Benji Waterhouse
Appearances
The Moth
The Moth Radio Hour: Great Expectations
It seems that often, you know, the solutions to people's lives aren't straightforward, and even psychiatry's modern best cures, you know, best treatments can be as disabling as the conditions that they aim to cure. And it's been weird for me, like, remembering that back then, you know, 10 years ago, the thing that really scared me was the patients.
The Moth
The Moth Radio Hour: Great Expectations
But now, with the benefit of experience and being more informed, by far the biggest thing that I'm fearful of is that, as a psychiatrist, I am maybe causing more harm than good. But maybe if I wanted things to be black and white, I should have specialized in radiology.
The Moth
The Moth Radio Hour: Great Expectations
I remember when I started at medical school, I was sitting in a great old lecture theater, wearing a stiff white coat, and our plummy dean was saying to us, your main job as future doctors is to keep your patients alive. Into my fresh notebook, I wrote, keep patients alive. And then I underlined it.
The Moth
The Moth Radio Hour: Great Expectations
By the end of the six years, though, I realized that I was less interested in the body and more into the mind. And so I hung up my now stained lab coat and specialized in psychiatry. I now know that people are quite confused about the difference between a psychiatrist, a psychologist, and a psychic.
The Moth
The Moth Radio Hour: Great Expectations
So just to quickly explain, psychiatrists are medical doctors who usually specialize in more serious mental illnesses, things like schizophrenia, and can prescribe medications. And boy, do we.
The Moth
The Moth Radio Hour: Great Expectations
We also have the power to kind of detain or section people, which is like a strange superpower that allows us to lock a person up in a psychiatric hospital against their will and even force them to take medication without breaking the terms of the Geneva Convention. a kind of sad but what's considered necessary evil to keep patients and society safe.
The Moth
The Moth Radio Hour: Great Expectations
There are a lot of unfair, I think, misconceptions about psychiatrists, that the male ones all have mad families themselves and wear cashmere jumpers and have beards. Which just isn't true. This is a machine-washable wool-polyester mix
The Moth
The Moth Radio Hour: Great Expectations
It is true, though, that one of my motivations for becoming a psychiatrist was hoping to get my hands on the secret codes to fix my own slightly dysfunctional family. So I remember turning up optimistically on my first day as a psychiatrist, enthusiastic to get my hands on these secret codes. Instead, I was given a strangle-proof lanyard, a panic alarm, and self-defense training.
The Moth
The Moth Radio Hour: Great Expectations
Our judo instructor was this, like, martial arts guy. And he told us, before he taught us the throws and the slams and stuff, he said, the biggest bit of advice he would tell us if we wanted to last long on the medical register was that we avoid any of our patients committing homicide. I couldn't believe what I was hearing. Like, this was nothing like Frasier. Yeah.
The Moth
The Moth Radio Hour: Great Expectations
or how psychiatry was depicted in Woody Allen movies. But he said, don't worry, he reassured us, the chances of a psychiatric patient killing a random member of the public are very low. Thank God for that. Far more likely, he said, they'd kill someone they knew, like their family member or a mental health worker.
The Moth
The Moth Radio Hour: Great Expectations
And so he said, I said, he said though, but don't worry, like the most important thing he said was if going to see a patient in their home, the most important thing was that if you're going, it was that you have to go for safety, always go in pairs if staffing levels allow. So it was my first week and I was working in this
The Moth
The Moth Radio Hour: Great Expectations
like inpatient ward, which also we also, under a consultant, we also had a clinic. And a patient one day didn't come to his clinic appointment, which my boss told me could be a red flag that people are deteriorating. So he wanted me to go and check he was all right. So I was going on this home visit in this first week. I was alone, obviously.
The Moth
The Moth Radio Hour: Great Expectations
And I knocked on the front door, like trying to not look like I was absolutely shitting myself. And the person I was going to see was called Billy, and he was a young man with something called paranoid schizophrenia, which, contrary to what Hollywood depicts, isn't actually about split minds and multiple personalities, but more usually delusional ideas and hearing voices.
The Moth
The Moth Radio Hour: Great Expectations
And after knocking on the door, I was pleasantly surprised when Billy opened it, and he gave me a warm smile, and I told him why I was there, and he said, oh, sorry, I completely forgot. He said, do you want to come in? Fancy a cup of tea, slice of cake? These were early signs that Billy was doing okay. So yeah, I got grateful, accepted that.
The Moth
The Moth Radio Hour: Great Expectations
I went in and the daytime TV was burbling away in the living room and we went through to the kitchen. And as he was fixing the teas, Billy told me a bit about himself. He said he lived there with his mum and he said they supported each other and they watched TV together. And he said, although they weren't churchgoers, apparently they watched Countdown religiously. But she was just out, he said.
The Moth
The Moth Radio Hour: Great Expectations
I took the opportunity to ask my generic psychiatric questions that my boss had taught me to ask, like, was Billy sleeping okay? Was his mood all right? Was he thinking of killing himself? No, no, no, everything was fine, he said, except for the voices. My ears pricked up. And that probably, I thought, explained the unopened packets of medication that I'd noticed on the side table.
The Moth
The Moth Radio Hour: Great Expectations
I tentatively asked him what the voices said. They're telling me to get milk, which is so annoying because we've already got milk, he said. I relaxed a lot because even I knew back then that schizophrenic voices are often more sinister than that, and psychiatrists don't tend to get struck off or make front pages for having patients well-stuck in the lactose department.
