The DSM V -I am deliberately and passive-aggressively continuing to use the Roman numeral rather than the newly instituted Arabic 5) has never interested me very much. It is a necessary evil that does some good. It has been widely misunderstood and misused. Lawyers, insurance companies and bureaucrats rely upon it much more than practicing clinicians, most of whom, like myself, I suspect find it of very little day to day use. The new edition is outrageously priced, thus ensuring that I and no doubt more than a few other private practitioners will have to struggle on as best we can without benefit of its wisdom. Of course we have no choice but to employ the diagnostic codes for any insurance billing we are obliged to do. Other than that, the DSM V figures little if any at all in my life. I do recall once years ago earning close to $2,000 in a deposition over the question of whether the then DSM was the standard of care in psychiatry at the time. I might have profited more but the court recorder ran out of paper to transcribe on. The attorneys asked me in every possible way they could think of in an effort to obtain my professional opinion that the DSM was the standard of care. I don’t remember what the case was about or why I was testifying as an expert witness. I tried every way possible to help them by saying that it was the best thing available but that it was far from perfect and therefore, no, I certainly did not regard it as a standard of care. What happened to the case as a result I never learned. I thought then and still think now that my response was rational and the best that could be made. The DSM, then and now, is the best thing we have – but it is certainly nothing close to “the Bible of psychiatry” as journalists like to call it.

All kinds of issues have been raised and old wounds opened by the brouhaha over DSM V. The anti- and over- medication gangs are mobbed up and working themselves into a frenzy again. The anti-Big Pharma paranoiacs are more agitated than usual. And the usual yahoos who go about direly proclaiming that “they” -the psychiatrists- are engaged in a diabolical plot to pathologize and medicalize normal behavior are steamed up and spewing into print. I believe Thomas Szasz  has sometime back passed on, but his confusions and misunderstandings march on. They may prove immortal. The charlatan Philosophe Michel Foucault pounded the same drum in a more obscure and historically fallacious manner. Anyone who has ever spent time with chronic schizophrenics, to mention just one example, knows perfectly well what wicked, hurtful nonsense these men and others like them have propagated by their writings.

Psychiatry, like everything else, is changing at an incredible, uncomfortable rate. I have watched it retrogress during most of my career. There is not a single new psychiatric drug that is therapeutically more effective than the limited repertoire we had in 1970. But there are enormous and therefore important differences: the drugs have far fewer side effects, which means people are more prone to take them as prescribed and to derive whatever benefit they can from them. The early drugs such as Elavil and Thorazine were truly awful with their side effects. One could scarcely blame people for not wanting to take them. On top of that, to make a bad situation worse, the tricyclic antidepressants (Elavil, Tofranil etc.) were highly lethal in overdose. A single week’s worth could be fatal, usually by causing cardiac arrest. Every single fatal therapeutic drug overdose I ever saw or heard about was from a tricyclic. It was by no means uncommon for a depressed person to overdose on them and die. This problem is virtually solved. Fatal overdoses with modern(Prozac and afterwards) antidepressants are extremely rare and almost always involve other drugs and alcohol as well so that it is difficult to be sure what actually caused death). And the side effects of modern antidepressants and antipsychotics are, at least to people who have had experience of the original ones, minor. Very unpleasant or serious reactions are rare. But that they are inherently more efficacious when taken as directed is doubtful.

Floyd P. Garrett, Sr.

Objectively regarded, the Old Man -my father, Floyd Phillips Garrett, Sr.- was a failure – but he was an interesting failure, for which there is at least something to be said. Commonplace failures are familiar and dull, a dime a dozen, obvious in their causes and predictable in their consequences. Not so with the Old Man, at least from what fragments of his life I have been told about and pieced together. Some of the best evidence of the failure angle comes from his own hand in the form of letters to me shortly before his unexpected death. He wrote that he was living in an apartment “small enough to gyrate a cat by its caudal appendage” and that he was employed by a perfume company and supervised two salesmen. He sent me samples of the product along with the usual newspaper clippings he thought edifying and the customary promises to soon be able to contribute a small sum to my education. There was a Micawberish quality to these assurances of future financial aid, which never managed to make an appearance. His greatest and as far as I know only contribution to my education or to anything else  relating to my mother and myself was a small life insurance policy. He was 66 years old when he died of kidney failure within a matter of weeks from the onset of symptoms. I have his death certificate, which lists nephrotic syndrome as the cause of death. There are any number of specific disease possibilities that might have caused this.

