Squatting Archive - Personal View (Pat Day, BMJ, 9 Nov 74)

[Radical doctor's account of living in a suburban squatting community (Grosvenor Road, Twickenham, England)]

Twenty-five years after free health care was initiated a number of minority groups, such as unattached young people, are left uncared for by a health service orientated by laissez-faire relationships. Doctors and other health workers tend to be recruited from the middle class. So there is plenty of empathy between doctors and middle class patients, but little between them and unconventional patients, who are therefore liable to find themselves labelled as ill. In the case of minority groups, also, an active service (rather than passive reliance on self-referral) may be necessary to counter a disinterest in health, which sometimes amounts to a death wish.

With these ideas in mind 18 months ago I moved into a community of homeless young people in south-west London. I intended to remain relatively value free and role free and to avoid any suggestion of "doing good" or of personal gain - though prepared to offer advice and skills when necessary. Since I had few social ties and was not strongly career orientated within medicine, I was able to squat rent free, and sustain myself financially on occasional locums and agency work. I felt that an essential part of the rapport I hoped to establish would stem from my non-specialization and relative youth together with a desire to relate first as a person and later as a doctor.

The community was made up of about 100 young people, two-thirds of them men, mainly squatters in empty property awaiting redevelopment. The average age was about 20 and about 60% were working.This was a fairly stable developed "alternative" community and it had definite social characteristics. So a sense of community was maintained by free access to most squatted houses, sharing of food, and fluidity of social relationships - with frequent changing of rooms and close friends. Casual work patterns were preferred, and money was not spent on the usual consumer items, some 20% of income being spent on drugs including alcohol.

The core of about 50 permanent residents spent some time in creative pursuits, such as motor bicycle building and house repairs. There was a widespread interest in mythology, mysticism, popular eastern philosophy, and conservationism, which was cross-fertilized by exchange visits to country communities.

The community was good copy for the local press and a frequent target for the criticisms of local councillors, magistrates, and traditional residents. But fortunately there was little hostility from public utilities and social agencies: the relationship between squatters and police were best described as mutual tolerance.

My empathy with the group was obviously essential to the scheme though I soon became aware that my professional role included constraints (I needed to have a car to get to work, and had to keep drugs locked up) which hindered a totally free relationship.

Meetings of the resident community were held for a time in the hope that some emotional exchange might develop, but in the event they served rather as social gatherings and forums canvassing proposed social activities. At one time I ran a "surgery" with a fixed location and time. This was in reponse to a demand which was not backed up by consultations, which occurred at any other time and place from that specified - a vindication of my initial policy of offering low key advice. In the latter part of my stay several "projects" emerged for entertainment and creative work. These were developed organically and were generally well supported and smooth running, in stirling contrast to projects conceived outside the community.

The medical problems encountered in this group are those which one would expect and fell into three main groups: sexual (including pregnancy, venereal disease, and psycho-social); drugs; and psychiatric (usually subclinical and linked to the first two groups). On the whole sexual problems appeared to be handled well. Drugs were the subject of numerous consultations and perhaps excessive interest, but they generally caused less ill health than inadequate diet and housing conditions. No more than 5% of the people came near to qualifying for dependence clinics. With the commonly used drugs there was widespread and realistic knowledge of their effects. I noted no problems with marihuana; people using lysergic acid occasionally required support from habitues during bad trips; but it was Mandrax, amphetamines, and the barbiturates which were probably the most abused.

The ambience of psychiatric terminology in the community, with some modified Laing concepts, was presumably a useful safety valve, though I felt it might delay presentation of any overt psychiatric illness which could be treated by extablished methods. Even so, the incidence of such overt illness seemed to be low and such psychosocial disturbance as occurred could with some mutual support be adequately handled within the community. Any shortfall in mutual support was probably a function of both the introspection of the community and the inadequacy of the welfare services (such as nursery schooling and social activities) for this group. My most useful contact was with the local probation officers, whose approach to the multiple problems of the squatters seemed to be the most realistic. I also made occasional contact with local social services, voluntary and community groups, schools, police, and the prison medical service, but no working relationship emerged, and interested individuals were more valuable than official concern.

After about six months of living in a community of deprived young people I began to experience a dichotomy. My original hypothesis had been that a blurring of the established traditional doctor/patient relationship was necessary to reach this kind of group. The problem now was just how much of the doctor status I should retain, and there were two alternatives. Firstly, I could merge my identity and attitudes totally with this group and drop out. This could be a pleasurable experience, but would negate any efforts I made to offer medical advice (I had already ceased to be a "proper" doctor). Secondly, I could become a straight doctor again and pay occasional visits to the community to deal with any problems, as by holding a surgery. I could no longer operate as I had originally chosen, because of the lack of financial support and of a sympathetic community organization. (Emotional work strains in this situation are best shared).

There is obviously a need for community work with this group. Most medical and social agencies are not flexible enough to provide the low-key approach which would at least gain them a hearing. But it tends to be overlooked that this is a young adult group, some of whom have infant dependants, and that it is also probably getting bigger. Certainly the pressures that have caused young people to move towards this sort of community are increasing.

Patrick J. Day (British Medical Journal, 9 November 1974, p340)

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