The Moth
The Moth Radio Hour: Great Expectations
But for completeness, I asked, do they say anything else? And Billy said, well, yeah, they're not going to like me telling you, but yeah, they do also say that I'm the Antichrist and that the only way to wash away my sin is to sacrifice my mum. I was like, oh yeah, that's more like it. But I just ignore them. He said, I just ignore them. They're stupid. I don't do what the voices say.
The Moth
The Moth Radio Hour: Great Expectations
I let out another huge sigh of relief. It's when patients don't feel able to ignore these so-called command hallucinations that psychiatrists don't sleep so easily. And so this wasn't the case with Billy, you know, reassuringly.
The Moth
The Moth Radio Hour: Great Expectations
And as he was, like, making me this nice cup of tea, and, you know, I could hear the intro music of cash in the attic just starting up from the living room, and the sunshine was pouring in through the windows, I was thinking, I think I'm going to quite enjoy psychiatry. And Billy asked if I took milk, and I said that I did.
The Moth
The Moth Radio Hour: Great Expectations
And he was busy, like, removing the tea bags with a spoon, so I thought I'd help. I went over to the fridge, and casually opened the door to discover milk. Cartons and bottles and cartons and bottles and cartons and bottles of milk filling every possible compartment of the fridge. I froze. I literally couldn't move my body. Shit. Billy was obeying the voices.
The Moth
The Moth Radio Hour: Great Expectations
My eyes were like transfixed on this wall of white. And like trying to sound calm and normal, I just asked again where Billy's mum was. I just told you, she's out. I took one of the bottles out and shut the door. And when I turned, I saw Billy was now smiling and holding a kitchen knife. Then he cut us two slices from the lemon drizzle cake.
The Moth
The Moth Radio Hour: Great Expectations
And he thanked me for the milk, and he put some in our teas, and we went to sit down in the living room in front of Cash in the attic. It was this incongruous scene where I was just thinking, Benji, if you behave normally, everything will be normal. But I could barely swallow this cake in my dry mouth, like trying to wash it down with sips from this scalding hot tea.
The Moth
The Moth Radio Hour: Great Expectations
But my mind was racing through all the worst-case scenarios, like I was just replaying that warning that our self-defense judo instructor had told us, like, far more likely they'd kill someone they knew, like their mental health worker or a family member. And I asked specifically where Billy's mum was. Shopping, apparently. And as we sat there, I said, like, but will she be coming back soon?
The Moth
The Moth Radio Hour: Great Expectations
And Billy went, shh, just nodded me to the telly. And my eyes kept being drawn to this, like, staircase, like at the back of the room that led up to the other floor. And I asked Billy if I could use the toilet. And he said, well, I mean, yeah, if you must. I didn't actually need to, like the adrenaline surging through my body had seen to that.
The Moth
The Moth Radio Hour: Great Expectations
But he said, yeah, it's upstairs, first door on the left. So I got to the foot of the stairs and I kind of looked up at this dark landing. And I hesitated. I was like, am I really going to do this? This isn't what I fucking signed up for. And so I went up the stairs, and at the top of the landing, there were two doors, both slightly ajar. And I gently pressed open the one on the left.
The Moth
The Moth Radio Hour: Great Expectations
Yeah, it was just a bathroom, empty. And I let out this breath that I felt like I'd been holding in for the last few minutes. But I knew there was another door. And I could feel my heart beating out of my chest. My shirt just felt way too tight, sticking to my back with sweat.
The Moth
The Moth Radio Hour: Great Expectations
And the thing was, I already knew what nightmare awaited me on the other side of that door from tabloid front pages and horror films and true crime documentaries. I went to open the second door. Bang! The sound of the front door closing. And from downstairs, I heard a woman's voice say, hello, love, I'm back. Crazy busy in Tesco today.
The Moth
The Moth Radio Hour: Great Expectations
And as I headed back downstairs, I overheard Billy say to his mum, did you remember to get milk? In a loving kind of, what are you like kind of way. She said, yes, angel, I got you your milk. And I managed to avoid sectioning Billy on the condition that he restart taking his medication, which with much persuasion from me and his mum, we managed to make him agree to.
The Moth
The Moth Radio Hour: Great Expectations
And back at my workplace in the hospital, I was telling my boss about how shit-scared I had been, and he told me that actually, people with schizophrenia are more likely to be victims of violence than perpetrators of it.
The Moth
The Moth Radio Hour: Great Expectations
He also told me that alcohol and drugs are far bigger risk factors for homicide than schizophrenia is, so actually, technically, I was safer being in a psychiatric patient's house than at a psychiatrist's house party. And it's a weird one because I am now the consultant psychiatrist with 10 years experience now. And I've seen thousands of people not dissimilar to Billy.
The Moth
The Moth Radio Hour: Great Expectations
And I've had a few close shaves, but I'm yet to judo slam any patients, which is a strange thing for a doctor to boast about. And the dean of my medical school, I think, would be proud of me too, like, All of my patients, luckily, are still alive, as are the people that they've kind of crossed paths with. But I sometimes wonder at what cost.
The Moth
The Moth Radio Hour: Great Expectations
Yes, with medication, Billy's voice is quietened, and we got the milk situation under control. But they took away other things. On this powerful antipsychotic medication, side effects meant that he'd sleep for like 16 hours a day. And when he was awake, the lethargy meant that he felt like a zombie. The meds also gave him obesity and later diabetes and heart disease.
The Moth
The Moth Radio Hour: Great Expectations
And during a painfully lucid moment when I was reviewing him later in the year in clinic, he said to me through groggy eyes, I know you're going to write in the notes that I'm doing well, aren't you? Just because I'm taking my meds, but on them, I'd rather be dead. So, I'm still very much looking for the secret codes for my family and for, at the more extreme end, people like Billy.