My Psychoanalytic Story: with Judith Trowell

Niamh: Can you tell me your name, where you’re based, and a bit about your professional background?

Judith: My name is Judith Trowell. I’m based now from home and do private work here. I’ve had a number of different roles throughout my career. At the moment, I chair the Ethics Committee for BPAS. I was, for many years, a consultant child and adolescent psychiatrist at the Tavistock. Then, for a short while, I was Professor of Child Mental Health in the West Midlands at Worcester University. I’m a trustee of Coram and have been for many years. I worked at the NSPCC for 10 years and also, a colleague and I founded the mental health charity for young people called Young Minds.

Niamh: Can you name a specific reason or motivator that prompted you to go into your line of work? Did you always know what you wanted to do or has that changed over time?

Judith: Well, in the latter years of my high school education I seemed to be doing quite well and so I seemed to have a choice of what I wanted to do. For a long time, I wanted to be a vet, I was very keen on animals. Then, shortly before applications had to go in, whilst I was walking home from school, I thought:

“Well, what am I doing working to help animals? Shouldn’t I be doing something a bit more for human beings?” It felt more important that I do medicine. So, that’s when I started.

I enjoyed most of medical school although I didn’t like surgery. I always wanted to talk to people. Once you determined what the problem was, you weren’t supposed to talk to them but I was always thinking,

“Well, why has this happened to them now? Why have they got this particular condition? What’s going on in the background?” and I remember being told off about that. I was also very aware of how distressed a lot of people were. So, I began to be interested in psychiatry but what I really loved was paediatrics. Once I had qualified, I went into paediatrics and I really loved that, I loved working with sick children.

I’d married my husband some time before that and we decided to have children of our own. So, I left the hospital and had two children and went into general practice. I did five years in general practice, and I guess that was quite formative for me in many ways. I think most hospital consultants should have a time in general practice to see what it’s like within the community. However, over time I got very fed up. I was the only woman in the practice of men, so it meant I got a lot of the gynaecological work. I still loved working with children but if there was anything serious going on health-wise, I had to refer them to a hospital, and they were treated there. So, that was frustrating.

At that time, there was a lot of social change. I remember that a local factory closed and I used to do home visits as a GP. I’d go onto a number of estates, and I’d see all the men sitting outside, who’d all been made redundant. Meanwhile, in the practice, I noticed lots of women and children coming in with all sorts of conditions which I realised was probably a reaction to losing money and the husband being home and unemployed. So that’s when I began to think that I should perhaps do psychiatry and try and understand these mental health problems. So that’s what I did.

So, I began working with adults in a large asylum and I loved it, I was very happy there. Then, I saw some job posts at the Tavistock Clinic that I’d actually seen them when I was still a GP and it piqued my interest. So, I applied and that’s where I did my training in child and adolescent psychiatry. During my time there I went up through the ranks, I got a consultant post there and then head of department.

At that time, the Tavistock was very psychoanalytic, and that psychoanalytic world is very interested in understanding where these issues come from, which is why I went on and did the psychoanalytic training. Not necessarily because I wanted to go purely into psychoanalysis, but I wanted to be the best psychiatrist I could be.

Niamh: Psychiatry and psychoanalytic work are renowned for taking a very long time to learn and practice. Can you pinpoint a certain time in your career where you were able to feel confident in your abilities to help people? Your experience certainly speaks to the fact you probably helped a lot of people but when did you start believing that yourself?

Judith: I can’t say there was a turning point. I think I was very, very lucky in the people that supervised my work. So, it was a very gradual process. I also had two children at home, being grounded within the family and ordinary childhood problems really helped to keep me rooted. Then I began, gradually with good supervision and teaching, to build it all up.

Niamh: Let’s talk a little bit about your roles with BPAS and Young Minds and the more organisational parts of your career. What made you want to move into roles like that? And what did you gain from those roles?

