An Erudite Encounter with: Jayashri Kulkarni

Jayashri Kulkarni has been Professor of Psychiatry at the Alfred and Monash University since 2002, where she directs psychiatric research as part of the Monash Alfred Psychiatry Research Centre. She has pioneered the use of oestrogen for the treatment of schizophrenia and is internationally acknowledged as a leader in the field of reproductive hormones and their impact on mental health. Jayashri has conducted many studies developing new treatments for women with psychoses, bipolar disorder and perimenopausal depression, and most recently borderline personality disorder. Currently, Jayashri is President of the International Association of Women’s Mental Health, and this is the culmination of a quarter of a century of work improving the quality of care of women with mental illness. In 2010, she and a colleague won the Grand Final of ABC TV’s New Inventors programme, and she has regularly featured on TV and radio advocating on behalf of consumers and carer organisations.

Cutting a rug with Professor Kulkarni while being repeatedly told to ‘keep up’ should not have come as a surprise after having earlier witnessed her literally swim with sharks in the Melbourne Aquarium and then engage in a verbal sparring match – in what I dubbed the ‘Kulkarni Carnivale!’ The mantra ‘work hard, play hard’ truly epitomises Jayashri, who uses her considerable wit and personal charm to propel and inspire those around her.

What drives you? I am driven by an innate passion for equality, respect and justice for all, which underpins my work with people with mental illnesses, particularly women. Women patients and professionals in psychiatry face many challenges that are rarely highlighted or discussed frankly. As a psychiatry trainee, I noticed several issues that affected female patients adversely. Being female significantly impacts the presentation, treatment and outcomes of psychiatric illnesses, and yet, treatments in psychiatry are still ‘gender-blind’.

What advice would you give your younger self? I would advise myself to pursue an academic career with greater clarity and more self-confidence and to focus on women’s mental health earlier. Books and rigorous studies on leadership styles detail the interesting observation that women consistently underestimate their skills and potential, while men overestimate theirs (Ehrlinger and Dunning, 2003; Kay and Shipman, 2014; Paustian-Underdahl et al., 2014).

So my advice to younger me, and to all young women in psychiatry, is to develop career goals early in life and to work hard to achieve these goals without undue distraction, plus be less perfectionistic about unimportant details.

As a psychiatrist what have you learnt about the human condition? Over the years, I have learned to respect the incredible resilience that people have. So many people have faced horrendous events and are still able to achieve goals. Another important learning is the incredible value of early attachment. Many mental illnesses have a basis in suboptimal early life attachment to a primary carer, which appears to be expressed through altered brain mechanisms. The marriage of psychodynamics and neuroscience, I believe, leads to great revelations about the human condition.

Research is fundamental to psychiatry because … without it there is no hope for improvement in the treatment of patients. Neuroscience research in mental health is absolutely required to move the field forward.

The topic in psychiatry I am most passionate about is … women’s mental health. I have many passions in this area, which include the integration of neuroscience with psychosocial constructs to provide better approaches for women with mental ill health. I abhor the term ‘borderline personality disorder’ and I am working on the neuroscience of trauma – to hopefully improve the approach and treatment of women with this highly stigmatised disorder. Safety for women receiving psychiatric care is also a key passion.

What is the future of psychiatry? The future for psychiatry as a profession is uncertain and depends on whether we can adapt to the growing need for new answers, approaches and treatments (Katschnig, 2010).

We need to genuinely listen to the many criticisms made about our profession, especially the view that we are ‘not progressing in our knowledge or ideas fast enough’. Mental suffering is increasing, but the services provided by psychiatrists are increasingly limited to small percentages of the population suffering from particular conditions, often without optimal outcomes.

The last important shift in Australia was deinstitutionalisation and the advent of some new psychotropics in the late 1980s and 1990s. Neither of these compare to the great progress made in cancer treatment and other areas of medicine. We need truly innovative approaches that can help us understand the causes and impacts of mental ill health, reverse brain and body changes and apply psychosocial skills to help patients to improve their lives. Objective markers of psychiatric illness for accurate, early diagnoses are urgently needed, as well as rapidly acting, effective, personalised treatments without adverse effects. Psychiatrists need to be able to broadly encompass the many biopsychosocial facets of mental illness and be open to new paradigms. If we can do this for our patients, then their future is bright – and this is our purpose as psychiatrists.