SPEAKER_10 0:02

Welcome to the Thought Broadcast, a trainee-led podcast from Australian Psychiatry. My name is Fiona Wilkes, and I'm a trainee associate editor of Australasian Psychiatry. And today's podcast records a set of interviews I did with Andrew Amos, one of the deputy editors of the journal, and a sample of attendees at the 2024 College Congress here in Canberra. We discuss a broad range of topics at the Congress, including AI, the historical use of malaria to treat neurocephalis, and some practical issues like tips for keeping babies happy at scientific conferences. Our first guest was Tess, a third-year trainee from South Australia, who told us about a talk on the concept of shrinkflation in psychiatry.

SPEAKER_03 0:38

G'day, I'm Andrew Amos, I'm Deputy Editor of Australasian Psychiatry. We're wandering around. Fiona Wilkes is my associate, one of the trainee editors. We're just wandering around trying to get some opinions about how the Congress is going, what you found interesting, that sort of stuff. So could you just introduce yourself?

SPEAKER_11 0:54

I'm Tess. I'm a third year stage two trainee in South Australia. Yeah, I think the thing I've found most interesting so far probably was a talk yesterday in the forensic psychiatry stream talking about the shrinkflation of psychiatry. I found I think that it kind of aligned very well with maybe some of the thoughts and feelings I've had in my day-to-day work that I haven't had the words to describe.

SPEAKER_03 1:17

So it was What is the idea of shrinkflation in forensic psychiatry?

SPEAKER_11 1:21

It was more kind of general psychiatry framed, but the idea was talking about similar to shrinkflation kind of in the world, in terms of the serial boxes getting more expensive but getting smaller over time. And talking about that's kind of what's happened with a lot of our public psychiatry systems, that the I guess resource expenditure is increasing, but what we're actually offering our patients is probably less than the costs going up at service is going down. Exactly. So kind of the idea then that we're operating on in this system that's kind of dictated by the resource limitations rather than by what our patients individually actually need.

SPEAKER_03 2:00

For sure. Where where where do you work at the moment?

SPEAKER_11 2:02

At the moment I'm working in a community mental health team in the northern suburbs of Adelaide, which is one of the least resourced um and most disadvantaged areas of South Australia.

SPEAKER_03 2:12

Well, this must be Gismet, because I grew up in the northern suburbs of Adelaide. The fair city of Elizabeth. I don't know if you're familiar.

SPEAKER_11 2:18

I very much am around the corner from my work.

SPEAKER_03 2:21

So it was uh General Motors Holden had a big factory there and we've got a lot of Scottish uh immigrants and those sorts of things.

SPEAKER_11 2:27

Pretty um tough group of people, but and then they closed the factory, which created a lot of socioeconomic disadvantage in the area. Didn't help the situation.

SPEAKER_03 2:36

Do you think you've seen in your working life that sort of increase in expectations and decrease in funding?

SPEAKER_11 2:41

Well, definitely. At the moment I work within kind of an acute community service. Yes. And I think that's kind of exactly what our limitations are, is that we have referrals and we have kind of one-off assessments where we can absolutely see that more longitudinal input would provide a lot of benefit to that person who has some chronic symptoms but isn't acutely unwell. Yes. So they're not going to hospital, but also we're not going to keep them because we don't have the longitudinal resources available.

SPEAKER_03 3:08

Oh, indeed. Did they have any solutions to offer, or is it just all problems? I put you on the spot.

SPEAKER_11 3:16

I think it was mainly problems. He did say he was going to end on kind of a positive note, and I think the idea was that I I guess he kind of was talking about trainees and people kind of advocating for the ongoing kind of involvement with those individuals and advocating that we should be looking at our patients individually and advocating kind of for formulation and an approach to the individual patient and their individual needs as maybe a pathway forward.

SPEAKER_03 3:42

Sure. Anything else that you're looking forward to at the Congress?

SPEAKER_11 3:46

I'm very much looking forward to the forensic psychiatry talks this afternoon. I think you can tell I have a preference.

SPEAKER_03 3:53

Not on the label?

SPEAKER_11 3:54

Not on the label yet. Hopefully next year.

SPEAKER_03 3:56

It's my third year, of course, so next year you're going to uh branch out and do it. That's the idea. Well, fascinating topic.

SPEAKER_11 4:04

Yes.