This interesting failure of a man was no part of my life after my mother left him for the second and final time when I was in the third grade at Mary Todd elementary school in Aurora, Illinois. The last straw, and a manifestation of one of the principal problems,  was when my mother and I were gently evicted by management from the Aurora hotel in which we had been living for several months. Evidently the bill was in serious arrears. We were literally put out on the street, told not to take anything with us because I suppose the hotel management had a vain hope there would be some valuable possessions that might offset the unpaid balance. I am sure they were disappointed, though we left with nothing but the clothes on our backs.  We rode the train into Chicago and joined up for the night in a tiny hotel room with my father. It was around Christmas and he gave me an orange. I have absolutely no memory of scenes, recriminations, or any sense of crisis. I don’t know what I thought was happening – but whatever I thought, it must have seemed normal and safe enough. Then my mother and I took the train to Hammond, Indiana and spent a few days with her sister, my aunt Sarah and her family. After that it was on to my mother’s birthplace, the family farm outside Inman, S.C. Sometime shortly after that my father arrived, no doubt in an effort to restore the relationship. I remember tramping around some with him and showing him the Big Gully – a hellish, rat-infested, burning and smoldering trash dump for the city of Inman a few miles from the farmhouse. That was the last time I ever saw him. Communication by mail was erratic over the years. There were long intervals of no communication. Letters from him, when they came, contained newspaper clippings and assurances that financial assistance would be forthcoming in the near future. I don’t recall being particularly interested in him, the letters, or the situation as a whole. Somehow it all seemed normal, nothing to be concerned about, certainly nothing to regret. My mother never mentioned him except once that I can recall when she exclaimed in exasperation “You’re just like your father!” This was not intended as a compliment. I have no idea what she was referring to.

It’s not entirely true that she never mentioned him, for it is thanks to her that I know that following: (1) she met him when she came to Washington, D.C. fresh from the farm, a high school diploma and a certificate from Gregg’s Secretarial School in Spartanburg, S.C. under her belt, and went to work for the U.S. Government where she became his secretary; (2) she fell in love with or at any rate married him because of his intelligence; (3) he was controlling and told her what clothes to war; (4) he couldn’t get along with co-workers because he thought he was smarter than they were and acted that way; (5) one of the reasons she left him was the fear that his personality would have a bad effect on me. But the strong subtext behind and beneath all of this was that the Old Man could not seem to hold a job or pay the bills. A strange development for a man whose occupation on my birth certificate is listed as “research economist” and who used to recommend that I read Adam Smith’s “The Wealth of Nations.”

This is where his failure begins to become interesting. It became more interesting still when I learned late in life, not long ago, that my mother was actually his third wife, that his first wife was from South America, that he had a daughter by his second wife, and that he left his second wife to marry my mother. As far as I can tell he never married again. In fact, he and my mother never were divorced, an oddity that was never explained to me. I have never seen or located a marriage certificate. It says on my birth certificate that they were married and my mother always said they were.

From my half-sister I learned a few years ago that the Old Man had apparently been doing very well financially prior to the Stock Market Crash of ’29. He was involved in real estate in Virginia, at Virginia Beach I believe. Whether from the Crash or something else, his fortunes declined. At the time he met my mother he was apparently a junior level executive with the Federal government in Washington D.C. He was a Republican and hated FDR. His Federal employment probably did not last long. I have no idea whatever what jobs he held, if any, after that. Was he actually earning money as a “research economist” when I was born? What on earth is a research economist anyway?  Whatever it meant for him, it seems to have been another step downwards on a descending stair, the bottom landing of which was a job as a low level manager for a perfume company.

Thus exercise is for me a matter of fits and starts, moods and momentary impulses, something never to be expected or counted or upon, but like the wind, cometh and bloweth when it listeth. Perhaps the term exercise is itself too glorified a term for an activity that consists of mere walking on paved sidewalks, and by no means walking at an accelerated or demanding rate. It can only be described as lazy walking, though  more generous words would be strolling or ambling. For such it might seem to an observer without access to the hidden laziness that actually determined the gait.

In my strolling, when the mood is upon me, I am these days always drawn to the Virginia-Highlands area where I grew up. There is something comforting about this old neighborhood, which has changed  little in overall appearance. The sidewalks are lined with trees which are full of singing birds.  The ground slopes gently without exhausting, terrifying ascents of the kind that easily discourage the lazy walker. There are not many people about, just a few runners and dog walkers.

