Retrospective: Australian and New Zealand psychiatry: What 50 years have brought

The growth in Australasian academic psychiatry is truly wonderful. When I joined Leslie Kiloh in Sydney in 1963, there were five Professors of Psychiatry in Australia and one in New Zealand. In earlier times, academic psychiatry had been ahead of Britain, in that both Sydney and Adelaide had made Psychological Medicine compulsory in the medical curriculum by 1888, while Sydney had appointed a Professor by 1922. What follows applies only to academic psychiatry during the last 50 years, not to the massive expansion in state mental health services, a multidisciplinary workforce and private practice. David Maddison, then the only Australian-born professor, was at Sydney University, Leslie Kiloh had just arrived at University of New South Wales (UNSW), Bill Cramond had been appointed at Adelaide, FA Whitlock had come to Brisbane and Brian Davies had arrived in Melbourne. Wallace Ironside had been appointed Professor in Dunedin in 1962. Our other medical schools either had no chairs of psychiatry or were not yet established. Psychoanalysis was prominent, especially in Melbourne, and psychodynamic expressions were de rigueur in professional conversation. There was little research activity and no focussed programmes. Cade’s finding on lithium had just started to be applied, but mainly in Denmark and America.

Now consider what academic psychiatry in our two countries has achieved some 50 years later. We now more than hold our own on the international stage, despite our small population. As I see it, we have excelled in five fields: instilling rigour in routine clinical practice; in epidemiology, notably through longitudinal population studies in both our countries; the burgeoning field of neuroscience; excellence in treatment of the psychoses and the affective disorders; and health services research. The wave of imported academics from overseas is now only a trickle. Incidentally, there was a period in the 1970s when five professors in Australasian psychiatry had come, either by birth or their previous job, from just one source, Aberdeen: Cecil Kidd in Perth, Bill Cramond in Adelaide, Wallace Ironside in Dunedin then Monash, Leslie Kiloh in Sydney and myself in Hobart. I cannot offer a rational explanation for that p-value.

As in medicine and surgery, our younger graduates no longer need to go to the United States or United Kingdom for advanced training. Instead, because travel is much easier, they now have invaluable exposure to research at international symposia, often leading to lasting alliances with other investigators. Research from our two countries now commands great respect, and sometimes envy, in the rest of the world. Consider the authorship of papers in any of the leading international journals, or the input of Australian and New Zealand psychiatrists at elite international research societies and their symposia, or invitations from major overseas institutions to give expert advice, on site.

What greatly interests me is how this exceptional development has come about. I can think of six factors. First, it took place when psychiatry across the world was starting to take its proper place in medicine generally and to have a place in the undergraduate medical curriculum. Second, Australian and New Zealand medical schools were seen as highly attractive places for many British academics. Third, both countries have for long had their share of exceptional young minds with the capacity to think innovatively. These young graduates now stay on here. A few have chosen research in psychiatry because of the unique scientific and clinical opportunities it offers. But more should be invested in this precious group, lest their numbers decline (vide infra). In my own view, we need a much better research career structure for promising young physicians. As it stands, National Health and Medical Research Council (NHMRC) and Health Research Council (HRC) grants go only to those who are already established and often not even then. I say this as one exceptionally fortunate individual whom our NHMRC supported for 26 years with a small team, albeit untenured and for only 5 years at a time, but in full-time research. How many psychiatrists do our Councils currently support under such conditions? Fourth, the Society for Mental Health Research (now so-named) has played a part, providing a forum for younger investigators across disciplines. Cecil Kidd and I got it started in 1970 as the Australian Society for Psychiatric (sic) Research (ASPR). I now see that was a very worthwhile initiative. Fifth, like planning a long voyage, many of us have been quite good at selecting fertile areas to explore, then developing collaborative relationships with each other, but also with investigators in the United States, United Kingdom, Europe and the Nordic countries. The results of collaboration have been good for us, but also for them. Something akin to this happened to me when trying to understand the nature of social relationships (Henderson, 1974). In our other collaborations, notice the contribution from non-medical colleagues in both countries. I am referring to some exceptionally able psychologists, biostatisticians and other scientists. They have brought a rigour in methodology that is often lacking in our own training. Finally, as it reaches its 50th year, the Journal itself has played a powerfully facilitating role in the development of Australasian academic psychiatry. Our Journal began in 1967 with Alan (1967) as Editor. He noted it was the 215th psychiatric journal in the world. It has been a major vehicle for research and opinion in our community and overseas.

Our research now influences what governments do about mental illness. We have shown what life is like for people with psychosis and what needs to be done about it (Morgan et al., 2012). These and so many other influential papers are bringing about precisely what Alan Stoller wished in his Editorial for the first issue in March 1967. He set out three elements for the Journal’s policy: to bring together groups of psychiatrists living thousands of miles apart; the acquisition of knowledge of what is best in psychiatry (author’s emphasis); and to make real contributions to world psychiatry itself.

But beware. Psychiatry is at a critical phase in its evolution. In an essay of great significance, Katschnig (2010) identifies the threats for which we need to adapt. Like him, I believe that academic psychiatry should focus on the core of our discipline: mental disorders that are severely disabling. This calls for biological knowledge melded with clinical and interpersonal skills. Within the specific area of academic psychiatry, the situation is of particular concern as we said in our Editorial 2 years ago (Henderson et al., 2015). Yet consider what Australia and New Zealand have given to medicine in the last century. This is unlikely to wither. It may be that the very obstacles Katschnig identifies will force us to adapt to a changing environment. It is the only way to survive and therefore reproduce. The many registrars that I listen to give me every confidence that psychiatry will continue to have a few thoughtful, caring physicians who are also driven by the need to enquire.