Letters

In some circumstances, it’s justifiable to grant anonymity to governmental whistle-blowers. However, the review of Une jeunesse française (LRB, 9 March) was permeated by the arguments and style most commonly associated with academic reviewers. If such is the case, anonymity liberated an armchair polemicist to ascend to ever-greater heights of stylistic tomfoolery and moral flippancy. Evidently, the pseudonymous reviewer conceives his ‘imprescribable right to criticise’ as entailing no public accountability, no risk to his own professional reputation, and no sense of personal responsibility.

In the course of reviewing five books on Soviet intelligence (LRB, 23 February) Christopher Hitchens dwells upon an occasion in 1982 when he and Victor Navasky, then editor of the Nation, were my luncheon guests at the University Club in New York. With remarkable precision, Mr Hitchens remembers that the club’s ‘fine silver’ gave off a discreet ‘tinkle’. In all other respects his memory is, to say the least, blurred.

Mr Hitchens refers to me as ‘a Cambridge spy’. He asserts that I was recruited during the ‘very period’ of the Hitler-Stalin Pact. He adds that he asked me ‘flat-out’ if I had not worried that (in transmitting secrets to the Russians) I was ‘giving ammunition to the enemy’. All of these assertions are simply untrue. I was not a spy in the accepted usage of that word: I was approached (by Anthony Blunt) not in the ‘very period’ of the Hitler-Stalin Pact but in the spring of 1937, when the Soviet Union seemed to be the principal antagonist of Nazi Germany. In my brief terms as an economist for the State Department and a speechwriter for the White House I never sought, received or transmitted any secrets of any kind.

Mr Navasky and Mr Hitchens did indeed question me – as to whether I was not worried that in publishing my book, After Long Silence, I was rekindling the flames of McCarthyism. That was the question to which I replied that the possibility had not occurred to me.

Christopher Hitchens is on his way to join the spy fantasists he saw off in his witty review if he believes that John Cairncross, ‘a working-class lad’ and ‘believing Communist’, ‘got hold of the real stuff’ and thus ‘enabled the Russians to re-equip in time to win the battle of the Kursk Salient’. Cairncross may well have been a quieter and more competent spy than the toffs, but his best efforts would hardly have helped here. Ever since the invasion in 1941 the Russians had been producing the T34, the best tank in the world as the Germans described it, in prodigious numbers, and Hitler remarked that if he had known of its existence he might not have invaded. The Russians won at Kursk through crushing tank superiority, and a shrewd assessment by the Stavka – not difficult to make in June 1943 – where Hitler would strike next. They certainly benefited during the war from Allied intelligence, but they needed no help in this instance from Cairncross, or any other Western spy.

Incidentally, I should like to thank Kevin Laffan (Letters, 9 February) and Brian Donaghey (Letters, 9 March) for informing us in such scholarly detail about F. Desprez’s memorable recitation favourite ‘Lasca’ (in the authoritative text of which she draws her ‘dear little dagger’ neither from her ‘bosom’ nor her ‘garter’ but from her ‘girdle’). If such recitations were still given poetry today might be more memorable?

Conor Gearty’s incisive account of the ‘inefficient, authoritarian, hypocritical and morally bankrupt way’ in which Conservative government has run the country since 1979 (LRB, 9 March) omits one highly significant example of the corruption engendered by Thatcher and upheld by Major. I refer to the advantageous treatment, amounting to illegality, handed to Rupert Murdoch in allowing him a monopoly of our national press and positively nightmarish control of satellite TV at the expense of a consistently undermined BBC.

We used to be told that liberalism was dead. What we now get, paradoxically, are repeated attempts to discredit the progressive liberal thinkers of the 19th and early 20th centuries by smears and innuendoes rather than responsible argument. I am sorry to see John Sutherland stooping to this kind of thing in his remarks on T.H. Huxley (LRB, 23 March). According to Sutherland, Huxley in his last years became a ‘populariser of vulgar Darwinism and its crude applications to social and ethnic conflict’ – a racist and proto-Fascist whose views are supposedly ‘sanitised’ by his latest biographer. Sutherland gives no evidence of what the later Huxley thought and said, but by far the most influential expression of his ideas was his essay ‘Evolution and Ethics’ (1893) which is unremittingly opposed to vulgar Darwinism. Huxley’s whole point is that ‘cosmic nature is no school of virtue’ and that civilisation and social progress must be measured by moral standards, not by victory in the ‘struggle for existence’. Perhaps Professor Sutherland would care to say just where, in this famous essay, he finds a justification for his ill-judged and deplorable attempt to link Huxley to Hitler.

