Writer Colm Tóibínis a friend of the renowned Irish psychiatrist Prof Ivor Browne. Here, he recounts how his friendship with Prof Browne lead him to take part in one of his therapy programmes
IN THE mid-1980s, as I got to know the psychiatrist Ivor Browne, I found that he had no small talk. He seemed genuinely uncomfortable with a large group of people.
Unlike many men of his generation, he did not tell funny stories or have a store of jolly anecdotes. He had a way of watching you when you spoke, as though he was expecting you to concentrate and be serious.
Each time he saw me, he returned to the questions about my background that he asked me when I met him first. Slowly, I realised that he felt I needed to talk to him, or someone like him.
This often, at the beginning, made me uneasy. A few times, almost as a way of evading the calmly searching questions he was asking me about my own background, I changed the subject to Ivor's own profession and I thus discovered certain interesting things about modern psychiatry which I did not know.
In the battle against mental illness, I discovered, advances had been made, or seemed to have been made.
It had seemed, at one time, that Prozac might be a cure for depression, and that several drugs seemed to reduce psychotic episodes in those suffering from schizophrenia. Even drugs such as Ritalin, prescribed for attention deficit disorder, seemed to be working, or having some beneficial effect.
All this was a vast improvement on electro-convulsive therapy (ECT), or indeed on lobotomy or lifetime incarceration.
As I listened to Ivor Browne, I discovered that things were, however, not so clear. While many of the drugs prescribed by psychiatrists had been effective, they had served to mask the actual problem, rather than eradicate it or alleviate it.
The side effects of some drugs had, in turn, caused further problems, some of them very serious. But because the drugs seemed to work, especially at first, a whole generation of psychiatrists had emerged who knew which drugs to use for which symptoms and in which doses.
They had no interest in psychoanalysis and had not asked if the symptoms might have causes (just as oncologists did not ask if cancer cells had causes) which might also be looked at.
I pressed Ivor in a number of conversations to formulate all of this, as he pressed me to tell him more about my feelings about my father's death when I was 12.
I can still see him watching me, holding my gaze.
"Did you know him well," Ivor asked me. "No," I said, "no, there were four other children, three older than me, and he was very sick for the last four years of his life."
"But did you ever have a relationship with him?" Ivor continued. "Oh yes," I said, "when I was younger, before he became sick, I used to go down to the museum he had founded in the town every day with him after school, and when I was even younger I used to go and sit at the back of the classroom" - he was a teacher - "or write on the blackboard."
Suddenly, as I spoke, and as Ivor still watched me - his look was always even and open - my eyes filled up with tears. "Do you realise," he asked me, "that you have blocked the experience of his death, all your grief, and you are going to have to do something about it?"
Over the next while we discussed the theory of this. There were certain people, Ivor said, who had lived through traumatic experiences without actually experiencing them, who had used a mechanism to block the ferocity of the trauma and gone on living, pretending that what had happened had been fine, no real problem, or had not really occurred.
Strangely, he said, this could include someone's own birth - the agony and trauma of being born would lock itself into the psyche, where it would harden.
It could also include grief - the loss of a loved one would be simply too unbearable and it would be stored away, held at bay, rather than really felt. It could also include rape or sexual abuse.
This blocking would work in the short term - it would make the pain easier to tolerate - but in the long term it would work like a badly built dam. The water around it would stagnate; only some would go through, the rest would build up.
It would have a deforming effect on the personality. The only way for the person then to manage was by finding other ways to dam the water, but these would always be temporary. The successful way was to live the experience, to let what happened hit the psyche as if for the first time, even though it was many years later. This was one of the ways, he said, in which psychoanalysis or psychotherapy worked.
Ivor ran a workshop at St Brendan's in Grangegorman. It lasted from Friday morning until Sunday evening. He told me I should do it. It was used by his patients or by people who he felt had been disabled in one way or another by a trauma which they had not fully experienced.
In May 1992, Ivor telephoned me. He suggested that, since people came to the workshop in pairs, I do a workshop with the writer June Levine as my partner. June herself was interested in doing it and, since we knew each other and trusted each other, Ivor thought we could work together easily.
I agreed to do it and thus I found myself driving to the church early on a Friday morning not long afterwards.