Many memories and milestones mark the path of my lazy strolls. My first more or less connected memories began, as a TV station flickers, comes on, goes off, then comes on the air again, at Mrs. Langley’s Boarding House at 892 Ponce De Leon Avenue, N.E. This building is long gone, superseded by the Lake Chiropractic Clinic, itself having now seen better days and seeming to totter on the brink of extinction or renovation. It was at Mrs. Langley’s Boarding House that my mother and I lived in a tiny single room apartment for two years while she worked downtown as a U.S. government secretary and I attended the 1st and 2nd grades at the Happyland Elementary School a few blocks away on St. Charles Avenue.  The building still stands and is a prominent landmark on my walks. It is now The Gift of Grace House, a Catholic ministry serving indigent women with AIDS. I can locate no trace on the web of Happyland School itself. It was a small operation, no more than 15 or so children in each grade. My memories are few and disconnected – but I expect to return to them here if my laziness and indiscipline do not prevent it.

Not far from Happyland School, a few blocks away on the corner of North Highland and Ponce de Leon Avenue, looms the once proud and distinguished Briarcliff Hotel.  It has long since fallen upon hard times. Built by Asa G. Chandler, Jr., son of the THE Coca-Cola magnate, it began as luxury apartments and deteriorated to Section 8 housing in recent years. Even from the outside one can see that it needs much work. Sometime around 1950, my mother, father and I briefly stayed there.  There were marital problems, serious ones indeed. Mother mother left my father in Chicago where I was born and spent the first 4-5 years of my life and brought me to Atlanta and to Mrs. Langley’s Boarding House and Happyland School. I do not know whether the very brief hiatus at the Briarcliff Hotel was before, during or after that first hegira. Was there some plan between my mother and father of which I will now remain forever ignorant? She left him -that much I know because she told me so later- but then, what was he doing there, what were all three of us doing there in the Briarcliff Hotel? Was that before or after or during Mrs. Langley’s Boarding House and Happyland School? I have exactly two memories of that Briarcliff Hotel excursus: (1) my father instructing me how to urinate on the wall of the commode rather than into the water “in order not to wake your mother,” who was evidently napping, and (2) somebody, my mother I believe, dropping a small jar of instant coffee which broke in the middle of Ponce De Leon Avenue as we were returning from a grocery store across the street in the Plaza shopping center. What happened after we left the Briarcliff, who went where and why and with what eventual plans, I do not and now will never know.

All the same, I am glad the technology was not available when I was a child, for it has erased boundaries and invaded personal spaces in ways whose effects we have yet to appreciate.  Modern technology allows, if it does not require, instantaneous communication; the human brain and body, if we accept the tenets of biological evolution, have not had even a minute fraction of the time that is probably required to adapt and catch up with the telegraph and the automobile, much less later developments.  Events and reactions to events and reactions to reactions to events move at almost literally light speed, often on a national or even worldwide scale. This introduces a level of instability and contagion of thinking whose consequences cannot be foreseen.  Speed of communication can act as a force multiplier for emotions, permitting people to act and respond to events before they have had time to calm down and think them through.  Of course at the same time such communication allows the correction and clarification of misunderstandings which, left to themselves, might have festered and grown, setting in train other confusions.

Memory of course can be misleading.  The tendency to idealize and sanitize childhood as one ages is well-known. This has to be kept in mind in all comparisons of then and now. So does the obvious fact that individual conditions and experiences differ widely even at a given time and place. We have to approach such matters with the admonition of Aristotle in mind that the degree of precision in a subject must be in accord with the nature of the subject itself.  Thus regarding most if not all human matters we must speak of what is true in general, for the most part etc. Exceptions and counter-examples are numerous – but they do not logically negate the overall impression. Thus it is rightly said that exceptions prove the rule.

That said, the simplest way to express my impression of the difference between then(the Fifties) and now is that school and everything connected with it was as I recall it just no big deal.  It is true that I remember very few details – but I believe my recollection of the Gestalt is likely more true than false. I certainly do not remember it as idyllic, Edenic, or even particularly happy. It -school and all that- just doesn’t stand out in my mind as having been as big a deal as it seems to be today.

I am certain we had homework – but I do not recall ever doing any, nor any consequences related to homework. I cannot recall, in fact I cannot even imagine my mother helping me with such homework as there was. There were no “projects” to be done and handed in as seem to be common in some schools today.  Organized after school activities no doubt existed, but I neither heard of nor participated in any of them. I did not know anyone who did. The general idea was that one was obliged to attend school until around three o’clock and then was released from captivity to do whatever one liked. There was a sense of freedom and liberation when school was “out.” I know that many children today then proceed promptly to some other structured activity such as sports. Their time seems to be fully filled up. The amount of homework and school projects they are assigned often sounds unbelievable to me. I cannot imagine having endured such schooling.

