Farewell to Gabriel Kirtchuk

Farewell to Gabriel Kirtchuk

from John Gordon

To Autumn

Season of mists and mellow fruitfulness, 
Close bosom friend of the maturing sun,    
Conspiring with him how to load and bless    
With fruit the vines that round the thatch-eaves run:         
To bend with apples the mossed cottage-trees,  
And fill all fruit with ripeness to the core;       
To swell the gourd, and plump the hazel shells       
With a sweet kernel; to set budding more
And still more, later flowers for the bees,
Until they think warm days will never cease,          
For summer has o’er-brimmed their clammy cells.            

Who hath not seen thee oft amid thy store?
Sometimes whoever seeks abroad may find                         
Thee sitting careless on a granary floor, 
Thy hair soft-lifted by the winnowing wind;
Or on a half-reaped furrow sound asleep,
Drowsed with the fume of poppies, while thy hook
Spares the next swath and all its twinèd flowers;
And sometimes like a gleaner thou dost keep 
Steady thy laden head across a brook;
Or by a cyder-press, with patient look,
Thou watchest the last oozings hours by hours

Where are the songs of spring? Aye, where are they?
Think not of them, thou hast thy music too—                                                                          
While barrèd clouds bloom the soft-dying day,                                                                        
And touch the stubble-plains with rosy hue,        
Then in a wailful choir the small gnats mourn
Among the river sallows, borne aloft
Or sinking as the light wind lives or dies;
And full-grown lambs loud bleat from hilly bourn;
Hedge-crickets sing; and now with treble soft
The red-breast whistles from a garden- croft;                                                                         
And gathering swallows twitter in the skies.
                                                                        
John Keats

Gabriel Kirtchuk died on April 2, 2019 after a long and debilitating illness. He would have been 70 in June. Grace under fire is an understatement to describe his four year-long struggle with a nightmare, especially for a person always so essentially alive. For Gabriel was mentally and physically constantly in motion, thoughts and observations tumbling around and out of him as he would circle a room discussing work with colleagues or drinking wine and socialising with friends. When we would get together to plan our books and papers, I eventually realised that I just had to sit calmly and restrain myself from trying to follow him with my gaze as he drifted around talking - really a spirit in perpetual motion. For someone so active, the slow physical degeneration Gabriel suffered was tormenting, but even to the end his mind was clear, his insight into people, clinical work and organisational dynamics exceptional, and his creative thinking profoundly stimulating. We were working on a paper even in the last weeks.

Gabriel Hector Kirtchuk was born on June 10,1949 in Córdoba, Argentina. His Jewish ancestors had immigrated to South America from Russia. He graduated from the University of Córdoba Medical School in 1972, and as a young doctor moved to Israel, partly to escape the anti-semitism he had encountered on campus but also to explore what he considered would be an exhilarating way of life on a kibbutz. He very recently regaled me with tales about that experience: ”I was pretty left-wing in those days (that has changed considerably!), and we used to have regular presentations and discussions of all kinds, political, artistic and cultural topics. It was a fantastic place to be”. On the other hand, having dived in at the deep end required learning a new language while working and serving in a clinical role in the army. In Israel Gabriel trained as a psychiatrist and psychotherapist, and it was there that he met his wife, Orita. They moved to London in the early 1980s when Gabriel pursued his psychoanalytic interests at the Tavistock Clinic, returned to Israel but then decided to relocate to London for good. Their two children, Liza and David - now both doctors of whom Gabriel was always immensely proud - were born in London and Jerusalem respectively. Last September Gabriel was overjoyed to become the grandfather of Liza’s and her husband Daryl’s daughter, Gabrielle.

I came across Gabriel for the first time in late 1987- early 1988 when, as a very recently employed psychotherapist and group analyst in Bob Hinshelwood’s psychotherapy department at St Bernard’s Hospital, I participated as a member of a panel to interview applicants for a non-medical psychotherapy post which had become available. Gabriel had applied for the job, and I clearly remember asking him what he would do if he were appointed and subsequently, as expected, his medical and psychiatric qualifications were approved by the relevant UK authorities. He replied that he would stay in the psychotherapy position. We all liked him, he was appointed, and very soon he had made a major contribution to the training offered by the psychotherapy department in the form of a new course on assessment for psychotherapy.

