the Comédie humaine I have hauled back from Paris.
Thankfully, my work is supervised. Colonel de Jager is a kind man, no doubting that, but some of his views are very questionable.
‘I am of the old school,’ he tells me proudly. And he wears his years of service like the red badge of courage. He is a big fan of electroconvulsive therapy. ‘No muscle relaxant, mind you,’ he admonishes me. ‘That is the way to get a big convulsion.’ Here he pumps his fist for added effect. ‘Bigger the better’ is the cornerstone of his therapeutics. To stop the patient convulsing right off the bed, ‘simply apply a little weight to his chest,’ he advises. ‘It’s basic mechanics, really.’
He looks pleased with himself, but the anaesthetists are outraged. ‘You can fracture vertebrae without the relaxant,’ they chorus.
‘Bullshit,’ responds my boss. ‘That nonsense is in the small print.’
He has never seen it, not once in thirty-five years, but the anaesthetists will not budge. No muscle relaxant, no anaesthetic. The colonel is forced to concede. ‘Anti-psychiatry blackmail,’ he fumes.
The Colonel has two subordinates I can turn to, if need be: Commandant Yin and Commandant Yang. Where Yang is swarthy, short, portly and tone deaf, Yin is fair, tall, lean and musical. In theory they are supposed to be alternately available, but Yang is always going away on courses. ‘To improve myself,’ he tell us, or to get his Iron Man certificate. He returns as mean as before – and with a limp and a hobble, an arm in a sling, a leg in a splint and a mouth with razor-thin lips spewing a thousand excuses for failure. Which we all have to listen to because he is second in command and we are nothing, less than nothing. Lower than snake shit, to be precise.
The point is this. The clinical problems are often complex and I am out of my depth. Sometimes I get stuck and I ask Yin and Yang for help, but they can get stuck too. So we turn to Colonel de Jager. We find him chatting up a secretary half his age and double his height. He takes the interruption well, given he is hell-bent on scoring. I present the case. Yin chimes in. Yang takes issue with Yin. They argue. The Colonel says nothing. His thoughts are elsewhere.
Six months into the job, the relentless flow of soldiers in distress has become a blur, the faces of the patients less distinct, their names overlapping.
Paranoia is endemic, the common denominator that underpins three quarters of what I see. But paranoia has many faces, from the simple garden variety – ‘The Sergeant is plotting to harm me’ – to the more complex, ornate kind – ‘My sperm is being controlled by men in Saudi Arabia’. Sometimes the more bizarre delusions are remembered, but when you are assessing eight to ten patients a day, the details are more often lost.
It is soon clear to me that we have to practise a very different kind of medicine. What is good for the State is not always good for the patient. Take the anxious soldier, for example – and by anxiety I am not referring to a few butterflies in the stomach. The kind of anxiety that flows our way is incapacitating, accompanied by sweating, tremors, palpitations, a knot in the stomach, diarrhoea, light-headedness and a feeling so intense it becomes a conviction on the part of the troopie that he is dying. He doesn’t die, of course, but these waves of angst hit him relentlessly and it is just a matter of time before he makes his way to us with a furrowed brow, sweaty palms and a heart full of fear.
What now? His history usually reveals an anxious temperament to begin with, the neurosis present since childhood, but manageable. A worrier by nature, a poor sleeper under stress, a nail-biter perhaps, uncomfortable in crowds, a little self-conscious, functions best in small groups and among people he is familiar with, a few close friends and a loving family.
Well, all that is gone now, blown away overnight, replaced by screaming corporals, furious sergeants, apoplectic commandants, 04:00 wake-ups, bellyaching hunger, toilets that are blocked solid, men twice your size rubbing shoulders with you in vast communal showers while you stand naked waiting for your jet of cold water … but what are you to do? And everything has to be done in double time: ‘Hurry up, hurry the fuck up, you useless piece of shit.’
You don’t need six years of medical school to see why long-standing, low-grade anxiety quickly balloons into symptoms far more troubling. And the solution is just as easy to identify: Send the soldier home. Discharge him back into the predictable routine of his suburban life where he can once more find comfort in the quietness of his bedroom and the warm embrace of a doting family. But that won’t do, not at all, not here in the engine room of the Republic. With an approach like that, the sickbays would be overrun with the anxious – real, imagined or simulated. Lower the threshold for medical discharge to a diagnosis of anxiety and the whole show would grind to a halt.
An army cannot reach a compromise with neurosis. So we are instructed to treat these men – boys, really – with the express aim of returning them to their units. And it can be a very uncomfortable thing to do because as I dole out therapy, be it pill or talk, as I follow the SADF’s orders like the good soldier I am, using whatever rudimentary skills I have, I hear the admonishing whisper of Hippocrates in my ear. Therein lays the tension of military psychiatry. The army comes first. The State trumps the mental state.
There are, however, times when even military necessity must bow to the power of a mind gone awry. One case in particular exposes the curious juxtaposition of a madness that obeys no rules and an iron discipline that is uncompromisingly rule bound. A seventeen-year-old infantryman, Private Jardine, is sent for assessment, straight from the detention barracks. The Major who makes the referral has been with the military police for years.
‘Never seen a case like this before,’ he confides. ‘At first, we thought it was gross insubordination, a wise guy taking the piss, but it seems to be much more than that. No amount of punishment can make Private Jardine see sense. He’s like an effing parrot.’
The story unfolds piecemeal. Jardine has been in the military for three months. He was called up the same time that I was and sent to the 4th SA Infantry Base in Middleburg. Everything starts off reasonably well. No warning signs, just another conscript, one of thousands passing through the system. Three months in, Jardine reports to the doc, claiming a Corporal Smits is picking on him. He is advised to get over it fast and told the corporals are paid to pick on people because that is what they are good at. ‘It will make a man of you,’ is the doc’s parting advice. Nothing more is heard of Jardine until one early-spring morning when the platoon is drilling on the parade ground.
‘Halt,’ yells Corporal Smits, the very same Smits Jardine had complained about.
‘Halt,’ echoes a reply from deep in the ranks.
Smits starts. Has he misheard? Has a soldier shouted halt as well? Impossible. Who would dare do such a thing, let alone in an infantry unit? I must be hearing things, reasons Smits. Must be the wind playing with my voice. He looks about him. It is certainly gusting. Mini sandstorms swirl around the feet of the platoon. His men stand immobile before him. Dead still, not a flicker from one of them. Three months of drill and just look at them! Lean and mean! Fifty synchronised men marching as one, just where he wants them. Oh well, I better get on with it, he thinks. Time enough for kudos later.
‘Forward march,’ he bellows.
‘Forward march,’ bounces back the reply.
A ripple of unease runs through the marching men. Smits hears a stifled laugh. No mistaking it. And no mistaking the echo this time either.
‘Halt!’ he screams.
‘Halt!’ bounces right back.
‘What the fuck … ?’ is
