Graeme Smith
Mentor of the Month: Prof Graeme Smith
Wednesday, 04 August 2004
Johan Khor talks to Prof Graeme Smith of Monash University in a fascinating interview recollecting his experience of psychiatry as a trainee, the beginings of ANZAPT, reflecting on psychiatry of the present day and into the future...
JK: Before we start, I would just like to point out that this newsletter is presently distributed to roughly 900 psychiatry trainees throughout Australia and New Zealand, as well as the Executive Officers of the College, and the Chairs of several College committees including the Fellowships Board, the Committee for Training and the Committee for Examinations.GS: (nods)JK: Thank you very much for giving up time to share your valuable insights and accumulated experience in psychiatry with the next generation of psychiatrists.GS: I'm absolutely delighted at the opportunity.JK: As a general introduction, perhaps we could begin by asking you to talk about your professional background and training in the field of psychiatry.
GS: Well, when I started medicine in Australia there was very restricted training in psychological matters. I recall we had only six seminars in psychiatry and the clinical demonstrations were done in large groups at Royal Park Hospital by a dynamically orientated psychiatrist Dr. Preston Reynolds.I became interested in developmental and psychodynamic issues and how they related to psychological problems. For my own reasons, I began a doctorate on brain amine systems and took up the opportunity to train at Prince Henry's Hospital Melbourne in 1970 after Prof. Wallace Ironside was appointed as Chair of Psychological Medicine at Monash University in 1969.I was aware of my interests in psychodynamic issues and consultation-liaison psychiatry very early in my training whilst working with Dr. John Cade who was the Clinical Director at Royal Park Hospital during that time. I continued on at Monash University in the departments of anatomy and psychology before becoming involved in research in brain behaviour and the role of the cingular. My key interests became pre-eminent and I followed the work of Dr. David Copolov who was head of the Mental Health Research Institute at the time.
Following that, I spent time at both Oxford & Edinburgh Universities and also worked at Mount Sinai Hospital in New York. Upon my return to Australia, I was appointed to the Chair of Psychological Medicine at Monash University and set up the Section of Consultation-Liaison Psychiatry at the RANZCP as well as interest groups in Transplant Psychiatry and Interpersonal Therapy. I spent 13 years as Chair of the Committee for Examinations as well as 6 years as Chair of the Written Examinations Subcommittee.
JK: That's very impressive indeed. Thank you for providing us with that background. I understand youalso know something about the early history of ANZAPT.
GS: Well, it was already established in 1972 when I started psychiatry training and appeared to be quite active at the Victorian level. The President at the time was Dr. John Dingall who now works in Perth. I’m not sure about their activity in other states although I'm sure others can fill that in. In those days there was no coordination of training programs and the general hospital training schemes. Various state training committees were developed to enable trainees to meet training requirements of the College. ANZAPT grew as a response to the difficulties facing trainees at the time.
JK: How do you think the image of psychiatry has changed since the time you started working in this specialty?
GS: Well frankly, it hasn't changed that much. Trainees still face scorn from the public and from their own family and friends for choosing to train in this field. They are often viewed as 'traitors' to the medical model. Peoples' attitudes to mental illness, on the whole, remain uninformed and pejorative. The biggest change in recent times has been that consumer organisations are much more able to help change all this. In particular, groups like the Schizophrenia Fellowship have been extremely effective in lobbying the National Mental Health Plan and advocating for better resources for the management of schizophrenia, as well as the higher prevalence disorders including depression, anxiety and eating disorders.
JK: How has public psychiatry changed during your lifetime?
GS: Well, structurally there have been big changes with deinstitutionalisation of psychiatric services but it remains functionally unchanged. What has resulted is the great divide between psychiatry and the rest of medicine. In a sense, psychiatry has been allowed to practice without scrutiny for some time but that has changed. Also, the ongoing shortage in both funding and staffing resources has produced a certain degree of autonomy for those who choose to remain in the public system. That is the inevitable nature of deinstitutionalisation.
JK: What then do you see as the future direction of psychiatry?
GS: I believe it will become much more closely integrated with neurology. Mental illness will be viewed as a brain disorder, much like the catchcry of German Psychiatry in the 19th century. The high prevalence psychiatric disorders will have a negative impact on health mortality and health care costs. There will be increasing evidence for the effectiveness of psychotherapy and it will probably become a more acceptable treatment to patients. Some services will be also channelled to psychologists and general practitioners as cost-saving measures and they will be effective in delivering short-term psychosocial treatments.
JK: Anecdotally, there appears to be a current decline in the numbers of psychiatry trainees who are involved in psychotherapy of the analytic variety (for themselves). Can you comment on the importance of self-analysis for psychiatry trainees?
GS: Mental health professionals often undergo self-analysis only during moments of crisis however analytic psychotherapy is useful to explore wider issues in life. Some form of dynamic psychotherapy would be extremely beneficial for trainees, especially if they intend to use those skills later on their patients.
JK: Can you give us your personal advice & guidance on how to select and establish peer review groups when senior trainees make the important transition towards becoming consultant psychiatrists?
GS: There has to be a balance between like-minded and unlike-minded peers. I would encourage choosing a group of individuals involved in a mixture of practices. Overlapping fields and different sorts of practices within a peer group can provide a mind-sharpening exercise. It is important to remember the dangers of staying in one's own paradigm.
JK: What are your views on choosing between working in public psychiatry versus private psychiatry?
GS: It is a noble thing to remain in public psychiatry and I would highly recommend maintaining a position within the public mental health system. Private psychiatrists require expertise in a whole range of psychotherapeutic techniques as well as supportive psychotherapy and these are not taught well in the public system.
JK: You seem busier than ever after your “retirement†from Monash Medical Centre and I know you are still maintaining your university workload. What projects are you currently involved in?
GS: It's not actually retirement, simply a different emphasis on the other areas in my life. I'm still heavily involved with Monash University and various hospital committees. At present, I'm also involved as a member of a Multiple and Complex Needs Advisory Panel, established by the Victorian Government only last month. It's a statutory body that advises on how the needs of complicated patients can be met.
JK: Finally, what advice would you offer future generations of psychiatrists on how to maintain a good balance in your life?
GS: I would rely on my own ability to say 'no' to requests, depend on the willingness of others to say'yes' and be always conscious of my own vanity. I'm also cognisant of the fact that the same job can bedone by someone younger and just as capable(!).
JK: Thank you for those pearls of wisdom. On behalf of ANZAPT, I would like to express our collective gratitude for your generosity in sharing your reflections on psychiatry with us.
GS: It's been my pleasure.
Johan Khor