It also seems that recess -the high point I recall of the sixth and seventh grades until school let out- has been abolished or so altered as no longer to be recognizable. I am not sure how widespread this practice -denial or over-structuring of recess- actually is. I hope it is not the rule. At recess we were simply turned loose en mass on a loosely fenced in field and allowed to do as we wished as long as we did not kill or seriously maim one another. I am sure there were adults standing by to prevent such harm to life and limb, but I cannot recall them.

Teachers did not talk about sex or politics nor did they invite students to do so. Such topics would have been regarded by all as wildly out of place and inappropriate for the classroom, which was essentially a place where one studied and hopefully mastered the famous 3 Rs and such science as one could absorb. Doubtless what is today condescendingly termed “American exceptionalism” was the order of the day in textbooks and lessons. I know that Abraham Lincoln and George Washington became my ego ideals for personal honesty and rectitude. I thought the cherry tree story was a historical fact rather than a hagiographic myth. But historically true or not, it expressed a moral truth that helped form my character and, I am sure, the characters of other students.

We feared our teachers and in some instances respected them. But mostly, I believe, we feared them. We behaved for the most part because we had no doubt whatsoever that if we did not there would be undesirable consequences. One might “be sent to the principal’s office” – though for what, I cannot recall and am not sure I knew at the time. There would be some sort of disciplinary riposte to proscribed behavior. There was never the slightest uncertainty about this. Of course parents would also be informed, which might be the worst thing of all. I doubt any child of that era even dreamed that their parents would easily side with them against the teachers and principals, go to bat for them, argue with school authorities etc. No doubt this happened from time to time – but it must have been extraordinarily rare. I never heard of such a case. I never expected such a outcome if I got into trouble at school. My mother had told me that when she was a child and got a whipping at school -which was done routinely in her time- she got another one when she got home for getting a whipping at school, no questions asked. It was sufficient for her country parents that she had done something wrong at school.  Parents respected and trusted teachers and assumed until proven otherwise that they were right and their children were wrong. This seems almost to have reversed itself in many schools today. Some parents automatically side with their children in matters of discipline and especially grades and are prepared to go to considerable lengths and if necessary cause a great deal of grief for teachers they believe have unjustly treated or scored their offspring.

The psychologically interesting thing is that what felt and still feels like the best year or two of my life was by no means objectively the case. It was perhaps the very worst time, materially speaking. There was, I learned much later, barely enough to eat. My mother having left my father for the second and final time, she was our sole support, no help whatever from him or anyone else. She was at that time a low level U.S. Government secretary, perhaps a GS-4 or 5. We lived in a one bedroom basement apartment that flooded when it rained. I had a second hand, used bike. An automobile was out of the question. I am not sure we even had a small black and white TV when the photo was taken, though it was about that time we got one. Around this time I was required to make what turned out to be a fateful choice that could very well have determined the entire course of my life: whether, on the extremely limited funds available, we should go to the Lakewood Fair that year – or whether I should choose the (very) small Gilbert Chemistry Set that I had been eyeing in the window of a store in Virginia-Highlands where we lived. The choice of the chemistry set set in train a sequence of events that not long afterward led to the determination to become a physician – even though I had absolutely no knowledge of what that entailed. Everything I knew or thought I knew came from an old Lew Ayres-Lionel Gillespie “Doctor Kildare” movie I had seen rerun on TV.

By today’s standards, in other words, we were poor. My mother -who for some reason never divorced my father even though she never saw him again- was for all practical purposes a single mother. I was a latchkey child in the 4th and 5th grades, riding the bus to and from Westminster School(then just opened and on Ponce De Leon Avenue) and invariably arriving home before she got home from work downtown – riding the bus, of course. Public transportation was the only transportation until my first year at Emory College, when we acquired a used 1955 Plymouth. My mother was gradually but steadily rising up the ladder in her job. Eventually she became -and retired as- administrative assistant(i.e. secretary) to the Regional Director of the U.S. Post Office. That was much later. in 1954-55 things were tight, very tight.

I dwell on this perhaps too much because at the time it never occurred to me that we were poor and barely making it. Even looking back on it requires an intellectual effort and the incorporation of information later supplied by my mother as to the actual state of affairs at the time. I have never felt as secure and financially OK since. It is certainly true that ignorance can be bliss. Of course I was acutely aware that I could not have everything I wanted, that there were constraints upon my natural consumerism. This did not, however, translate itself into feelings of poverty, abnormality, injustice, inferiority or anything of the sort. It was just the way things were.

Another reason for mentioning this is to question the current widespread assumption that poverty, lack of money, single motherhood etc. necessarily exert baleful and destructive effects on a child’s development. That is far too simplistic an analysis. Many other factors, in some cases at least, more important ones, are also involved.