Ian Hamilton makes a mystery out of a molehill when he asks: ‘Why did Louis MacNeice have to wait thirty years for a biography?’ Anthony Thwaite (Letters, 23 March) also worries unnecessarily. There was no censorship. Some delay was certainly due to the sensitivities surrounding a once-divorced, once-separated man, who died prematurely and had a child by each marriage. Indeed, Jon Stallworthy still skirts around MacNeice’s relationships with women, not by concealing facts, but by tending to represent him as a commonplace philanderer: ‘The old lion was soon back at the BBC watering-holes … looking for another lioness.’ This diminishes the marvellous love poet who needed women deeply, suffered much pain in love, and was by no means solely responsible for the breakdown of his second marriage.

As for my own and Michael Longley’s share in the delay, the story is simply told. After taking on the biography (in 1976), we found that, with two jobs and no sabbaticals or finance forthcoming, we were moving too slowly. Soon after E.R. Dodds’s death we apologetically resigned, and later gave Stallworthy any help we could. Subsequently I wrote a critical study and Michael edited the Selected Poems (1988).

I welcome Thwaite’s invitation to ‘throw light’, since it prompts me to throw something else at Hamilton’s mean-spirited article. His stress on MacNeice’s ‘self-absorption’ is a characteristic English misreading of this Anglo-Irish poet. English criticism, conditioned by Wordsworth, often fails to understand the dramatic function, and public dimensions, of the self in lyric poetry that takes its cue from Yeats. As Yeats’s closest Irish successor, both aesthetically and culturally (the significance of his book on Yeats remains underrated), MacNeice grasped how to use elements of autobiography to explore the nexus linking individual lives with history. Autumn Journal is not ‘self-absorbed’ in any subjective or introverted sense. If it were, it would not be such a brilliant summa of the Thirties. When Hamilton sneers, ‘he was of the swim … but never in it,’ he ignores all the naive English Marxist poetry that was left gasping on the strand in 1939. What he terms MacNeice’s ‘dispirited self-scrutiny’ was always a metaphysical odyssey into dark places of the 20th century.

Secondly, reading the reviews of Stallworthy, I notice that English literary chaps only take the word of other English literary chaps. Thus Humphrey Carpenter, in the Sunday Times, relied on testimony about MacNeice from a bitchy and jealous John Betjeman. Unreliable, too, are Hamilton’s informants ‘who had social dealings with MacNeice … and recalled his lack of warmth, his silences, his impenetrable moods’. This is not the witness of his true friends – who went in for friendship, rather than ‘social dealings’. People whom MacNeice ignored were generally careerist bores lacking what he meant by ‘warmth’. Then Hamilton wheels on Geoffrey Grigson to complain about his dirty fingernails and ‘almost squalid appearance’. ‘ “Squalid" seems a bit extreme. What was Grigson hinting at?’ asks Hamilton keenly. I thought everyone knew that Grigson was himself ‘a bit extreme’. Hamilton also notes MacNeice’s ‘ramshackle private life’ and wonders whether ‘there is a wish to smarten [him] up a bit, to cut down on his drinking’. Once again, MacNeice’s behaviour has not been censored, nor does it require Hamilton’s shallow patronage. But I like this implied ideal of a chatty, teetotal poet with immaculate fingernails and a tidy life.

From his Anglocentric viewpoint, Hamilton thinks that MacNeice never quite made it. One conspicuous fact about MacNeice’s afterlife is how variously he has fertilised poetry from Northern Ireland. Poets such as Derek Mahon, Paul Muldoon and Ciaran Carson have assimilated his central importance in modern poetry. It might be argued that no poet was better placed to combine influences from Yeats and Eliot in a period when poetry was being tested by heightened political consciousness (a legacy not only relevant to Northern Ireland). Hamilton, however, does not mention MacNeice’s Northern Irish posterity. Is it because recent English achievement has been rather less distinguished, that – with subtextual racism – he paints MacNeice as a dirty, drunken, whingeing Irishman? By a strange coincidence, I remember taking Hamilton to task many years ago for a review of Seamus Heaney in which he referred to ‘muddy fingers in Russell Square’.

Several points need to be made in response to Jean McNicol’s admirable piece about the current crisis in community care for the mentally ill (LRB, 9 February). For example, it is not correct that acute psychiatric beds cost ‘almost twice as much as less expensive community care’. In essence it is all about paying people to look after people and if those carers are skilled nurses they will cost more than good-hearted but amateur ‘care attendants’. Of course, an acute psychiatric ward also has to have additional staff for the more disturbed patients, and requires medical and other support personnel, and one has to be prepared to take anyone for whom admission is required. Ex-patients who were once in hospital for many years, by contrast, require little in the way of support – perhaps a visit once a day to help keep a house tidy. But more dependent patients, with limited self-care skills, may require intensive help, perhaps up to eight carers for four patients. Even in the old asylums there were the ‘refractory wards’, that needed many more nurses than the rather indolent ‘chronic’ wards. In fact, it may well be that asylums are cheaper overall than community care, because of the economies of scale. Such economies are not available in many typical community hostels or residential houses, the average size of which varies between six and ten people. It is, however, generally accepted, and ‘user’ (to use the correct language) questionnaires seem to support this, that living in a relatively small building is more human and more humane. Simple things like the curtains in your room, the time of getting up, and when you eat are not institutionally rostered. But such choices come with a cost.