SPEAKER_03 4:05

Well, look, thank you for talking with us, Tess. Lovely to talk to you. Hope you have a great uh rest of the Congress.

SPEAKER_11 4:09

Thank you.

SPEAKER_03 4:09

Fantastic.

SPEAKER_10 4:11

So uh I don't know whether either of you both know this yet, but I'm working with Australasian Psychiatry with Professor Louis, who's taking it over. This is Andrew Amos, who's one of the deputy editors of Australasian Psychiatry, and we're wandering around talking to people and asking them how their conference is going and asking them a bit about themselves. So I'm very much targeted of you guys because I know you're local and I know you, and I'm interested to hear how conference is going for you. If you could introduce yourselves and tell us briefly about how you're going and how you've been finding conference so far.

SPEAKER_02 4:39

Sure, so I'm Dan Hurd, as you know. I'm a psychiatrist currently in private practice here in Canberra, previously in public older persons community, but now doing general adult and old age psychiatry in the private sector. Um, yeah, I've really enjoyed Congress so far. There's been some really great presentations. We saw Jeff's presentation this morning, which was wonderful. The big panel discussion on emerging treatments uh in uh depression yesterday I found really interesting. And it's actually been really great just um bumping into people in the breaks in between, having chats, seeing people that you haven't seen in a couple of years. So, yeah, it's been great.

SPEAKER_10 5:14

Excellent. And Matt?

SPEAKER_05 5:16

Uh hi, I'm Matt Brazil. I'm a psychiatrist working a mix of public and private practice. In my public job, I work in older persons' mental health, and in private I see general adults. It's been really fantastic being at uh Congress. As Dan said, there's been some really interesting talks on a wide range of topics of things which I normally wouldn't think about to engage in, but that's the really nice part of uh coming to Congress. And what kind of things? What kind of things? Like uh the session we just went to on health economics, for example, that's something I normally wouldn't dream of thinking about. Uh Jeff Lewy, of course.

SPEAKER_03 5:50

Oh Jeff, Jeff Jeff's name is on everything. So Jeff Lewis we we're a bit conflicted because of course he's the uh editor of Australasian psychiatry.

SPEAKER_05 5:58

That's right. But something which I wouldn't normally think of to sort of learn about, but uh very interesting and uh important.

SPEAKER_10 6:04

And what else are you looking forward to this afternoon?

SPEAKER_05 6:07

Um I'm not sure actually. I haven't uh sort of uh got that far ahead. I usually plan sort of a uh a session at a time.

SPEAKER_02 6:13

Uh I'm looking forward to the section of early career psychiatrist welcome drinks. Uh the new fellow welcome drinks. So um I'm I'm the ACT Section of Early Career Psychiatry representative, so um I'll be going to those drinks and meeting all the new fellows from around Australia. Um, yeah, really looking forward to it.

SPEAKER_10 6:31

Fantastic. Well, thank you both for your time.

SPEAKER_03 6:33

My name's Andrew Amos, I'm a deputy editor of Australasian Psychiatry. Right. Um can you just introduce yourself?

SPEAKER_07 6:38

I'm um Anne-Marie Swann. I'm a psychiatrist, I'm a psychoanalytic psychotherapist, uh, and I all I work in private practice and in the public sector. I do a lot of supervision and I do a lot of teaching. So I've just been to a lived experience session which really blew me away. It was with uh Miri O'Hagan, and she was just fantastic talking about the need for partnership and the principles of partnership. But this has just been a great opportunity for me to join with other colleagues, you know, and it's been an amazing experience.

SPEAKER_03 7:15

I think uh I've been involved with training for a little while, and I think the coverage of psychoanalytics psychotherapy appears to be there may be a few gaps there.

SPEAKER_07 7:24

You mean it's there's not a lot on?

SPEAKER_03 7:25

There's not a lot on.

SPEAKER_07 7:26

That's a shame, yeah. That really is a shame.

SPEAKER_03 7:29

Do you agree or do you think that there is enough in our program?

SPEAKER_07 7:32

I come for a broader perspective than just my own. Sure. So it didn't worry me that there wasn't more, but I guess from the point of view of people hearing more, we could do a lot more. I I do a lot of teaching of psychedynomy.

SPEAKER_03 7:47

Yep.

