Being With and Saying Goodbye: A Reflection, by Andrew F. West

Healing Between the Lines: How doing and being go hand-in-hand

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My book (I feel inclined to say “my first book”), Being With and Saying Goodbye, has just been published and is on the shelves. This is an exciting, but teetering position from which to reflect; I am still asking myself if the book is any good. True, Karnac Books invested in it and I still bask in the extremely positive comments of the book’s endorsers. The only criticism I have received so far has been that the book may reflect an unrealistic hope, and that the first chapter might give the impression that the whole is about Zen Buddhism.

Support from family and friends, being an expression of love for me rather than the book, is a less reliable assessment than my own – and I am reserving judgement until it has been on the shelves for a while. What, then, can I say at this point? The Introduction, chapter list, and a fair selection of text, can be found on GoogleBooks, so to replicate these here, with a description of the content, seems spurious. Yet there does seem to be something to say. I can detect in me some creative impulse connected with this current (as opposed to any future) book. Leaving aside the perfectly plausible argument that this stems from an unhealthy and oedipal-parental reluctance to release the book from my direct control, I shall explore what this impulse might be.

To my mind, process and content have always gone more than hand-in-hand, particularly when it comes to matters of communication. If this piece of writing is about my book it will be so, not only by virtue of any factual information that it contains, but also by demonstrating my style: It will be about what I wrote, but also about how I think and write and how I am.

Being With, in order to make sense of the title before losing its audience, had to start by tackling the difference between doing and being. This piece cannot tell about my writing without being my writing. It will do what it is and be what it does – which realisation (I realise through writing this) could be said to be the aim of therapeutic work.

The book, from being a modest attempt to simplify the process of therapeutic work, becomes an attempt to assert the importance of subjectivity in a context in which the subjective (despite being the medium as well as the message) is increasingly denied weight. There is an irony, therefore, in my doubting a subjective assessment of its worth. But irony – or the reliance of an argument upon its counterargument – is also a leitmotif, not only of the book, but also my life.


our subjectivity gives colour and value to the world

Being With is about journey, uncertainty and equipoise, and the importance of value over evidence. It is a battle-cry of the reticent. It is therapeutic, not only in intent, but also by virtue of the fact that, if my own doubt can accrue sufficient self-belief to stand and say “I am of importance here”, it demonstrates a really quite extraordinary paradox along the lines of – of all things – the Cartesian argument that it is my capacity to doubt that makes my existence meaningful.

Given that there is no way of knowing how the story ends, it might be practical and/or imprudent to write about its beginning, but I am curious to know what gave this timidity the sort of confidence needed, not only to write a book about itself, but also to lend substantial dollops of its self to children wavering on paths of perilous development without any likelihood that that the loan would be returned.

As the book amply represents the written, I shall say here just a little about the writing (and, inevitably, the writer).

My writing for the outside world began with a poem ostensibly about a steam train. I will not reproduce the poem here, thought short, because I hope sometime to gather my poems together. But this one received a commendation in a national newspaper children’s poetry competition. It was the first official encouragement my writing received. I think of that poem as a link to my father. It was quite aggressive in its cadence, impatient in its response to the state of the world, and it made a passionate case for an aesthetic version of efficiency. In doing so, and in begging the question of both what is desired and how best to obtain it, it was a prototype of Being With and Saying Goodbye.

Indeed, there are multiple parallels drawn by this juxtaposition: One of my reviewers described Being with as “a poem”. My father was a doctor, a psychoanalyst, and an idealist, and I am unequivocally at least some of those things. He wrote books that brought together his professional expertise and his hope for a more peaceful world. And approximately there I hope that the parallels cease, because the world is hardly more peaceful now than when he wrote, and he became a disappointed man. I have, though, brought together my professional expertise and my urgent hope – in this case the hope that we shall not lose the “ghost in the machine”.

canstock27017314 (1)If the poem about the steam train was my father, there is another poem from a similar era that is my mother. She ran a single handed rural general practice. The poem conveys the breathless rhythm of her leaving the house on a home visit. The crux of the poem is that the doctor’s (and, no doubt, the mother’s) task is not just to preserve or promote the material existence of people, but also hope, without which a human life is – at least subjectively – worthless. One chapter of Being With is titled “Uncertainty, the mother (or father) of hope”.

The second poem, fittingly, was about the self-doubting gift of the self, whist the first was a claim to subjective authority. It seems that I have been rewriting these poems since then and finally have them between covers.

