The Boy with the Topknot

by Sathnam Sanghera

  It really did take all the willpower in the world to resist storming down to the surgery to stab the doctors through their respective skulls with a garden fork. The single worst thing about being illiterate is the way people can deny you your rights. But I tried to keep calm, reminding myself of what Dr Patel had said, that continuity of care is important for people with my father’s condition, of what my mother had said about the eldest of the male doctors – he had been supportive throughout the mayhem of her early marriage – and telling myself there could be any number of prosaic reasons for their procrastination, short of them trying to cover something up. Maybe they’d not had a request to view medical records before. Maybe they’d been put on edge by the word ‘journalist’ – it puts me on edge sometimes and I am one. And you need only glance at a Bollywood movie to see why they might be perplexed by the idea of a book about Mum and Dad. The misery memoir is very much a first world phenomenon. In India, you only need to glance out of your window to feel grateful for your lot.

  But when weeks threatened to turn into months, I lost my patience and visited the surgery with Dad, where I found myself discussing the request with Dr Dutta’s wife, Mrs Dr Dutta, if you like, who I’d last seen when I was ten and having trouble with eczema. Resisting the urge to roll up my sleeves or remove my trousers, I launched into an unexpectedly controlled speech about how everyone had the right to view a copy of their medical records under the Data Protection Act of 1998, how my mother in her capacity as my father’s carer, and I, in my capacity as a son and translator, wanted to view my father’s records, and how they were obliged to present them within forty days in a format we would understand.

  Mrs Dr Dutta looked taken aback. But not as taken aback as I must have looked when she responded by saying we could see my father’s medical notes, as it was our legal right to do so, but the practice could only supply us with records going back to the mid-nineties. The explanation provided for this was that my father had briefly been under the care of another doctor during the nineties, and that this doctor hadn’t, apparently, forwarded his older notes, an extraordinary claim because one of the excuses proffered for the delay was that there were so many notes – going back all the way to 1969 – that it was taking ages to copy them.

  Somehow I managed not to explode, and through teeth clenched so tightly they were at risk of being ground to flour, I repeated the request, saying we wanted to see all the notes they could find, as it was our legal right to do so, and that I would be contacting my father’s previous GP about the older notes. I did so immediately, roaring to the other side of town in a taxi with my father, where I sat flicking through copies of Bella magazine for an hour as the surgery staff searched for any sign of the files under the various misspellings of his name – Jaggit Singh, Jagitt Singh, Jangit Sangera, Jagit Singh Sanghara, etc. – and various dates of birth, until, as expected, they confirmed they didn’t have them and, as expected, added they were confident they had been forwarded.

  Back in London I wrote a letter to the GP I’d met, forcing myself to be more polite than I felt, thanking her for the care and attention with which she and her family had looked after my parents over the decades, explaining I’d visited the surgery of my dad’s previous GP, and that they’d told me they had forwarded his full set of notes, going back decades, to her practice when my father switched back to their care in the mid-nineties. I added that I’d expected this was the case, given what her husband had told my mother, that we wanted the surgery staff to have a thorough search through the files, and that we looked forward to seeing a full set of photocopies soon. My mother eventually heard back from the practice manager, who sent an application form, which I filled out and returned with a cheque for £50 and a note repeating our desire to see the FULL set of records.

  Christ.

  Finally, after a couple more prods, and well after the forty-day period within which doctors are supposed to provide them, a brown parcel landed on my parents’ doorstep with a promisingly heavy thud. Naturally, the first thing I did when flicking through the sheaf of double-sided photocopies, with Mum sitting next to me, was look at the dates. Were there any documents pre-dating the mid-nineties? Yes: letters and notes from hospitals and GPs from the nineties, eighties, seventies and sixties. Relief, mingled with resentment at having been lied to.

  What was their problem?

  The next thing was to try to find the earliest notes, related to my father’s first few months in Wolverhampton in 1969, when he moved in with my mother at my aunt’s house in Park Village. In another of those episodes almost too difficult to contemplate, Mum had got lost on her way to Wolverhampton – it was the first time she had travelled in Britain on her own, and she was badly injured – disembarking at Birmingham instead of Wolverhampton. She had been put back on a train by a helpful Indian, but got lost again in Wolverhampton, where my aunt Pindor, the eldest of my father’s sisters, had understandably given up waiting. Mum eventually arrived half a day after she was meant to, and as a doctor was called to attend to her, my father arrived in his taxi. In a story since confirmed by my uncle Malkit, my Pindor bua’s husband, he greeted my father at the front door wielding an axe, saying that if he showed any hint of the violence he’d displayed in Grays towards his wife or to anyone else – this was the first time they had seen him since the chaos of that bank holiday – he would be given a taste of his own medicine.

  Apparently, my father had been registered with Dr Dutta that very same day, as he tended to my mother, and having seen my own very full and detailed medical notes, I was hoping for something along the lines of:

  10/5/69

  Patient age 19 years, 13 stone. Arrived England January 1968. Labourer in Essex. Wife, also registered, showing signs of violent abuse. Living at sister’s house in Park Village. Withdrawn.

  20/5/69

  No violence. Seeking work. Indications of depression.