SPEAKER_07 7:48

I was actually asked to give a talk on psychiatry and ethics to the psychiatry interest forum. Oh yes. So I did that on Sunday. So that's medical students looking to whether medical students, it's international medical graduates and um PGY1 and PGY2, you know, first and second year residents.

SPEAKER_03 8:08

Indeed. I've done a few of those up in northern Queensland and they they had some surprisingly sharp questions.

SPEAKER_07 8:13

Oh yeah, they were a great group. They all came up and hugged me later afterwards, you know. They were so enthusiastic about coming into psychiatry. Indeed. And I mean, I just think it's a fabulous profession. I really do. I think it's great. But to hear someone like I just heard who has lived experience of mental health and some of the bad press psychiatrists get was very sobering, you know, to think that some of that's still going on today, and how we create partnership is so important.

SPEAKER_03 8:45

Can I ask a maybe a controversial question? Do you have a particular paradigm of psychoanalytic psychotherapy that you work with in, or is it more eclectic?

SPEAKER_07 8:53

Look, I'm a great integrationist. So I absolutely, you know, I think health's about wholeness. So I I I don't think any one form of therapy is necessarily better than another. Sure. In fact, I think it's probably horses for courses. But um, so yeah, I'm m more out of the British middle tradition, you know, Winicottian myself, but but traverse a wide range of I think I think today you have to be multilingual. You know, you you have to understand a lot of different models. Indeed. And I think there are certain core principles of psychodynamic therapy that traverse differently.

SPEAKER_03 9:32

Do you find that um the new psychiatrist coming through, well, one of the areas that may have been a problem, we don't introduce them to a lot of different ways of doing things.

SPEAKER_07 9:40

Oh, I think absolutely that's true. Um but I think the the biased psychosocial paradigm in psychiatry to me is very important. Even though I'm a psychoanalytic psychotherapist, I actually do keep up with medications, I do sometimes prescribe medication. Sure. And I think often psychiatrists completely lose sight of the social aspect of psychiatry, you know, what kind of environments people live in. So you have to tell me the question again because I've gone off.

SPEAKER_03 10:06

Oh, and whether whether whether in training we expose our uh registrars to all of the different paradigms. I think you've answered the question.

SPEAKER_07 10:14

Well, I don't I don't think we do. You know, I I think to me health is wholeness and it's integration. Yes. And I I just really want to preserve the biopsychosocial approach of psychiatry and that we all in our subspecialties adhere to that kind of integrationist model so that we we don't do what's happening in the world today where everyone's getting siloed, everyone's getting polarized. If we as a profession cannot talk to one another and talk to difference, then Well look, I might make a comment.

SPEAKER_03 10:48

I don't know if you went to the uh detransition lecture yesterday. So it was a group of psychiatrists presenting about gender medicine and and there was I'm going to the next one, the gender, yeah, because I think that's an important area. And well, I think what was great about yesterday's talk, it's a it's a controversial topic, but it I thought it was handled very well and it was the start of a discussion rather than the beginning of an argument.

SPEAKER_07 11:13

And to me, I I just went to a IPA conference recently, uh the Asia Pacific branch of the International Psychoanalytic Association. They had Taiwan, China, Japan, Korea, and India. And it was just so hope-inducing, you know, because everyone, it's like you say, people might have had differences, you know, but it was being able to talk to one another, being able to find a common ground of humanity. And I I for me that's what Sicatria is all about.

SPEAKER_03 11:44

Yeah, I think we'd hope that if uh China can talk with Taiwan, then gender-affirming and gender critical affecting. I thought this is this is unbelievable.

SPEAKER_06 11:51

These people are actually, you know, presenting cases, and you know, nothing's blowing up, you know. It's it's interesting.

SPEAKER_03 11:58

Look, Henry, thank you very much for talking with us, and I hope you enjoy the rest of the uh conference. We'll just introduce ourselves. I'm Andrew Amos, Deputy Editor of Australasian Psychiatry.

SPEAKER_10 12:07

Fiona Wilkes, I'm uh one of the trainee editors of Australasian Psychiatry, I'm also an advanced trainee here in Canberra.

SPEAKER_03 12:12

And Denise, I'm going to give you the microphone. You could introduce yourself.

SPEAKER_08 12:16

Uh look, my name is Denise Redin. I'm a psychiatrist working here in the ACT. I'm the director of clinical services for our division of mental health, justice, health, alcohol and drug services, so a bit of a mouthful. And what I still think of primarily is my day job, I'm a child and adolescent psychiatrist.

