Debate & Analysis The James Mackenzie Lecture 2012 Bothering about Billy

摘要

I first read Simon Armitage's poem, A Painted Bird for Thomas Szasz, over 20 years ago. I was a new GP in Birmingham, and drawn to it because it was written by someone about my age, a probation officer, a practical poet connected to the real world. Most of all, his description of Billy, a rough sleeper with a serious mental illness, made sense to me. He described seeing and being bothered by Billy at a local bus station, 'talking to the drivers who ignored him', in an arcade smelling 'like a wet dog, drying', and 'in the covered precinct pissing himself through his pants onto the concrete'. I saw Billy most weeks at the Summerhill Day Centre where my practice ran a drop-in medical service for anyone homeless in the city. I used to start each consultation by asking people why they'd ended up needing to come to Summerhill. I heard stories of unemployment leading to divorce and rooflessness; of too much alcohol; of a life led in institutions, in care, or in prison; or in the army then discharged onto the streets; and above all, for about half the people I spoke to, I heard stories of teenage 'breakdowns'. I was also left with an unshakeable impression that psychosis was something that primary care could and should engage with, and, if I had anything to do with it, would engage with.