  24/06/69

  Moved out of sister’s house with wife, due to overcrowding: living in rented room nearby.

  3/7/69

  Fractures wife’s nose at home during sister’s wedding. Aggression alternating with catatonia, and emotional flattening, severe apathy, indications of paranoia: claims wife is having affair. Indication of auditory hallucinations. Acute depression.

  Something along those lines would have been enough to corroborate Mum’s story, to give me enough to pen a journalistic account of what happened. But, not for the first time, I was confusing my experiences with my parents’. My medical notes were lengthy, detailed, coherent typewritten documents, because I was on private health, and because I was a literate hypochondriac, who demanded to know what was going on. But my father was an illiterate mentally ill immigrant who didn’t know what was happening to him, in a family of illiterate immigrants, who didn’t know what was happening to him, dealing with an NHS doctor who was himself an Indian immigrant. Correspondingly, the doctors’ notes for the period consisted of nothing more than:

  After a great deal of squinting, all I managed to decipher were the phrases ‘Paracetamol’ and ‘AC mental troubles’ – no shit – ‘Small cut’ and ‘Communication impossible … something about water’. At this stage I wrote another letter to the surgery, this time to Mr Dr Dutta, saying it would be useful if he could decipher his notes, and that I would pay him for his time if necessary, but received no reply – and still have received no reply, but remembering I was a panther focusing on the task at hand, I moved on to the next bit of the story, my father’s first hospitalization, which was at least covered by a typewritten letter.

  This may have been neat and legible but in many ways it was even more impenetrable than the murky photocopied squiggles that preceded it. The dates tallied with the dates Mum had indicated and it described a hospitalization, which must have been the hospitalization Mum discussed, but that was the point at which the details ceased corresponding. Mum had told me that the hospital was in Stafford and this letter came from a hospital in Wolverhampton. The address
cited in the letter was my aunt’s address, whereas Mum said she and my father were living in a rented room at 15 Prosser Street by this time. Most confusingly, the tone of the account of my father’s breakdown in the letter – as much as there is one – didn’t in any way relate to the tone of Mum’s story.

  According to Mum, my father’s violence had become so extreme that my aunt Pindor had insisted that her parents – my grandparents – rent a room in the same house to keep an eye on him. And on one of their first nights together Dad was being so aggressive that my grandmother insisted on sleeping in their bed, to keep them apart. But even this didn’t help: according to Mum, my father reached over his mother – she can’t have been much of a buffer – and attempted to strangle Mum with her own chuni. It was at this point that my grandfather, in his sixties now, ran into the room and pinned him down, allowing Bibi to take my mother downstairs to safety.

  With Dad still showing no signs of calming down – Mum said he kept on saying: ‘You’re going to be dead by twelve tomorrow, just you wait and see’ – my grandfather spent the night on the stairs, to make sure he didn’t come down after my mother. In the morning, with no sign of his anger abating, and the landlady threatening to throw everyone out of the house before somebody was killed, Baba broke the habit of a lifetime, said he wouldn’t go to work and called Dr Dutta. On arriving the doctor apparently immediately called the police. The police, for reasons my mother does not understand, refused to restrain him. According to Mum, they had to be called twice more that day before they agreed to take Dad away – and then only did so when, with a crowd of people watching my mother being taken to safety at another house, my father lunged at her in front of them.

  However, this letter made my father sound like Robbie Williams checking into the Priory after a disappointing set of album sales. There wasn’t even a hint of a forced committal: it sounded as if he had volunteered to come into hospital. Indeed, so large was the gap between the accounts that I began to wonder whether there might have been some confusion with identities. The spelling mistake – Jugclecler Singh – was spectacular, even by my family’s illiterate standards.

  But discussing the letter with Mum, and delving further into the notes, explanations began to surface. Subsequent letters revealed that while the letters came from Wolverhampton, ‘the Psychiatric Unit’ referred to in the letter was indeed in Stafford. Mum explained that my grandfather was the only member of the family who went with Dad when he was taken away, which might explain the massive spelling error (my grandfather didn’t speak or write English), the mistake with the address (having just moved he most likely hadn’t had time to memorize the new address), and maybe was the reason why the violence wasn’t mentioned. The language problem, combined with his inevitable confusion and shame over what had happened, perhaps explained why he didn’t convey the extent of my father’s breakdown to the doctors. You would think the GP would have done, but then, judging from his notes, Dr Dutta was hardly loquacious, and, remember, this was the doctor who, sixteen years later, didn’t tell Puli she had schizophrenia when he diagnosed her.

  But these possible explanations only gave way to more questions. What did the psychiatrist mean in the letter by ‘state of depression’? Wasn’t Valium used to treat anxiety disorders? Wasn’t Tofranil – internet search – an antidepressant? Slowly, the horrible reality of what had happened sank in: Dad had been misdiagnosed. Not only had he been misdiagnosed, but he had been mistakenly given ‘electroplexy’ – ECT – as a result.