SPEAKER_10 12:33

And of course, you're hugely important in Canberra in our training scene as well, with the manager in our thousand.

SPEAKER_08 12:38

Yes, I work very closely with our director of training and all of our trainees and really want to provide the best kind of training environment that we can. And I do also have a role with the substantial comparability pathway, so I'm also involved in the education and progress of our international medical graduates.

SPEAKER_10 12:57

And how are you finding Congress so far?

SPEAKER_08 12:59

Look, I'm really enjoying it. It's been a busy few days, so because of some of the roles I play, I've been attending some of the meetings. I was fortunate enough to be here on Sunday and then all day yesterday. I think it's really exciting that there's such a breadth of presentations. It's great to see so many people here in Canberra. I think a lot of people are enjoying our sort of slightly chilly weather, but that's okay. But I think it's so good to see so many people from across Australia, New Zealand, and internationally, and to see people at so many different stages in their career from medical students who are in part of the uh of the PIF to people who are sort of retired or semi-retired and from so many disciplines in psychiatry.

SPEAKER_10 13:43

It's just been fantastic catching up with people. I've got colleagues I went to medical school with who are in Darwin now and who are here, seeing people from New Zealand. It's been lovely.

SPEAKER_08 13:51

Absolutely, and yesterday I'm pretty sure that I saw somebody that I was at medical school with in Newcastle upon Tyne in the UK who just walked past and I thought, I'm sure I know that person, so I'm going to go and stalk them.

SPEAKER_10 14:03

Wow, excellent. So that's very funny.

SPEAKER_08 14:09

Absolutely.

SPEAKER_10 14:11

So, what have you enjoyed most so far of the presentations?

SPEAKER_08 14:14

So, yesterday I went to the presentation around perinatal mental health, and um I just thought that was really inspiring, obviously, as a child and adolescent psychiatrist, that sort of emphasis on early years in development and how it provides such a rich opportunity to be able to intervene and support parents who themselves may have experienced quite a bit of adversity, who are very committed, as most parents are, to wanting the best for their babies and infants to see the work that's been done across a number of different places in Australia to work with that sort of mother-infant diet and to do that for people who experience quite a lot of complexity in their lives. And those studies that, you know, they're they're challenging studies to do when you don't have a lot of um exclusion criteria, but when you really focus your studies and research in real-life clinical space, and that's what that spoke to me about yesterday. So that's been my favourite.

SPEAKER_10 15:11

Lovely. We were talking in one of the uh talks, I went to the Bi National Committee for Trainees talk about improving the college yesterday, and there were everyone was raving about the CAMS rotations and how much we all enjoy the fact that we do CAMS training as part of the training. And there were talks about what other bits should or shouldn't be compulsory. But I was thinking in particular when I had my son a couple years ago just thinking about prenatal things. My goodness, I don't know how people have children without having done CAMS rotations. At least I felt slightly more prepared for things. Um, but it's just wonderful the amount of training that they do do. I've got another colleague who's since come as part of Heracam's advance training and done an observation with my toddler now as to look at normal toddlerhood. It's just it's such a wonderful field that you guys are working in, and perinatal as well, is so important.

SPEAKER_08 16:00

Absolutely. I've been a psychiatrist for a lot of years. Um, I feel very privileged. I love what I do. I wouldn't change, if knowing what I know now about psychiatry in my career, I would not change the decisions I made. And CAMS is got to be, you know, one doesn't want to be biased, but it's certainly got to be the most exciting space, and there's going to be so much more development in the CAMS space. It's really exciting.

SPEAKER_10 16:25

Such a wonderful spot for intervention as well.

SPEAKER_08 16:28

Look, I think it's a really good spot for intervention. I think you get the opportunity as well to be able to work with parents, and so I think that you're starting to influence not just the young person that you're seeing, but maybe helping for somebody to go on a circle, uh, a pathway of recovery from their own experiences. Um you also get the opportunities to interact with colleagues from so many different professions, so you know, the interactions with um schools, with care and protection services, with some of the NGOs, and so that opportunity to work with and influence and be influenced by people from a range of different backgrounds.

SPEAKER_10 17:09

And speaking of excited, what are you excited for for the rest of Congress?