On Passover in 1988 Gabriel, Orita and the kids came over for the Seder, and thus began a thirty year extremely close friendship between us. Not only were we both from Russian Jewish stock, but my maternal grandparents had eventually ended-up on the Arizona-Mexico border where, even on the American side of the “line”, 95% of the people were Mexican and everyone spoke Spanish or, in my case, the Chicano Caló dialect. So Gabriel and I really hit it off immediately, and our conversations - and to some extent the entire life of the psychotherapy department and then the forensic psychotherapy department - became a version of a Yiddish-Hebrew-Gaucho-Cowboy-Spanish-speaking barrio. He eagerly supported my proposal to start a wine club, which I called The Analytic Wine List: Internalise The Best. During one period, when the forensic psychotherapy department was based in North House, I had been to a conference in Buenos Aires and brought back a traditional Argentinian hollowed-out gourd with a silver straw. Gabriel enthusiastically set about initiating us into the hallowed rite of passing around the yerba mate during staff meetings. This particular “herb” in fact has slightly stimulating characteristics which Gabriel was obviously accustomed to and barely affected his own natural state of active fecundity. But the rest of us found it disconcerting to be suddenly experiencing the world even slightly through his eyes. We went through quite a few large bags of yerba but ultimately decided to return to earth, although in no way had the creativity of our group, under Gabriel’s leadership, been reduced.

To return to Gabriel’s professional life, his time in the psychotherapy department, as we had more or less predicted all along, was inevitably fairly brief. He was soon recruited as Consultant within the same Trust to take over a longstanding therapeutic community for patients with personality disorders, the John Conolly Unit. The previous Consultant, a psychoanalyst, had just retired and this seemed a perfect opportunity for Gabriel, who had already begun his psychoanalytic training at the British Psychoanalytical Society (Institute of Psychoanalysis), to develop his clinical and leadership capabilities. But in under a year the Trust managers decided to close down this unit, and these same managers were then faced with the $64,000 question: what in the world could they do with Gabriel? To cut the story short, Gabriel (initially supported by Beatrice Stevens, a very experienced psychoanalytic psychotherapist) established from scratch a forensic psychotherapy department in what was to become the largest NHS forensic psychiatric service in the UK. He did this through the exercise of a very special gift: Gabriel was a schmoozer par excellence, a networker of genius. I nicknamed him EL VINCULO, the link, and he was constantly in contact with virtually everyone in the organisation and its wider environment in order to promote the department’s clinical interventions, trainings and provision of reflective practice groups for multidisciplinary teams throughout the Trust and beyond.

Gabriel was a Consultant Psychiatrist in Psychotherapy (Forensic). He became a Fellow of the British Psychoanalytical Society in 1996. He was for many years Lead Clinician of the National Forensic Psychotherapy Training and Development Strategy which extended his linking to interested professionals throughout the UK. From 1995-2002 he was Training Programme Director of the West London Higher Training in Psychotherapy Scheme, and from 2011-2015 he was Chair of the Special Interest Group in Forensic Psychotherapy at the Royal College of Psychiatrists. He was also for many years an Honorary Senior Lecturer at Imperial College Medical School. Based on his development in association with Birkbeck College of a Post-Graduate Diploma in Psychotherapeutic Approaches in Mental Health, which subsequently became an MSc in conjunction with Buckinghamshire New University, Gabriel was first an Honorary Senior Lecturer and then Visiting Professor at the latter university, a role that he savoured especially when this MSc was recognised as the core academic teaching for ST4-6 psychiatry trainees within the Trust. He was the founding Chair of the Forensic Psychotherapy Society, a post-MSc training recognised as a Member Institution of the British Psychoanalytic Council, and he took part in clinical seminars on forensic patients at the Institute of Psychoanalysis. Over the course of his career, Gabriel was actively involved with the BPC and the Association for Psychoanalytic Psychotherapy in the NHS. He frequently participated and presented papers at international conferences, especially those of the International Association for Forensic Psychotherapy. In his training role Gabriel influenced and inspired generations of psychiatrists and junior doctors as well as innumerable non-medical professionals in hospital, prison and community settings. His publications with colleagues included group psychotherapy with adolescents, the containing function of the physical setting in forensic work, psychotic processes in forensic institutions and, most extensively, the countertransference impacts on clinical staff of contact with forensic patients as well as interventions - especially reflective practice and interpersonal dynamics consultations - which could help staff to manage these intense emotional pressures.

