathan Atherton hospitals”, and I threw myself into seeing all the sorts of souls living there, with little supervision and lots of initiative and hope. I had a great year. However the permanent staff were caring for patients who were very troubled by unmanageable moods and thoughts, despite treatment, rarely cured; many were troublesome, and many staff were quite demoralized. I had particular responsibility for the dementia wards (there were few nursing homes then) and extended families were disappearing fast (so no carers for the elderly). My job was to sign the death certificates (life expectancy was about two years from admission), review/increase medication, do physicals and keep a low profile. Nurses had run the place for the last 100 years. These patients were in huge Nightingale wards, 50 each, 50 chairs around the day room; chairs with arms allowing a long sheet to be passed along them to restrain the patients, and another long sheet was
under the chairs for ... They were placed in these chairs for breakfast and spent the entire day there, usually needing help to feed (this being the result of the immobilization), doses of sedatives they required for sleeping, usually manacled, with little touch or conversation during the day, and then to bed. An event I especially treasure was when I was holding an “existential group” in a chronic general ward of mostly mute, occasionally catatonic, paranoid cases when one of them who worked in the farm’s piggery and who had not spoken for 15 years, grunted, during a silence, “But they’re very good to the pigs”. Then he stopped speaking again. Another memory is of the med super dressing me down for seeing patients in their homes, keeping them out of hospital and discharging too many. This meant he was about to lose a cook because of dropping bed numbers, and in a country town an employed cook is much more valuable than a young doctor!