On the other hand, many patients refuse to go to hostels because they know they will only receive £10-£12 per week in pocket-money once all expenses have been met. They would much prefer to live in their own flat, possibly accumulating rent arrears and bills, but at least enjoying their own lifestyle. This may be unrealistic, but the desperation of mental illness makes it hard to plan ahead. In such circumstances going back into an acute psychiatric ward can be a considerable relief, not only because one may be treated for unpleasant symptoms, but because one continues on full benefit for a number of weeks, and bills may be paid off. An acute 20-bed ward in London costs between £500,000 and £600,000 a year to run, at least in terms of staffing, while a high-dependency hostel for eight people costs about £200,000. Simple arithmetic shows that 20 divided by 8 makes 2.5, and that 2.5 multiplied by 200,000 makes half a million. But community care needs the ward as well as respite care, for the inevitable relapses: should one charge those costs to the costs of the hostel or not? In the end there is little difference, and compared to the revenue-saving device of making someone homeless both are grossly expensive.

The Government’s response to all this has been that of the classic desk-wallah, organising ‘care plans’, in which the careful documentation and the continual meetings of many people are seen as the key facts. Thus the Care Programme Approach insists that all individuals brought into hospital with severe mental illness should have their needs identified, a key worker nominated and an aftercare plan drawn up to deal with those needs. This approach is formalised under Section 117 of the Mental Health Act, in which such meetings and plans are a statutory duty. Of course, if there is no ward clerk to organise the paperwork, and no spare key worker to take on yet another severely disabled individual, all the planning in the world will not help. How many patients/clients can one individual key worker take on, particularly in the inner city? It is thought that perhaps ten to fifteen people with chronic severe illnesses, liable to relapse, is a reasonable caseload, but even formally documented demand does not generate additional resources. Community nurses in areas like Hackney may thus accumulate fifty or more clients and crisis work overwhelms any continuing care.

Most recently in this regard the Government has decided to set up Supervision Registers. These are a kind of Schindler’s List in reverse, a form of stigmatisation of those most in need of confidentiality. Patients must be included on these Registers if it is felt that they are suffering from a severe mental illness and ‘are, or are liable to be, at significant risk of committing serious violence or suicide, or of severe self-neglect in some foreseeable circumstances which it is felt might well arise in this particular case’. The decision to put someone on the Register has to be taken by the responsible medical officer (that is, the consultant psychiatrist in charge of the case) after consultation with the mutli-disciplinary team. There is no formal mechanism of appeal, and again no additional resources can be identified by this procedure. Apart from begging the question of what is meant by the term ‘severe’ or ‘serious’ in this context, these Registers are liable to provoke considerable argument among all those involved. Patients or their families may well object to the processes of labelling, and stigma will be reinforced. Nothing else will have been achieved practically.

The most obvious answer, the community treatment order, is already working in Australia, New Zealand and some of the United States. In the latter it is called ‘outpatient commitment’, requiring a court order for its implementation. However, it seems that in Great Britain the European Convention of Human Rights may make such an order impossible to put into force, since to interfere with anyone’s liberty against their will, unless they are deemed to be actively insane, is regarded as illegal. Yet keeping someone stable in the community can only be guaranteed if regular medication is part of that process. Since the Sixties the basis of community care has been the availability of effective medication, the sine qua non of the business. Which does not mean that social support, personal relationships, and a psychological understanding are not also vital in psychiatric care, but if the patient/client suffers from formal thought disorder, secondary to impaired dopamine pathways, little can be done by the comforts of talking.

As McNicol has correctly pointed out, the homeless are not those individuals who have been long-stay patients in asylums: only 2 percent, approximately, of homeless individuals in London have been long-stay patients. However, while the asylum closures have not led to any deterioration in care for those transferred to support in the community, a whole population of ‘new long-stay’ has never got into the regular asylum system. These are the ‘revolving-door’ people, who have responded well to treatment, have been discharged, but have deteriorated once more. Usually this is due to a mixture of limited aftercare, lack of insight, and a refusal to accept continuing medication. Their numbers have gradually increased over the last ten to fifteen years, and Christopher Clunis was certainly representative of them. Asylum care is no longer available, so they wander around the system, a stage army of troubled individuals, hiding in the woodwork so to speak, and re-emerging when their behaviour becomes socially unacceptable. The overflowing acute psychiatric wards of the inner city are sad reminders of their plight.