SPEAKER_08 17:12

I'm not sort of coming with a clear plan any day of what it is that I want to go to. I'm just sort of going to be taking the moments as they come, and it's always a bit of a challenge. Do you go to the child and adolescent areas because you're interested in it, or do you go to the other areas? So there's a bit of me that is aware, for example, that I don't know very much about neuroimaging or where that's up to these days. And so I kind of think, well, should I go and learn something about that? But some of my colleagues are doing some presentations around sort of child and adolescent, and I kind of thought we're really good. So it's a challenge. It's such a challenge. It is, but it's a lovely challenge to have.

SPEAKER_10 17:48

It is. Yes. Oh, well, thank you very much for talking to us. It's pleasure. Thank you. Thanks for having me. Thank you. I'm Friona. I'm a psychiatric best friend ATR. I'm also working with the Australasian psychiatrist, so we're just doing some interviews for the broadcast. Would you mind?

SPEAKER_03 18:04

Myself, Andrew Amos, I'm a deputy editor. Um, so yes, if you could introduce yourself, uh, tell you where you're from and what you're interested in.

SPEAKER_01 18:11

So I'm Shamadotta. I'm a consultant journal adult psychiatrist. I work in Sydney Local Health District. And yes, I'm a I identify myself as a as a journalist. So I look after patients, uh adult patients, and uh who come with uh various complex issues in my clinic.

SPEAKER_03 18:31

Well describing yourself as a generalist can be a very controversial topic these days. Are you are you interested in specific aspects of the Congress to do with your work or is it more general?

SPEAKER_01 18:41

Some areas of interest this is your Congress. Of course, it's like on excellence and empathy knowledge. But for me, I would like to know a bit more about the AI and the technology in mental health. There was a really great talk yesterday. And uh today I just attended a session on trauma, which is very relevant to my practice and uh what are the new uh treatment they are doing uh for the patients with trauma and which is uh yeah, I like to talk about.

SPEAKER_03 19:07

Was the uh AI talk, was that Elizabeth Moore and colleagues? And any highlights from the talk that you'd like to pick out?

SPEAKER_01 19:14

I think those who haven't attended, I would really have asked them to see virtually. I think it's more about what the future of psychiatry looks like when the technologies and the AI comes into place. There's another talk today on telehealth health and telepsychartery, so yeah, I'll I'll be looking into that as well.

SPEAKER_03 19:32

Are you scared of the technology or are you in uh in favour?

SPEAKER_01 19:34

I'm not scared, but I'm always open to see uh what new things are coming. And um it's an interesting time, interesting way moving forward, but definitely I'm not scared and willing to accept new technologies with open arms.

SPEAKER_03 19:50

So for the rest of the week, are you staying for until Thursday or are you going back home?

SPEAKER_01 19:54

No, I'll have to head back to Sydney on Wednesday.

SPEAKER_03 19:57

I I I hear there's a bit of uh small town rivalry between Sydney and Canberra. What do Sydney siders think when they come down to Canberra?

SPEAKER_01 20:03

I love the cold because controversial. I have spent uh actually also because I've spent a lot of time in UK, so it reminds me of my time over there. This type of cold of we miss in Sydney. So it's nice, chilly.

SPEAKER_03 20:20

Uh Sharma, lovely to talk with you, and uh hopefully you'll enjoy the rest of your time here and maybe we'll catch up down the track.

SPEAKER_00 20:26

I'm Claire Keating, I'm a forensic psychiatrist based in Sydney. This is Penny, who's nine months old, joining me at Congress.

SPEAKER_10 20:34

Penny's doing a fabulous job at Congress, I've got to say.

SPEAKER_00 20:37

I've been trying to time her naps with the uh sessions that I really want to get to.

SPEAKER_10 20:42

Is this her first conference or has she been to other ones?

SPEAKER_00 20:45

This is her first one, but we're going to the International Association of Forensic Mental Health Services in San Francisco in a month. So this is a bit of a practice because that one might be slightly more intense with jet lag and long flights. It's been really good. We're getting like a one-hour nap at about 10 and a one-hour nap at about two. And then we had a little bit of time jiggling at the back of the conference sort of rooms, and a little bit of time playing on the floor. That sometimes buys us another half an hour. And then I thought I might make up a bit with the family room and online sessions to sort of try and fill up the days.

