Educating Julie

Julie sat a maths exam back at the beginning of March.  It was against the odds: she had just been readmitted to hospital after yet another overdose. It was one of our early tests of the new hospital regime - whether or not they would let her leave the ward with me to take her exam.  We all fussed a good deal over the exam board regulation that she had to have access to a pencil sharpener. However, the hospital did let her out, and seven weeks later we have the results.  She got an outstanding mark in her exam, a comfortable grade A*.

It is a good result at the right time, because this is the very first of the many exams that Julie would have to sit to gain her GCSE's (the first round of qualifications gained by teenagers in England and Wales).  She managed to take this exam on a handful of home tuition sessions in the previous month, and the result has really boosted her confidence.  At the same time, just the prospect of sitting a similar exam in science next month reduces her to quivering tears.  I contacted the school and had to explain that she will not be taking more exams for a while.  Understandably, they were a little disappointed.

School work is a source of both trouble and joy for Julie.  On one hand, she enjoys the act of studying; she is bright and needs occupying: a daily diet of daytime TV is not the stimulus she needs.  But on the other hand, exams and assignments are a source of huge strain.  Julie is a perfectionist who has been known to spend six hours on a piece of homework that was supposed to take thirty minutes.  She does not recognise when she has done enough.  In the school attached to her hospital unit, she spends one studious week with her school books, and then two more weeks trying to avoid them.  A less able student might expect less of themselves, and make steadier progress.

Despite the attached school, the hospital on the whole does not make education a priority.  I cannot work out whether this is based on experience of what is possible, or whether they have a blind spot about educational achievement.  When they list Julie's strengths on paper, they record her musical or artistic ability, but never mention her academic strength.  The primary nurse that looked after Julie last year spent a lot of her time trying to persuade Julie that academic achievement was not that important - that it was just as big an achievement that she crocheted beautifully.  I lamely tried to back her up on this, but I could not do it very convincingly because I did not believe it.  I still use the many beautiful bedspreads that my mother crocheted, but when she was alive she had no doubt that what changed and defined the course of her life was not crochet, but being the first person in her family to study at university.

Why is it seen as so important that Julie relinquish her academic ambitions? Why can't she crochet and do maths as well?  Can she no longer expect to be academically successful now that she has entered the twilight world of mental illness?  Is it now dangerous for her to continue to study when she sometimes finds it stressful?  Or is it simply that the hospital staff do not expect their patients to be successful at their school work - are they even a little threatened by the idea?

I remember something curious that took place when we first started using CAMHS services (when Julie was just fourteen).  For some years she happened to have a fixed ambition to become a psychiatrist herself: we had met several child psychiatrists when her brother had been diagnosed with Asperger's Syndrome, and Julie had taken a keen interest in what they did.  She had chosen science subjects at school, and started reading textbooks on psychology.  Sometimes, when a psychiatrist wanted to get to know Julie better, they asked her what she wanted to do eventually, and out would pop the answer - "a psychiatrist".  This was always a really uncomfortable moment for the psychiatrist, and I have to confess it was the one bright spot for me in interviews that otherwise seemed interminable: smiles froze, and there was occasionally a hint of physical recoil.  One even went so far as to hastily correct her, "Well perhaps you don't mean a psychiatrist as such."  At the time I thought it was just misplaced kindness - they could not know how seriously she had pursued this, and they may well have worried that she was just reflecting back what she thought that they wanted to hear.  Later, thinking it over, I wondered if they knew more than I did about the outcome of her mental illness.  Were they just trying to adjust her expectations in line with the new reality that now faced her?  But occasionally since then, I have wondered if she had broken a taboo: is it forbidden for "one of them" to become "one of us"?  Put bluntly, is it presumptuous of a lunatic to dream of running their own asylum?

(Julie no longer dreams of being a psychiatrist, and I do not know whether I think this is a good thing or not. Perhaps she just grew out of that stage.  Perhaps psychiatry is the last thing she would want to pursue now.)

Julie's education or lack of it presents Joe and I with a dilemma.  Whenever we ask hospital staff about Julie's education, we are told that her recovery has to take priority - which is hard to argue against.  But as we enter the third year of her illness, with no sign yet of recovery, we begin to wonder if she should just make the best of the life that she has. Joe and I both come from the Scottish tradition which sees education as valuable in itself: something which helps you to lead a good life.  It is hard to explain this to hospital staff, who seem to see education simply as a gateway to a set of careers that Julie may never be able to manage anyway.

We have been discouraged by staff from taking steps to help her study, even when Julie has explicitly asked us to help.  Sometimes we have ignored them and helped her.  But are we being irresponsible in exposing her to the stress that exams can bring?  Or are we more irresponsible in colluding with the hospital staff in discouraging her from education?  After all, with practice and support, exams may come to seem not so stressful.  They may even become an opportunity: rewarding in themselves, in a fair and well-ordered world in which Julie feels at home, even when the real world seems unfair.