An Erudite Encounter with: Paul Grof

Professor of Psychiatry at the University of Toronto and director of the Mood Disorders Centre of Ottawa, Paul Grof graduated in medicine and then specialized in psychiatry in 1962. He worked as a research psychiatrist in the Psychiatric Research Institute in Prague and as a fellow in psychoendocrinology of affective disorders in West Germany before becoming a research psychiatrist at McMaster University, Canada. He has run affective disorder clinics throughout his career and has served as a Visiting Scientist at the National Institute of Mental Health (NIMH) and as an Expert for the World Health Organization, Mental Health section. In 2015, he was awarded the Mogens Schou Research Prize from the International Society for Bipolar Disorders (ISBD) for his life work in advancing our understanding of mood disorders.

Listening to Paul expound upon recent discoveries while standing in his apartment in downtown Toronto, looking out across Lake Ontario, it becomes apparent that his scientific brain constantly draws inspiration from his artistic mind. The lake and the surrounding buildings are distinct, but form a single vista; it is easy to appreciate why Paul chooses to live on the brink connecting the two.

• Drawing inspiration from Dr Seuss, what makes you you? My past and my present. My values, aspirations and dreams imparted by my loved ones, family, mentors and patients. My calling to serve as a bridge between the shores that seem separated: psychiatry and medicine; psychiatry and music; psychiatry conservative and radical; psychiatry traditional and transpersonal.

• The best career advice I ever received was … Four things: ‘Truly listen to your patients, with full attention’. ‘There is no perfect job – find the one that will allow you to do well what you genuinely desire to do’. ‘Do not work under someone you do not like and respect’. ‘You will never learn to use prepositions and articles in English correctly – let a native English speaker help you’.

• One of my favourite ideas is … continuity of care. When psychiatric care is provided to patients with mood disorders by a well-trained, properly organized team, including psychiatrists, psychologists, nurses, social workers, research and support staff, the tasks can be appropriately divided and shared: acute and maintenance care, medications and psychosocial support, continuing improvements by combining research and clinical care. Many more patients get and stay well, compared to solely psychiatrist-centred care. And if they ever need a hospitalization, they are treated by people who know them well – ‘friends’.

• One really important but soluble question in psychiatry is … Treating mood disorders that have an entirely episodic course with intermittent effective approaches. The trick is to forecast for each patient the high-risk periods for recurrence and to intervene beforehand, rather than treating chronically when not necessary and thereby exposing the patient to medication side effects (Grof, 2005; Grof et al., 2009).

• What is the future of psychiatry? The future is already here! I am convinced we are already undergoing a major transformation. The heated debate about the validity and usefulness of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) splitting the profession into camps (Frances, 2013); neuroscientists confidently proclaiming that they will solve major psychiatric conditions while at the same time entirely disposing of these conditions’ diagnoses (Insel et al., 2010); and brain imaging used for research of psychotherapy, meditation and spirituality.

While psychiatry, in both its daily practice and biological research, is still fundamentally rooted in mechanistic reductionist thinking, during the past century, the hard sciences have already constructed new paradigms and offer an entirely new worldview. Whether it is quantum physics, astronomy, geology or chemistry, the conceptual thinking is dominated by complex systems, multiple field phenomena and deep interconnectedness, which may be slowly penetrating into and transforming psychiatry.

To explore productively the complex bio-psycho-social interconnections, we must start truly cooperating in large consortia and give up the silos of egos. We might even have to start asking some serious questions about the role of human consciousness in psychopathology.

These radical changes have started only gently, yet I think there is no turning back. The future has arrived.