SPEAKER_10 21:20

Yeah, it helps that she's super cute, my goodness. Yeah. I was talking telling my husband yesterday when I got home about all of the people with kids here, and he, because we're going to a conference in New Zealand later in the year, immediately wanted to go, oh, could you could you just take your toddler with you then? So I get to it. But I feel like my mobile toddler would be slightly more difficult.

SPEAKER_00 21:39

I think a toddler would be hard. I even feel like with her we're reaching sort of the end of where it's easy and it might be challenging.

SPEAKER_10 21:48

And tell me about what you've seen, what you've managed to see so far. What have you enjoyed?

SPEAKER_00 21:51

So we saw Pat McGorry this morning talking about the sort of crisis of youth mental health, which was very interesting as well, as a new parent. But also, I'm the partner of an academic in the humanities, so naturally we're also a bit of a Marxist household, and discussion around neoliberalism and how that is affecting sort of the inequality for young people and their future and mental health was very interesting to talk about and listen to. So that was good. And we also we went to a forensic session yesterday afternoon, which was also an important one for us, which interestingly enough also talked about inequality and neoliberalism a little bit and um how that's affecting sort of marginalized people with schizophrenia who perhaps don't have much of a voice and who end up um becoming criminalized rather than treated, um, especially in a modern society where we don't invest very much in people that are sort of talking about the forgotten bottom, which as a separate aside from the hidden middle, I think, which people are talking about a lot. There's also this big swathe of people that are entering the criminal justice system because of a lack of mental health services. So that was good too. All of it a little bit depressing, and all of it, I think, a common theme of politics and ideology that's perhaps driving adverse mental health outcomes. And I I think I'm not sure what to do about that.

SPEAKER_10 23:20

No, we were talking to a trainee earlier who had been to the same talk, and Andrew was asking, and what solutions could they provide? But it didn't seem like we don't we really have many at the moment, do we, apart from realizing there's a problem.

SPEAKER_00 23:34

Well, I mean, just even watching the ABC last night back in the hotel room, the Four Corners was about influences on social media, and I think there is this big scapegoating of social media, which is certainly a problem, but I think is probably a symptom of something bigger. And I there's this big focus on those smaller things that everyone can be outraged about, but seem to be a distraction from bigger political change, and then watching Jim Chalmers on QA talk about how we're going to increase housing supply to allow people to get into their first home and really dismissing any talk about things like negative gearing or tax restructuring, and there is just this real, I think, reluctance in Australian politics to do any sort of major reform. And it's probably driven by this problem of appealing to people's individual interests rather than addressing the broader structural inequality. But yes, I mean, what do we do as psychiatrists? Do we go into politics? Do we lobby more? Do we advocate more? And I think there is a bit of an appetite for that, but am I going to do it? I don't know, and so who is? If not, if not me, then who? Thanks very much. Nice to meet you.

SPEAKER_03 24:57

It's a Vox pop, well spotted, sir. Um I'll introduce myself. I'm Andrew Amos, Deputy Editor of Australasian Psychiatry. Uh Fiona.

SPEAKER_10 25:04

I'm Fiona Wilkes, I'm an advanced trainee here in Canberra and also on the book with Australasian Psychiatry.

SPEAKER_03 25:10

Uh Fiona's um one of our trainee editors, so we're trying to uh get out and talk to people at the conference, see how you're going, what you've been excited by, and what you're going to do for the rest of the week.

SPEAKER_04 25:20

I'm one of the people who constantly submit articles to Oz so I can get them knocked back because they're too long.

SPEAKER_03 25:26

Robert, did we talk to you last year in Perth? Yeah. Yeah, you did. You did.

SPEAKER_04 25:32

Okay, so what would you like me to discuss? I'm here at the conference to present several papers on history of psychiatry, including the oldest movie of psychiatric treatment in Australia. It's a film done in 1926 of malaria therapy at Montpark Hospital. Wow. And it's in beautiful condition, nicely edited. So it'll be a bit of a change from people talking. I'm also here in my capacity.

SPEAKER_03 26:02

I don't think we should blow by this. So what happened with the malaria therapy? What was the outcome?