For the first real session, we had to divide into pairs.
We fetched mattresses; June advised me to put ours into a corner. We arranged that I would go first; she would have her sessions on Saturday morning and Sunday morning and I would have mine now and on Saturday afternoon. I had no idea what was going to happen.
I took off my shoes and loosened my clothes, as I was told to do, and lay down on the mattress. June sat on a beanbag beside me.
Twenty other pairs, maybe more, settled down as well. I closed my eyes and a soft voice, which I recognised as belonging to one of Ivor's colleagues, started to speak through a sound system. He asked us first to relax, then to breathe softly. There was soothing music in the background, and perhaps a drum sound.
He spoke slowly and told us to breathe as though our breath was liquid. I did what he said. He then told us to begin to breathe faster as though our life depended on it. The music changed, the drum sound became louder. I'm not sure at what moment it happened but I suddenly moved into a different state of consciousness. I don't know if some of the crying and moaning sounds came from the PA system or from the people around me, but I think from both.
I was in terrible distress. I knew that June was there beside me and that Ivor was somewhere close by. I could ask her for a tissue if I needed it, or to hold my hand, or just to stay close. I knew that I could even stand up and go to the toilet if I needed to.
But I had entered another world which was more urgent and real than the one I had left. I had to breathe hard, breathe like hell to stay there. It was dark in the church, but sometimes lights came on. Amid the loud music, there were heavy drum sounds and cries, babies crying, someone moaning in pain.
And I was moaning too and screaming. I was in my parents' bedroom on the morning that my father died. My mother was downstairs.
It was difficult to know how much time was passing. I know that I screamed "I cannot deal with this" over and over. I know that I screamed at the top of my voice. I know that June became worried about me and Ivor came to look at me.
I would ask for tissues and blow my nose and, without any prompting, go back into myself and start screaming and thrashing around on the mattress.
What was happening was real; the distress was absolute. I both could and could not stop. I was back in that bedroom.
An hour, two hours must have gone by. I kept blowing my nose and calming down and then starting off again. I felt the shock and the powerlessness of the grief - fierce, wild, absolute things. The realisation that he was dead would cause me to seize up on the mattress and start to scream and cry out.
When Ivor came over at one stage, I thought that he was going to take me out of this ordeal - sometimes I desperately wanted to stop - but he made me turn on all fours and he held my stomach.
"Get it all up now," he said, as he pushed in my stomach muscles. He had brought a metal bowl with him and I screamed so hard I started to vomit mucus into the bowl.
And when I lay back he told me to breathe heavily again. The whole terrible pain came back. As before, I began to sob and then cry and then call out and scream, but it was worse now, this sense of pure loss, or being abandoned, of someone being torn away, of being utterly forlorn but, more than anything, of not being able to deal with it.
I do not know how much longer it went on. It could have been half an hour or more. The music changed all the time, but there were always drums and sounds of voices, with other music in the background - African or South American music. Eventually, Ivor came and said that I could rest now.
The next day it was my turn to mind June. My job was to sit with her until she asked me to do something. Thus I had a good chance to look around. Once the fast breathing started, it was like a vision of hell; everyone on the mattresses was involved in a private nightmare, as though there was a story being told to them which made them scream and cry out and then lie quietly for a while.
As my second session on the mattress approached, I did not think that I could delve any further into the experience of my father's death. I thought that something new would arise, as we fetched the mattresses and rolled them out. But, as I lay down and the music started and then the breathing, it began again, but more intensely.
Fifteen years later, it is difficult to make raw remarks about what happened that weekend. But it has to be said that I did not know before then that my father's death, the pure and almost unbearable grief which I had denied for so many years, was so close to me, could so quickly be summoned up. It was an extraordinary thing to learn.
Ivor has extraordinary powers of perception and sympathy, which is what makes him such a great doctor. It would be impossible to say that after that weekend all problems went away altogether or anything like that, but the recognition of the problem alone came to me as an enormous relief.
This article is an abridged version of a foreword to the book Music and Madness, by Prof Ivor Browne, a look back at his life in psychiatry, which will be published on Thursday, by Atrium, an imprint of Cork University Press. The book retails at €25.