Judith: When I was a senior member of staff at the Tavistock, I became much more involved in training and my medical background meant I could remain partly in clinical training. So, I began to do quite a lot of teaching of junior people coming in like doctors, psychologists, therapists and nurses. This meant I began to see a lot of issues that they had to struggle with and also heard from them about the sort of situations they were having to work in. They would come to the Tavistock to do the courses, but they brought the issues and problems from their home situations to work with them. I’d always been interested in community but this made me much more aware of the context in which people were working. Then I took on a management role at the Tavistock and I had a much more active involvement in the management of the organisation.

I also went on a couple of Leicester Group Relations events. Those were very interesting trainings where you get stripped of all your accolades or status, so you’re all equal. Then you would have to do tasks and work in a group and take on different roles and I always seemed to emerge as sort of leader. I never quite understood how that happened but I seemed to be able to not be afraid of taking on roles that require making a lot of decisions.

Sometime before that I’d started the Monroe Foundation – where we had centres for young families who would receive support when they couldn’t cope with their babies – I remember walking into a team meeting once and one of the managers saying,

“Judith, you always just make decisions. You don’t seem to be fazed by making a decision. How do you do it so well?” and I said,

“When it’s clear, I take it. When it’s not clear, I take it and hope it’s alright. But if it’s not, we can undo it and do something different.” Sometimes decisions just have to be made. So that’s why I began to move into more organisational roles. I could see what needed to be done and sometimes it was very painful, but you had to do what you had to do.

This colleague and I, for example, realised that child mental health was in trouble. We really wanted to do something about it and make change. We deliberated and thought about it, but then in the end we realised that the important thing was just to actually do something. We can’t just pontificate or hold forth about the awfulness of what’s happening in child mental health. So, let’s see if we can start something that will make a difference. That ended up being the charity Young Minds that’s still active today and I’m pleased to say it’s done really rather well.

So, I was always interested in community and outward facing roles. They offered something more than just sitting in a consulting room seeing X number of patients a day, that wasn’t the way I wanted to go. So, I’ve liked my role as the Chair of the Ethics Committee for the BPAS, before that I was Chair of Child Training. Those are roles that I feel I’m much more comfortable with.

Niamh: It sounds like all of these projects you’ve worked in would be quite a lot to juggle. Do you think it’s benefitted you in the long run?

Judith: I think so. It’s not always been easy. Although there have been peers and colleagues around me that have maybe chosen a more straightforward path, but this is who I am and this is the life I’ve had.

Niamh: Can you think of any particular challenges in your career that you had to overcome?

Judith: There have been so many but I suppose the challenges in paediatrics could be particularly hard. There was a little girl that came into the ward that ended up losing her life due to injuries inflicted by her mother. The mother explained that she and her husband were divorced, that she’d been to court that week and she was adamant that she didn’t want her child spending any time with him. It was hard because the woman was clearly in psychosis and whenever she was going to come out of that she was going realise she’d lost her child.

Niamh: Do you think that it’s kind of things like that to make you want to get to the root cause? Work on preventative treatment?

Judith: Yes, absolutely. It was so tragic that there was nobody that picked up on the impact that was had on this woman, of going into court and whatever decisions that were made legally. I wasn’t there, I have no idea whether the decisions were made rightly or wrongly but the consequences of those decisions were pretty horrendous.

Niamh: Bringing us into the present day, how do you feel about approaching your retirement years, does it feel like the right time? And having worked to actively within organisations and charities related to your profession, are you hopeful for its future?

Judith: Well, I mean, a bit of me thinks that I should be out there doing a lot more but I’m also aware that it’s time to step back. The next generation have to do what they have to do. From the people I’ve trained, I know there are lots of very good professionals around.

I think that the political and the financial situation is so grim. It makes me glad that I worked through a time that there was money for services. Especially when Tony Blair was in power, there was money for child mental health services and there was funding for youth work too. That money meant that we could set up services and make change but that’s all gone now. So, there’s a sadness there. There’s also a lot of anger about the way the country’s been managed and the way money has been managed. So, I think it’s right that I step back, other people have to take that on because it’s very painful to see what’s gone.