Two of Gabriel’s initiatives should be highlighted as they currently have a vital influence both within and beyond the West London NHS Trust for which he worked. Gabriel did the advanced training, including the training for trainers, in Mentalization-Based Therapy under the auspices of Dr Anthony Bateman and Professor Peter Fonagy, its founders. He encouraged all of his colleagues in the forensic psychotherapy department to do the MBT training, and this gave rise to a number of MBT-based psychotherapy groups on the forensic wards. Gabriel also organised many MBT training events throughout the Trust.

Complementing and deeply reinforcing a mentalizing stance was Gabriel’s link with the Operationalized Psychodynamic Diagnosis Group, a German team of psychiatrists and psychoanalysts who had developed a complex protocol for assessing psychiatric patients. One aspect of this system, Axis II, involved the assessment of a patient’s interpersonal relationship patterns. Gabriel invited several of the senior members of the OPD Group to the forensic psychotherapy department where they elucidated their method for him and his colleagues. Interpersonal Axis II elicits how a patient repeatedly perceives others, staff included, as treating him through attitudes or actions; how the patient experiences himself responding; how others, including staff, repeatedly perceive the patient’s attitudes and actions toward them; and how others, staff included, experience themselves and their responses. From a psychoanalytic perspective, these four dimensions of any interpersonal interaction describe the crucial transference-countertransference interactions between a patient and his clinical team which deeply resonate with significant past relationships. Gabriel inspired a Kleinian revision of the OPD Interpersonal Axis II so that it could be applied in a forensic setting, and Interpersonal Dynamics (ID) consultations and trainings soon became a regular part of organisational life, including weekly tele-conferencing workshops with interested colleagues from all over the UK. 

In the last months of his life, Gabriel reviewed the proofs of a now published paper to which he had contributed which extended the ID consultation beyond the forensic context in which he had developed it to general medical settings. This expansion built on an earlier paper and a book chapter on the consultation as well as on a manual and a further book detailing this approach to enabling teams of professionals to become more aware of - to mentalize and to contain - how they would inevitably get drawn into maladaptive patterns of interaction with patients which could severely hamper the effectiveness of their treatment interventions. In the weeks before he died, Gabriel and I were devising the outlines of another paper which applies the ID consultation to inter-group relationships, thus making it a method for understanding organisational dynamics from a psychoanalytic perspective. Although he could no longer roam around the room, during these last visits with Gabriel his vivid thoughts erupted and ricocheted as usual, often for over an hour, and I was hard-pressed to take in such exuberant abundance.

For Gabriel’s 60th birthday in 2009, he and Orita came over to our flat for dinner: por supuesto un magnífico bife de chorizo a la parrillada - barbecued sirloin steak, the gaucho-tanguero’s and Gabriel’s favourite. On an earlier trip to Paris I had discovered a bottle of 1949 Château Langoa Barton, a great Saint Julien Bordeaux, which I had stored in my cellar awaiting this occasion. In the course of our wine adventures together, Gabriel and I had once bought out Sainsbury’s entire stock of the fabulous Bodegas y Cavas de Weinert, an Argentinian Malbec, Cabernet and Merlot blend of which 15 cases were consumed over successive years. The 1949 Bordeaux vintage, however, is one of the most exceptional ever produced, and we could not believe the simultaneous depth of mature flavours, freshness of fruit and extended afterglow which that Langoa Barton delivered. It seemed to be destined to last for many more decades. Now I will not be able to share another bottle with Gabriel for his 70th, but his enriching memory will continue to reverberate in the minds and hearts of the countless people whose lives he touched.

Adios vato, mi querido amigo.                 

Now cracks a noble heart. Good-night, sweet prince; 
And flights of angels sing thee to thy rest. 

 

John (Juancito) Gordon
 

Date: 
Tuesday, 23 July, 2019 - 16:32