  It was a very good job I’d read around the subject by this stage. Otherwise I would have surely struggled to control my anger. The stalling from the GPs had made me tetchy and suspicious, and, on the face of it, a misdiagnosis doesn’t have worse consequences than ECT. From its negative portrayal in One Flew Over the Cuckoo’s Nest, to U2’s anti-ECT anthem ‘The Electric Co’, few medical procedures have a worse popular perception than ECT. And the last thing a paranoid schizophrenic needs is to be forcibly electrocuted.

  However, the discovery didn’t make me angry at all. Sad, but not angry. Why? In part it was because I knew that while many psychiatrists think ECT does not help treat schizophrenia, there are some, including the great E. Fuller Torrey, who think it has a modest role to play. Also, while the initials ECT bring to mind an array of horrific images of people being cruelly electrocuted against their will, it is unlikely my father would have been given it unmodified: it is generally administered under anaesthesia and with muscle relaxants.

  Any potential outrage was further tempered by the understanding that even the very best psychiatrists struggle to diagnose schizophrenia. In Schizophrenia: Understanding and Coping with the Illness, Dr John Cutting admits that over a period of four years he was referred some fifty psychotic patients by colleagues, to give a second opinion, and that in no less than twenty of these, the diagnosis turned out wrong. ‘I myself am continually making mistakes on the basis of one interview,’ he admits. Furthermore, it was highly likely that when my father was assessed, he was in a highly depressed state. Schizophrenia and depression go hand in hand. Though my father sometimes does a good impression of one now, there aren’t many happy schizophrenics out there.

  But the main reason I didn’t immediately get on the phone to a medical negligence lawyer, or travel to the doctors’ surgery with mallet in hand, was that I was distracted by another detail in the letter, a detail which provided an answer to the question that had been troubling me most since Mum had given me her account. The question was this: why did my mother stay with my father?

  She had told me that in the weeks after the hospitalization, the formidable machinery of Punjabi honour had finally cranked into gear. Several men from her family village in India had appeared, saying they’d heard about what had happened and that they wanted to pay for her to be sent back to India. A telegram had arrived from her father, saying he wanted her sent home and that he would pay the fare. There was also a conference of my father’s relatives, where several of my uncles offered to pay to send her back to India, if only for a break. They would do everything they could to make the marriage work afterwards, they said, adding in a typically melodramatic, typically Punjabi flourish, that they would all leave their wives, my father’s sisters, if the family didn’t honour the marriage. (It says so much about the role of women in Punjabi society that even at this stage the implication was that Mum was fortunate to have a husband.) People were falling over each other to help, Mum must have been terrified, desperate to see her family, she was still only eighteen or nineteen, had only been married for four months, but still she refused to go. Why?

  Of course I understood that Mum’s approach to relationships was different from mine. Over the years I’ve split up with girlfriends, and been split up with, for myriad reasons: because they were not bookish enough; because they lived on the wrong side of London; because they smelt funny; because, how could I forget, I had a fear of confronting my mother about wanting to be with an unsuitable girl. But I knew Mum was brought up in a patriarchal society, where a woman’s place was in the home, and where splitting up and divorce were taboo. I also understood that she had different expectations from marriage, expectations I hear her articulating now whenever my sisters have marital crises and call for advice. ‘In one’s life one must fulfil one’s duty,’ she will intone, standing at the phone in the hallway in her sandals. ‘Your kismet is your kismet. What is going to happen is going to happen.’ Unfortunately, ‘everything’ means everything up to and including domestic violence, which, alongside alcoholism, is the scourge of my community. Thankfully, I have never seen my father hit my mother, but domestic violence was a fact of life in other families as I grew up – there were Punjabi men on Prosser Street who would beat their wives in their back yards.

  I also understood that my mother loved my father. The love between them may not be of the romantic comedy variety, the type I aspire to, but having watched my mother take care of him, seen her cook his every meal, wash his cloth
es, ride his moods, I have always accepted it as a fact of life. In her accounts of the violence at the start of the marriage, Mum always qualified her descriptions by saying things like: ‘You’ve got to understand that I’ve never hated your father. Every time he hit me, he would cry afterwards and say: “I’m sorry, I’ll stop, I’m sorry, I’ll stop. Please don’t leave me.”’ In other words, even though she didn’t have the vocabulary or the medical know-how, she knew his behaviour was due to an illness. She knew he couldn’t help it.

  But despite all this, I still didn’t entirely understand why Mum didn’t go back to India, if only for a break. It was clear she was exhausted, there was nothing to be lost from having a break, she must have been grief-stricken with homesickness, and she must have known Dad would take a long time to get better. Even by her exacting moral standards, it didn’t make sense. But when I transcribed the dates mentioned in the letter on to the chronology section of my 1800 x 1200mm professional dry-wipe magnetic whiteboard, I was struck by a possibility, a possibility that had me returning to the tape recordings of my mother’s account of what had happened during my father’s hospitalization.

  ‘I used to go and see him at the hospital with the family in Stafford,’ she said. ‘It was a secure unit, like a prison really. But I would wait outside. Even then, everyone in the family was frightened he might try to attack me. During one of those early visits I remember being taken in to see his consultant. He asked so many questions and kept on saying he couldn’t believe how little I knew about marriage and life. I didn’t know anything.