SPEAKER_04 26:07

The outcome was very good. Remember, at that stage there was no treatment in psychiatry that actually worked. Psych wards had somewhere between 10 and 40 percent of patients with neurocephilis for whom nothing could be done. So this was the first treatment, and the first guy to do it in Australia was Ridge Ellery at uh in Melbourne, and he did that in 1925. And then he moved to Mont Park and he did a series of 90 cases and presented them. So then he made the movie to show everybody. And what you see in the movies, these people, they look bedraggled, they're miserable, they can't walk, their tongues are wobbling, and then you see Ellery and his team descend on them, they've got nice white jackets, you see the laboratory, and of course the injections of the malaria. And then the best part at the end is they're all dressed up in suits. There's a woman with a fur, and they're striding confidently, no ataxia, out of the picture. Good Lord. So it's a wonderful piece of movie, and I always stress this to people that there is so much film and audio record of past Australian history lying around, but it's very hard to find.

SPEAKER_03 27:28

How did you find that that's a particular video?

SPEAKER_04 27:30

I wrote a biography of Ellery and learned from his family this was given to the National Film and Sound Archives.

SPEAKER_03 27:37

Okay. So a bit of uh sleuth work and you've got some great results.

SPEAKER_04 27:40

Yeah.

SPEAKER_03 27:40

And you're giving some other talks.

SPEAKER_04 27:42

Yes, on Freud's first and only paper, not just in Australia but in the Southern Hemisphere, and about a woman called Helen Flanders Dunbar, the mother of psychosomatic medicine.

SPEAKER_03 27:54

The mother of psychosomatic medicine. What are you going to say about her?

SPEAKER_04 27:57

Well, she was a brilliant woman, and she really kicked off psychosomatic medicine in the 30s. She also was responsible for something that we now called accident proneness. And tragically, she drowned in her own swimming pool thereby living out her own prophecy. But a very interesting woman.

SPEAKER_03 28:16

Robert, I'm assuming you're not a native of Canberra. Where are you from?

SPEAKER_04 28:21

I'm from Wollongong.

SPEAKER_03 28:22

Wollongong, okay. How do you find Canberra?

SPEAKER_04 28:25

Look, I love coming to Canberra. It's laid out, it's beautiful, it's got great facilities. It's a pleasure just to walk around. Yeah. And of course, I haven't even got to all the museums and galleries yet.

SPEAKER_03 28:37

I'm told the portrait gallery here is quite amazing to see.

SPEAKER_04 28:39

It's on my list.

SPEAKER_03 28:40

Indeed. It's on my list. So lots of things to see and do.

SPEAKER_04 28:43

Yeah.

SPEAKER_03 28:43

Any other highlights that you want to talk about about the the uh Congress?

SPEAKER_04 28:47

Well, look, just looking at the program, it's incredibly diverse. Yes. It covers all the new things. I was very excited to be at the psychedelic talk yesterday.

SPEAKER_03 28:58

Oh, very controversial, yes.

SPEAKER_04 28:59

Yeah, and also threw in some stuff about the history of psychedelics.

SPEAKER_03 29:03

So uh is personal history, Robert, or uh No, no, no.

SPEAKER_04 29:07

I'm talking about the 50s and the 20s when they first started uh doing research on them. Uh my own past sorted history, I keep away from it.

SPEAKER_03 29:17

We'll keep it out of the podcast. Do you see a big role for psychedelic treatment in Australia or do you have some concerns or both?

SPEAKER_04 29:23

A bit of both. I think it's great that it's finally being released. I think there are gonna be some wonderful things done. But there's something called the stage cycle. Whenever a new drug is released or a new treatment, there's wild excitement. It's gonna fix everything. Then we hit stage two, and suddenly, oh, there's all these errors, there's all these side effects, it doesn't work, and finally you get to stage three where there's a narrow band where you know you can use it. But it is very promising, and I'm delighted it's just a shame it took so long.

SPEAKER_03 29:56

I wonder whether you're also describing artificial intelligence and all of our hopes for that.

SPEAKER_04 30:00

All these things, even some of these new things with implants and vagal nerve stimulation, we've got uh a lot to learn. And that brings me back to my theme. The only way we can learn about the future is by learning more about our own history. Yes.

SPEAKER_03 30:15

Absolutely true. Well, fantastic. Any other thoughts, uh Robert, you'd like to share?

SPEAKER_04 30:20

Yeah, enjoy the conference. It's wonderful.

SPEAKER_03 30:22

Fantastic. Look, thank you for talking with us, and uh, we'll probably catch you next year as well, mate.

SPEAKER_04 30:26

Terrific, you will indeed. Thank you very much.

