Personal views: Old age psychiatry in Swansea
Authors: D D R Williams
Journal: BMJ (1999)

This new specialty has many advantages. It is particularly rewarding to those interested in local history, social and industrial change, and the history of the twentieth century. Our patients are survivors, people who have had long, often interesting, and sometimes distinguished lives, people who span the whole of the social spectrum. My only contact with an air vice marshall and a Bluebell girl has been as patients. I have also met the last rat catcher who worked at the local flour mill.


It is a specialty that bridges the divide between hospital and community. A large part of my time is devoted to the latter and there are many benefits. The key to good practice is unhurried assessment of patients in their homes. This approach, although time consuming, is clinically rewarding, and there are several hidden gains which are not obvious until you have worked in the specialty. 


My only contact with an air vice marshall and a Bluebell girl has been as patients



The Easter weekend was wet and cold. Many areas had had their first covering of snow. The following Wednesday was a glorious day, the sun shining from dawn till dusk. On Gower there was a clear view as far as the eye could see. I was indeed fortunate in having arranged to see patients in their homes on this spectacular peninsula on such a fine day. In 1956 Gower was the first area in Britain to be designated an area of outstanding natural beauty. On the south coast steep cliffs are interspersed with picturesque bays. To the north there are extensive marshes, mud flats, and cockle beds, all forming an area of importance for wetland birds. I had been to that area on Easter Monday to see if the herons were nesting again on a new site.

On another day I saw five patients and learnt several things in the middle of spectacular scenery. The first patient was in her mid-80s, able to give a good history, a widow who had spent six months in a home over the winter. She was deaf, her memory was failing, and she had recently broken her wrist. She was not contented. She was pining for her home. If she could be there all would be well. Was this hiraeth? This Welsh word has no English equivalent. It is the deep persistent longing for your dear ones, for home, and homeland. It has a definite Welsh and Celtic quality of longing for better days. It is not nostalgia, which is a more superficial emotion. Was this an appropriate state of mind or could it be a depressive symptom: dysthymia?

This lady told me that she was brought up in the Swansea valley and that her father had died young from “Monditis.” This term is not in the medical dictionary, but Donald Hunter, his pupils, and the doctors in this area would know immediately about the condition. Her father had worked in the Mond Nickel works at Clydach and no doubt had developed the severe respiratory complications associated with the refining of nickel.

Mid morning I saw the third patient at Horton, a small village on Gower’s south coast. I interviewed the patient in the porch in the strong sunshine. It could not have been a better day. Afterwards I returned along Cefn Bryn, the ridge that bisects Gower from north to south. The view all around was striking. In a circle you could see to the north west the Preseli Hills of north Pembrokeshire, to the east the Brecon Beacons, to the south Exmoor, and in the south west Lundy Island out in the Atlantic. This island, the distant hills, and the mountains can often be seen, but, on this day, the view was so much more impressive as all the high ground was covered in snow and highlighted by the clear spring sunshine.

Naturally, a real bonus of working in Swansea is the opportunity to meet people who have had contact with the city’s most famous son, Dylan Thomas. One of these was Mrs Trick, whose husband Bert had played such an influential part in encouraging the young Dylan to write and to publish. It is also possible to gain insights into two major formative influences on his work, the inspiring beauty of Gower and the natural spontaneity of the people. These two examples, an obituary notice, and a Valentine greeting from The Evening Post, could easily have entered the dramatis personae of Under Milk Wood.

“Evans, David Martin (Dai Dog), passed peacefully away.”

“Newman (Granada), I can’t wait to warm your tootsies in my sleeping bag. I’ll love you forever. Mrs Morgan.”

There are advantages of working in old age psychiatry. It is a pleasure to be out and about seeing interesting patients in splendid scenery, and Swansea has the added bonus of its cultural heritage. With the constant cycle of changes in the NHS and a further round of reorganisation in Wales it is important to remind ourselves of the benefits gained from our work.