Exploring the mind: a memoir of psychiatry

Despite the fact that one in five Australians is likely to experience some form of mental illness over a year, in our society it is something that is still feared, misunderstood, and misrepresented, although, in part thanks to efforts of advocacy groups such as Beyond Blue, less taboo than it has previously been.

Emeritus Professor Sidney Bloch is a psychiatrist approaching the end of a long clinical and academic career who has seen massive changes in the diagnosis and treatment of mental illness over more than four decades. With colleagues Stephen Green and Jeremy Holmes, Professor Bloch has recently published a fascinating collection of essays about the history, current practice, and prospects for the future of psychiatry.

The history of official psychiatry is not long. Sigmund Freud is most often credited as being the ‘father’ of the discipline, but for millennia human beings have been attempting to understand the workings of the mind, the basis of behaviour and its aberrations, and the vagaries of personality. 

For Shakespeare, the puzzle of ‘madness’ was a recurring theme, from the psychosis of Ophelia and Lady McBeth’s delusion, to Lear’s dementia. David the Psalmist swings wildly from the pit of despair to the heights of delight; was he bi-polar? It is speculated that the medieval English mystic Margery Kemp – many times a mother – who told of her visions of torment and feelings of misery, suffered enduring post-natal depression.

For Bloch and his fellow writers however, the profession seems to be at something of a crossroads, the drive to understand the mind morphing into a drive to understand the brain; the exorcising of demons or analysis of the humours having given way to brain imaging and drug therapies.

“The study of molecular biology was in its infancy when we (the contributing authors) started out,” he writes in his preface.

“The future of our profession is uncertain. If a comparable text were to be compiled in the middle of the 21st century, how would it look? Will psychiatry even exist as a medical speciality? Will it have merged with neurology? Will it confine itself to the minutiae of brain function leaving the world of emotions and relationships to psychology, nursing and social work? Or will psychiatry, we hopefully, but perhaps vainly suggest, finally have taken its place as the queen of the medical specialties, uniquely able to integrate the biological, psychological, social and cultural, and to connect with the lived existence and meanings of its patients?”

Psychiatry: Past, Present and Prospect by Oxford University Press is not a populist publication, but not strictly for the initiated. A lay reader with a developed interest in psychiatry will find the essays stimulating and stretching, appropriate for a field that deals, as essayist Steven E Hyman writes, with the brain: “arguably the most complex object of scientific enquiry.”

www.psychiatry.unimelb.edu.au