When the best way to change facts is through fiction
John Eagles wanted to show the public perception of psychiatric illnesses was outdated – so he wrote a novel
John Eagles grew up in Fife and then studied medicine at Aberdeen University, graduating in 1977. After training in psychiatry in Edinburgh, he returned to Aberdeen to take up an academic post whereafter he became a consultant psychiatrist at Aberdeen’s Royal Cornhill Hospital. He was lucky to continue within the NHS in a semi-academic post, doing research, publishing papers and teaching medical students. He became an honorary professor of mental health at Aberdeen University in 2005. After retiring in 2011, he embarked on a course in creative writing at Dundee University and commenced work on his novel, Starting to Shrink.
It is set in 1980s Scotland and chronicles the first year of Dr Douglas Barker’s career as a psychiatrist. It concludes with his appearance in front of the General Medical Council in London, after he is accused of having had sex with a patient.
The patients in Douglas’s new job fascinate him and he generally gets along affably with quirky colleagues. The exception to this is his consultant, Dr Edwin Burlington, who is conceited, blinkered and self-seeking. The relationship between Douglas and Dr Burlington suffers following a dispute about the management of an elderly lady’s illness. Things deteriorate further, and Douglas is moved to a post in psychotherapy. Here he finds some of his work compelling, some of it amusing and some of it puzzling. He treats several challenging patients, helping some and floundering with others. Five patients feature in the novel in some detail and have diverse conditions: depression, bipolar illness, anorexia, anxiety and abnormal personality.
He becomes close friends with his flatmate, Chris, a fellow trainee psychiatrist. They both drink too much. Their sparring relationship is generally good-natured, but becomes more complicated when Chris begins dating one of Douglas’s ex-girlfriends. Chris is critical of what he sees as Douglas’s shallow relationships with women, a pattern that has developed since the death of his fiancée.
The other backdrop to Douglas’s working life is his dysfunctional family, which has struggled since the death of his mother. Douglas experiences particular difficulties with his egocentric sister.
In his psychotherapy post, Lucy becomes his patient, and Lucy asserts that she and Douglas love each other. When he tells her that this is a delusion, she becomes furious and vows that she will get revenge. She does this through reporting him to the General Medical Council – and her complaint is supported by Dr Burlington.
At the GMC hearing, Douglas’s situation appears bleak, with the likelihood that he will be struck off the medical register.
A brief excerpt, during which the odious Dr Burlington feels that he accrues more evidence of Douglas’s degeneracy, may give a flavour of the book. Flatmate Chris has persuaded Douglas to skip an afternoon of academic tutorials and to head for the golf course instead:
Douglas smuggled his golf clothes in to work in a plastic bag, met Chris for an early lunch and was changing in his office, thinking all was going smoothly, when the door opened.
“Douglas Barker, your name’s on the door, baby, and what are you up to in here? Where are your trousers, honey?”
It was exotic Carol, the elated patient who had arrived on the train from Birmingham.
“I’ve come to the right place for some sex therapy then, have I, doctor?” she said with a giggle.
As she approached him, Douglas retreated towards the window.
“No, you have not. No!” he shouted. “I’m just changing. You should not be in here!”
“Don’t be nasty, Douglas Barker,” she said teasingly. “This hospital’s been such a friendly place so far.”
He managed to wrestle one foot into a trouser leg while using an arm to prevent Carol from coming any closer. He was shouting “Stay there!” at her and thinking that the situation could not deteriorate further when Dr Burlington put his head round the halfopen door. Dr Burlington’s head then swivelled from side to side, in a manner that Douglas later likened to a cartoon character.
“Preposterous! Bizarre! Degenerate!” he said.
“I was just changing my trousers,” said Douglas weakly.
“Who are you?” said Carol to Dr Burlington.
“Who am I? More to the point, young lady, who are you?”
“I’m Carol. Nice to meet you too. You’re one of the doctors, aren’t you? Isn’t Douglas a nice young man? He wasn’t doing anything you know. In fact, he was trying to get away from me.”
“He was attempting, you say, to escape. He was attempting, you assert, not to consort with you in a sexual manner, and yet clearly he – or you – had removed most of his clothing? I think not. I think otherwise.”
“Oh well, think what you like. Does it matter?” said Carol casually. “I’ll leave you blokes to chat about it. Bye, Douglas.”
With this, she sauntered out of the office.
“I can explain what was…” Douglas started.
“Explanations, I fear, Douglas, are effectively futile. It seems most propitious that I responded to the rumpus in this office en passant, since it seems highly probable that my intervention has prevented you from consummating a sexual relationship with a patient.”
“No, no,” stammered Douglas. “There was nothing like that. I was about to go…”
“Stop there, please. Further obfuscations may but incriminate you progressively. We must talk about this rationally when you are fully dressed and composed. There will be an opportunity, hopefully, to do that within the next working week. No doubt, in the meantime, you will take the opportunity to reflect upon your behaviour.”
Douglas sat at his desk for some time after Dr Burlington’s departure. He forced himself to rise and go to his car, where he knew Chris would be waiting.
“Iwouldloveitifa young person or two were to read the book and it swayed them towards considering a psychiatric career’”
Since Starting to Shrink was published, I have been asked several times why I wrote the book. Perhaps it is typical of psychiatrists to examine the motives of others more than their own, since I had not, until now, given this much thought.
I rather assumed that most people would like to write a book, if only for motives George Orwell called “sheer egoism”, including the desire to seem clever and to be remembered after one’s death.
Writing also afforded me a post-retirement structure and a feeling that I might be doing something useful with my time, which is perhaps a need shared by many retiring Scottish Calvinists.
There were broader motives too. The stigma associated with psychiatric illnesses can be exacerbated by sensationalised portrayals in books, films and television. I sought to show that “ordinary” psychiatric disorders can be fascinating and that they affect “ordinary” people. Psychiatric disorders are not weaknesses; they are illnesses from which people usually recover and return to a normal life.
A similar stigma can afflict psychiatrists, who are often portrayed as neurotic eccentrics peddling unscientific treatments. The book also portrays psychiatrists as fairly ordinary people.
Starting to Shrink does reflect some of the lessthan-scientific approaches that were deployed during the 1980s, and it should be emphasised that psychiatry has become hugely more evidence-based over the last four decades. This fact is not always appreciated and may contribute to the difficulty in recruiting adequate numbers of scientifically-minded young doctors into psychiatry, which is surely among the most fascinating of the medical specialties.
I would love it if a young person or two were to read the book and it swayed them towards considering a psychiatric career.
● Starting to Shrink by John Eagles is published by Austin Macauley, at £9.99, out now