Another aspect of the Clunis affair is the difficulty of clarifying a past history, when issues of confidentiality and a differential understanding as to the nature of mental illness pervade the processes of mental health work. Clunis told his social worker that he was on medication ‘because of drug abuse’. Understandably the social worker informed the Inquiry that he could ‘only go on the information he was given’, and was constrained by his inability to contact hospitals about any previous history. It is not uncommon for individuals to give different stories to different workers, depending on that worker’s background. This dichotomy is clearly signalled by the difference between the terms ‘client’ and ‘patient’.

Finally, there is considerable difficulty in keeping people in facilities deemed ‘medium secure’, a broad-church concept that involves everything between maximum security (i.e. Broadmoor) and the general acute psychiatric wards. The sheer expense of these beds creates pressure to move people downmarket – i.e. out of the acute ward. There is always another more acutely psychotic patient (or client) at the doorway, and nurses ruefully describe the dilemma of having to discharge patients as soon as they are coherent enough to be receptive to counselling and more interactive nursing care. These pressures are exacerbated by the requirement of the ‘catchment area’, whereby any hospital team has to concentrate on those who live in their particular district. Arguments between doctors and nurses about addresses absorb ridiculous amounts of professional time. Paranoid wanderers such as Clunis, who as soon as they are well disappear once more into the anonymity of urban life, are a common feature of psychiatric wards. In fact, the ordinariness of the peregrinations of Christopher Clunis is in itself terrifying.

McNicol has pointed out that ‘properly organised and funded community care should be able to protect the public and to treat and control a patient.’ Yet without the basic premise of regular medication such extra-institutional care is a shibboleth. Fears of mandatory community treatment revolve around images of men in white coats forcibly injecting people on the kitchen table, even though the Mental Health Act still insists that this can only be carried out in hospital. And most patients, once in hospital, accept the verdict of the law and are compliant with medication. Given a choice between living in their own home and being in hospital, the great majority would prefer to be out of hospital: if it is laid down by appropriate legal statute that they have to receive regular medication then that would become part of the deal. At present this can only be done for a month or two when the patient is on leave from the hospital.

Yet a kind of community treatment order does in effect exist. It is the restriction order, outlined in Section 41 of the Mental Health Act. A number of individuals already live in the community under this order, which can only be imposed by a judge in a Crown Court. Like Christopher Clunis, however, one has to have done something seriously dangerous to be the subject of such an order. It is a classic case of after the horse has bolted. Christopher Clunis, now reasonably clear-headed and under appropriate treatment, is locked up in Rampton but he would not have been a danger to the public at all if he had received regular medication. The outdated nature of the 1983 Mental Health Act is well brought out in The Falling Shadow, but getting a new Act will be extraordinarily difficult.

There is a general reluctance in Parliament to spend time debating issues of mental health. It takes twenty to twenty-five years for a new Act to come into force (in this century, 1930, 1959 and 1983), partly because of fears about civil liberty. In fact, MPs have included a special section (Section 141) for their own protection, whereby the Speaker of the House of Commons has to be notified, and a special report obtained from eminent physicians appointed by the President of the Royal College of Psychiatrists, if any Member of Parliament is ‘detained’.

In her response to my review of Eliza Fenwick’s 1795 novel Secresy (Letters, 9 March) Amanda Sebestyen accuses me of Being Mean (à la George Eliot) to ‘silly lady novelists’ of the 18th century like Fenwick. In turn, I am Not Mean Enough, it seems, to Jane Austen, that ‘crucial contributor to the terrain of English conservatism’ who wrote ‘uncomplainingly of women’s dependency while ridiculing the possibility of freedom for the slave’. In particular, in touching on Austen’s very real love and liking for her father, I am said to project into her novels ‘a happy father-daughter dyad, bathed in healing laughter that frees them from the dark feminine histrionics of the Gothic’. The Manichaeanism here is precisely the sort of thing I was speaking against. No one can doubt the complexity of Austen’s fictional portraits of family life, or the often ambiguous treatment of fathers (along with mothers and children and everyone else) in her novels. What separates Austen from a writer like Fenwick, I was trying to suggest, is her refusal to engage in symbolic violence for the sake of making a point. Emma’s Mr Woodhouse, for example, may behave like a tiresome infant, but Austen does not feel compelled to kill him off because of it or subject him to the kind of mutilating, cartoonish ‘revenge against the father’ so symptomatic of the female Gothic. Not only is there something appealing about this lack of sadism, it may have something to do with – yes – her artistic genius.

I suppose it is possible (LRB, 23 March), as Tom Nairn seems to be telling us, that the music of Van Morrison will prove to be the lasting solution to the Irish question, although after his duet with Cliff Richard I doubt it.