Picking Up The Pieces
by Grace Pearson

Kim has a borderline personality disorder and is registered as a 'vulnerable adult'. Despite being unstable and requiring care herself she also cares for her husband who has had a stroke, and is frequently verbally and physically abusive. Her grown-up children are also the source of much stress: one bullies her for prescription drugs, the other is a user-addict and involved in illegal activities. I met Kim in an emergency appointment at her surgery - she was having a mental breakdown and had tried to kill herself forty-eight hours previously by taking an overdose.

I have composed a piece of serialist music to reflect Kimís feelings and my own emotions after our encounter- part 1 is shown above.

It is based on a tone row (of 1 semitone, 2 semitones and 5 semitones) which makes the music very atonal and angular - this could be seen as a 'breakdown' of normal musical conventions and so reflects Kimís very first statement to the doctor: Tm having a mental breakdown'. I feel it also represents the despair and anguish she must have felt at the moment she decided to kill herself. This choice also reflects the shock that I felt at this lady's situation. I have used the oboe because this instrument has a very piercing sound which I felt portrayed the verbal and physical abuse she is subject to. I have also used many clashes -for example the triplets against quavers (in bar 23), and the dissonant chords in the piano accompaniment- to reflect the discrepancy between her husband as a carer and her husband as an abuser. The repeating triplets in bar 23 are also meant to represent the 30 tablets she took to try and take her life.

I have used the whole range of dynamics and the entire range of the oboe to portray the sheer number of problems that Kim has to face daily: her mental disorder which means that she is unstable and suffers from anxiety, depression and insomnia. These symptoms are compounded by domestic violence, bullying by her son and financial issues.

I could not believe how much this lady had to go through and I was particularly upset by the fact that she receives very little support from her family which is why I used such a range of musical techniques, as range of dynamics, pitch and timbre is conventionally used by composers to express a wide variety of emotions and experiences.

My title- 'Picking up the Pieces'- is a response to Kimís statement: 'I'm having a mental breakdown'. It formed a mental image in my head of her life, body and mind shattering into pieces. Her GP and the crisis team then have the job of helping her pick up these pieces and helping her recover.

I have not included the patient's real name for reasons of confidentiality and I gained Kimís permission to use her story as the basis of this creative piece.

Grace Pearson, GP Attachment, Year One, 2012