Doctor Jay has rarely during the time he has been writing this column meandered into the dangerous world of psychiatry as it relates to what I hope I can be forgiven for calling “the fair sex”.  It should go on record that I am by nature an ardent feminist, and if at any time I am in danger of steering from the straight and narrow pathway, both my daughter and my wife make sure that I wake up and duly see the error of my ways, which of course I am only too pleased to admit to.

Which brings me specifically to the issues of surgery, hysterectomy, and mastectomy, that is those operations, normally performed by men, on women with some of the most frightening pathologies that can exist, and which cause the most enormous amount of suffering.

I have to say that most of my colleagues in the world of gynaecology and general surgery are more than au fait with the consequences of their interventions upon the female of the species, and there can be little doubt, of that I am sure, that we are all aware of the consequences of the removal of the womb, its consequence upon a woman’s perception of her own fertility, and of her own capacity to bring forth life; equally the removal of a breast, or for that matter both breasts, has a significant effect not merely on a body conscious society, where “the body beautiful” has become the be all and end all of existence, but also from the point of view of the symbolic removal of the capacity to suckle, and a fear that the loss of these important glands will mean a change in status, not to say physical attractiveness.

To say the least these operations bring forth enormous amounts of emotional response, and surveys that have been conducted now for over 30 years have indicated that the incidence of post-operative depression relating to these conditions remains high, and perhaps understandably so.

It is in these areas that the work of the cancer therapists have playing such an important part, not to say the work of the mastectomy society, and those who have taken it upon themselves to guard a woman’s interests at times like these, and sadly, though understandably, most of these guardians happen to be women, who are the protectors of their own sex, in a way in which perhaps men, contrary to public opinion, are not.

One of the most horrifying stories I have ever heard happened to a lady who was a patient of mine when I worked in General Practice some years ago; she had in fact, sadly, had to have both her breasts removed, and she went for follow-up with the doctor who had performed this sad couple of operations.  She was accompanied for the visit by a member of “The Women’s Action Group”, and as it turned out it was fortunate that she had not indeed gone alone.

As she sat patiently in front of the doctor’s desk, the doctor fiddled with the bits of paper that were lying in front of him, because obviously he was deeply embarrassed by the lady’s problems. 

Eventually, without lifting his eyes from the desk he said “Tell me Mrs. So-and-so, what does it feel like to look like a man?”

Now this remark is not in any way meant to criticise the medical profession, though doubtless some will take it as that, nor is it meant to indicate that Doctor Jay himself is exempt from making crass remarks on the grand scale, I am certainly not.

Nonetheless, it does indicate the difficulties the medical profession has in dealing with “women’s complaints” and this is a difficulty that needs to be highlighted if the psychiatric and emotional adjustment problems of women who have had this kind of surgery are to be considered and dealt with in a more open and compassionate way than has been managed so far.

The bottom line therefore in considering psychology and surgery is the considerable need for voluntary self-help organisations who can grant support at times of great difficulty; sometimes such organisations are seen as being made up of “interfering old busybodies” whose aim in life is to make doctors’ lives a difficulty.

Not so and far otherwise I hope I hear you all cry, for such organisations present an absolute opportunity for those in need to receive support not merely surgically, but in helping with the unseen traumas, the unseen pains, which often exist long after the scars themselves have healed up.