The medical setting, an appetite and talent for writing, and a sense that material values are insufficient for human life, provided the beginning of Being With. I hope that they are still more than merely evident in its whole. The book identifies the relationship between professional and patient as the crux of the matter, and declares what happens between the lines to be at least as important as the prescribed treatment. It bemoans the almost universal expectation for quantified and empirically demonstrable output, and it attempts to explain this all to those that have power but little understanding, whilst providing succour and encouragement to those with ample understanding but diminishing power.

If those early poems were the beginning, and publication of Being With represents some species of end, the middle consisted of decades of accretion, reflection, and rumination, threaded alongside and through what might be the official achievements of my life; medical school, doctoring, psychiatry – all that grown-up stuff – and my sharing in the creation of a family. I have always written and studied. I have taken life seriously, including the practice of seeing it all as a sort of hilarious spoof. Whenever I have caught, in either the performance art of my own clinical work or the creative output of other minds, a glimpse of confirmation that life is to be taken seriously and lived lightly, I have taken note; sometimes subliminally, and sometimes on paper.

I became a trainer in Child and Adolescent Psychiatry and, in mimicry of the therapeutic relationship, used my relationship with trainees partly as a setting for improvisatory exploration of the process of being a Child Psychiatrist. A few years ago I tried out the following words:

“I think I might write a book about Child and Adolescent Psychiatry and call it  Being With and Saying Goodbye, because it increasingly seems to me that those are the two main things that we do. It doesn’t seem to be any more complex than that.”

Where my parents reacted to my poetry with a mixture of admiration and perplexity, my trainee responded with polite interest. She then, being an excellent doctor, got on with her job.

Two years ago, I suffered a small but undignified surgical operation which required two weeks of recuperation, and, during that time the supersaturated solution of ideas crystallised around this grain of a title. Soon afterwards I was able to send a plan, introduction and first chapter to Karnac Books who expressed interest and provided that crucial intervention; the negotiation of a deadline.

This reflection has been gratifying. It affirms me as the undeniable offspring of my parents, and gives to my creative expression a most encouraging consistency and coherence. I am arguing for those things that I have long held dear and it seems that what I am saying today would have the approval of my childhood self; an approval that I hold on a par with the endorsement of respected colleagues.

Andrew F. West studied medicine at the universities of Cambridge, Leeds, and Oxford, and went on to work in medicine and psychiatry in Oxford and New Zealand. He now works as a child and adolescent psychiatrist in the National Health Service. His book, Being With and Saying Goodbye: Cultivating Therapeutic Attitude in Professional Practice, has recently been published by Karnac Books.

Reviews and Endorsements

andrew west 2‘The contemporary paradox of care is that even as medical science has advanced, so care – that compassionate engagement that is the mainspring of medicine – has receded. Andrew West offers a passionate, personal and, yes, often controversial response to this paradox. Yet Being With and Saying Goodbye is at the same time always deeply practical. Informed by a lifetime of experience in the author’s own field of child and adolescent psychiatry, the “therapeutic attitude” for which he argues has much to offer caring clinicians in every area of medicine.’
– Professor Bill Fulford, St Catherine’s College, Oxford

‘I would advise all child psychiatrists, and other associated professionals, to read this book from cover to cover, notebook or highlighter at hand, then to always keep it close at hand. You will find yourself apprentice to a wise and humane mentor, who will offer cogent advice on every aspect of your relationship with your patients, at the same time pushing you to think about the values that inform your work and challenging you to think anew about the nature of evidence and what really makes a difference. This is a timely, important book because the attitude so beautifully described and illustrated is in danger of being squeezed out of us. Reading it will help you survive through difficult times whilst rekindling the hope that things could and should be done better.’
– Penelope Campling, medical psychotherapist and co-author of Intelligent Kindness: Reforming the Culture of Healthcare

‘Andrew West writes a personal account of being a child and adolescent psychiatrist. In a brilliant conversation with the reader he goes “between the lines” to give a unique view of the expectations, pressures, obstacles and satisfactions of therapeutic clinical work with young people and their families. This is no autobiography, but a series of engrossing narratives of real experiences in modern practice. Anyone working in the field of child and adolescent health, education or social services will come away inspired and refreshed by Andrew’s candour, his ironic humour and superb writing.’
– Dr Sebastian Kraemer, Honorary Consultant, Tavistock Clinic

‘This book inspires hope that we can recover a kind of professionalism that has been undermined by our current target-driven culture. Andrew West’s subtle, precise writing brilliantly describes the importance of qualities that can’t be measured and monetised, such as “being with” people in an attentive, non-judgemental frame of mind. His vision is compelling. A book that should be read by all those involved in commissioning services as well as by practitioners.’
– Sue Gerhardt, author of Why Love Matters

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