It is also worth recording what it was like to be a child in the 1950s in the South. Of course in my case that means being a middle class white child in an era of segregation. My mother had the good sense -good luck, perhaps, but I think mainly good sense- to choose a stable middle class neighborhood with a good public school(Samuel M. Inman) where she was able to cling on by her fingernails and by the strictest economy keep us in a small, converted, rented one bedroom terrace(basement) apartment long enough to improve our economic circumstances modestly.

Being a child then, in the Fifties, was nothing like what I gather it is like to be a child today. The consequences of this vast and still ongoing transformation of society cannot possibly be appreciated yet. They are too big, they have not had time to come to fruition. Those of us who have experienced them should make some effort, however feeble, to preserve them in written form for posterity.

Act III. Scene I.—A Room in the Prison.

Enter DUKE, as a friar, CLAUDIO, and PROVOST.

Duke. So then you hope of pardon from Lord
Angelo?
Claud. The miserable have no other medicine
But only hope:
I have hope to live, and am prepar’d to die.
Duke. Be absolute for death; either death
or life
Shall thereby be the sweeter. Reason thus with
life:
If I do lose thee, I do lose a thing
That none but fools would keep: a breath thou
art,
Servile to all the skyey influences,
That dost this habitation, where thou keep’st,
Hourly afflict. Merely, thou art death’s fool;
For him thou labour’st by thy flight to shun,
And yet run’st toward him still. Thou art not
noble:
For all th’ accommodations that thou bear’st
Are nurs’d by baseness. Thou art by no means
valiant;
For thou dost fear the soft and tender fork
Of a poor worm. Thy best of rest is sleep,
And that thou oft provok’st; yet grossly fear’st
Thy death, which is no more. Thou art not
thyself;
For thou exist’st on many a thousand grains
That issue out of dust. Happy thou art not;
For what thou hast not, still thou striv’st to get,
And what thou hast, forget’st. Thou art not
certain;
For thy complexion shifts to strange effects,
After the moon. If thou art rich, thou’rt poor;
For, like an ass whose back with ingots bows,
Thou bear’st thy heavy riches but a journey,
And death unloads thee. Friend hast thou none;
For thine own bowels, which do call thee sire,
The mere effusion of thy proper loins,
Do curse the gout, serpigo, and the rheum,
For ending thee no sooner. Thou hast nor
youth nor age;
But, as it were, an after-dinner’s sleep,
Dreaming on both; for all thy blessed youth
Becomes as aged, and doth beg the alms
Of palsied eld; and when thou art old and rich,
Thou hast neither heat, affection, limb, nor
beauty,
To make thy riches pleasant What’s yet in this
That bears the name of life? Yet in this life
Lie hid moe thousand deaths: yet death we fear,
That makes these odds all even.
Claud. I humbly thank you.
To sue to live, I find I seek to die,
And, seeking death, find life: let it come.

Miss Minnie was a sick woman from the first time I knew her. The local doctor kept coming by and hanging up bottles of D5W – 5% glucose in water to hydrate her. It was believed she was suffering from gallstones – though some years later, after she had taken to her bed and seldom got up, I believe it was a perforated peptic ulcer that killed her at age 84. She was no big loss to me. I cannot recall a single kind word that ever passed from her to me. I heard by the grapevine that she called me a “quare duck” and said that I was “the laziest white boy she ever did see.” She was an incubus over the whole house, someone to tiptoe around for lest she be disturbed. We walked on eggshells even though she kept to her bed, shut up in her bedroom, tended to by my aunt. I remember some groaning and moaning, Someone along the line she fell at church and broke her hip. I am not sure she had surgery for it, as she seems to have been bedridden afterwards. On rare occasions she would be helped into the living room to watch Arthur Godfrey on the small black and white TV that was a recent acquisition. If she ever read a book or a magazine I was not aware of it. Like many country people, she was deeply suspicious of my fondness for reading, which I believe she equated, not necessarily incorrectly, with laziness. There was no doubt that I found farm work much too exhausting for my tastes, But watching my uncle go day after day to tend the crops I developed an abiding respect for the character, discipline and, yes, the courage of farmers. It is not an easy life.

How did Miss Minnie come to be named Minerva Octavia? There must be a story behind that, one that I will undoubtedly never know. Those Cothrans, it might as well be said, were among the most tight-lipped, secretive people I have ever known. At the time, knowing no different, I thought it was normal. But normal it was not. The result is that I know virtually nothing about any of them, my grandparents or distant relatives. There was a certain stony grimness to it all that probably could not have been cracked even had I been minded to try.