SPEAKER_10 30:29

I'm Fiona. Hi, I don't think we've made up an advanced training training, but I'm also a trainee editor of Australia Psychiatry, so I'm wandering around with Andrew Amos here uh doing interviews with people. Would you mind introducing yourself for the podcast?

SPEAKER_09 30:43

Yeah, I'm Niraj Gil, I'm a psychiatrist on the Gold Coast, and I'm I'm a professor of psychiatry at Griffith University and at the University of Canberra as well. So I I work one day a week at UC, but it's remote, it's research work at the mental health policy unit.

SPEAKER_10 30:59

Right. And I think Congress is coming to you guys next year, I think.

SPEAKER_09 31:02

It is, it is, from Canberra to Gold Coast, yes, yes. So I'm on the local organizing committee of the Gold Coast Conference. Fantastic. I'm excited about it. Shui Chi and Stephen Parker are the conveners.

SPEAKER_10 31:13

Lovely. I should be getting my robe then, I hope. So I'm very excited about Congress.

SPEAKER_09 31:19

It'll be much warmer than this, I promise.

SPEAKER_10 31:22

Yeah, we've really uh put on the cold weather for everyone this year. Yes, yes. Um, what have you been enjoying so far about Congress?

SPEAKER_09 31:28

To be honest, I came last night, so I've just attended uh the the two sessions this morning, and they were good. Um I'm enjoying catching up with people. Um I attended the college ceremony yesterday, which was very which is always very good to see so many fresh young people, uh new fellows and new advanced trainees getting the and and all the awards and all that. So that was very nice. But I'm um enjoying meeting colleagues and uh looking forward to the sessions today and and for these next three days.

SPEAKER_03 32:00

I uh I have a confession to make. Niraj was one of my supervisors as I was going through training, and uh I happen to know that he's uh a big name now in the philosophy and ethics of psychiatry, and I'm wondering whether there's anything on the program to cater to those those uh areas of psychiatry.

SPEAKER_09 32:15

I'm doing a uh talk on human rights today in the lived experience session at 3 o'clock. So it's a lived experience session, human rights and mental health intersection about how lived experience can guide that, but I'm presenting the the human rights framework. So yeah, means uh uh so that's and I see there are a few uh sessions on on uh there was a one on law and uh NDIS and law and policy which was quite nice that I attended.

SPEAKER_10 32:46

There was a good one as well to the law and policy on yesterday on ID and giving uh tools and things to people when they're not necessarily know that they're giving them and what the law is around that and and working at some research. Suddenly it said that's assuming it was from Queensland, but it didn't look like there was anything actually written to the framework at that stage. Can you comment on that a little?

SPEAKER_09 33:10

As in as as in covert administration of medication, yeah. I mean, look, that's a tricky issue that's uh you know uh um so there is a I mean that's around a much bigger debate a around that is this whole substitute decision making and supported decision making. Yeah, I don't think there is anything in the Queensland law or framework around that. And um I I don't know what the the presenters had to say about that, but that's uh you know, we can't do those things. We can't say that I'm the doctor and I can't tell the family that you do this and everything will be fine, you know. We we're moving away from that highly paternalistic framework towards greater autonomy and um and yeah, sometimes that is as clinicians sometimes people find that a bit frustrating, but we have to see what is most important to this person uh and their the carers and community uh at large.

SPEAKER_03 34:03

Well you you're clearly excited about the issue. Uh are you working on any other pieces that uh gonna be published, so and that you like to talk to us about?

SPEAKER_09 34:10

Yeah, so I've um written and edited a book that is uh coming out in two months. So I've written that with Norman Sartorius from Switzerland on human rights and mental health. So in this I wrote 14 case histories of intersection of mental health and human rights and uh ethical dilemmas, and we had uh presenters from around the world who commented on those. We presented those in the World Congresses of psychiatry, Norman Satoris and I, and then we decided to write a book based on that. And uh then we have eight chapters on mental health law in different countries, including China, Egypt, France, Germany, uh, Scotland, etc.

SPEAKER_10 34:57

Oh, that's a great achievement. Thank you. We'll let you go. Thank you so much for your time. That concludes our podcast from the College of Psychiatry Congress 2024. Thanks to our producers Jason Beal and Nishda Kuma, Shady Dave for our intro music, Sydney Apprentice for our artwork, and of course relations for the opportunity to record this podcast.