The British Journal of Psychiatry
Bad Faith: Forgotten History of Family and Fatherland
Gerald Russell

There are two interwoven themes in this book. The first is the history of the French fascist movement before and during the Second World War, the Vichy Regime, and the persecution of the French Jewish population during the War years. The second theme concerns Anne Darquier, the daughter of Louis Darquier, an outspoken fascist and Commissioner-General in charge of the deportation of the Jews from Vichy France, and his Australian wife, who abandoned Anne in an Oxfordshire village in the care of an English nanny. The first theme is extremely important historically and the author reveals disturbing material, admirably well-researched and presented. Most poignant is the round-up of Jews in Paris on 16 July 1942, their subsequent hardship and deportation in their thousands, including 6000 children, to Auschwitz. It is the second story which is of immediate interest to readers of this Journal: Anne Darquier became a psychiatrist who trained at the Maudsley from 1958. Her short life ended tragically.

Callil’s biography of Anne Darquier is derived from two sources. Callil underwent intensive psychotherapy with Dr Darquier, in the course of which the therapist disclosed the stories of her own parents whom she could never forgive. The second source was indirect, she identified Anne’s clinical case history under the pseudonym ‘Sue’ in a book Forms of Feeling, by Dr Robert Hobson, psychotherapist at Bethlem Royal and Maudsley Hospital. Hobson gave an account of Sue to illustrate his mistakes in the failed psychotherapy of his patient. Sue went through episodes of disturbed behaviour. Later she died from an overdose of drugs and alcohol, which Hobson thought was suicidal.

Callil berates Hobson at a personal and a professional level. Her description does not accord with my own knowledge of a colleague who was a respected clinician. She is mistaken in stating: ‘In Forms of Feeling he fictionalised his patients, never an acceptable practice then, but today there is a Code of Ethics prohibiting, and a system of investigation, for offences such as this’. Hobson wrote his book in 1985, when editors had not yet formulated guidelines for the writing of case reports. It was only in 1995 that the Editor of the British Journal of Psychiatry, acting on legal advice, decided that:

‘Where the patient refuses to give consent, then the case study can only be written up if personal details and dates and other information which identifies the patient are omitted, to ensure there is no breach of confidentiality’ (Wilkinson et al, 1995).

The Editor’s decision had a powerful effect: I found only four case reports in the 2005 issues of this Journal, in contrast with 104 in 1994. In his account of Sue, Hobson still tried to hide Anne Darquier’s identity after she had died, but Callil recognised her.

Callil’s criticism of Hobson’s book presents us with a double irony. When Hobson described ‘Sue’ only a handful of close friends recognised her. Callil, however, has let all her readers know that Anne Darquier and Sue were the same person. Moreover, Callil made use of personal material obtained from her therapist, Dr Darquier. She recognised that Dr Darquier had transgressed as a therapist by disclosing details of her own life. The clinician must, rightly, be the soul of discretion; the historian feels free to break confidences.

Current constraints on the publication of psychiatric case reports damage our subject. Callil’s book will further discourage psychiatrists from describing their patients. Yet the life story of a patient as a narrative is the essence of clinical psychiatry. Its virtual elimination requires us to re-examine th thee balance between preserving patient confidentiality and assuring progress in psychiatry for the benefit of future patients.