An Erudite Encounter with: Paul Mullen

Professor Paul Mullen spent 13 years at the Maudsley and Bethlem hospitals and Institute of Psychiatry, first as a trainee then, for the last 5 years, as a consultant and senior lecturer. He became the professor of psychological medicine in Dunedin, moving 10 years later to become the foundation professor of forensic psychiatry at Monash University and director of the state’s forensic mental health services. After retiring in 2012, he worked with child protection and as principal medical officer to the state prison system. Professor Mullen spent a decade involved in research into the human pineal gland and the impact of the sleep wake cycle on hormonal rhythms. He later moved into epidemiological research studying the impact of child sexual abuse, stalking victimisation, and the relationship between psychotic illnesses and criminal behaviour. In clinical and phenomenological research, he has worked in the areas of jealousy, erotomania, querulous complaining and threatening behaviour. Recently, he has also carried out research related to risk assessment and management. In total, he has published over 200 peer-reviewed papers, 60 book chapters, and co-authored three books. Over the years, his work has been translated into many languages, including Japanese, German and Italian, reflecting his recognition internationally as an authority on forensic aspects of psychiatry.

Comparing notes with Professor Mullen on our Maudsley ‘experiences’, while supping in a Sydney café, it soon becomes evident that this is a man that doesn’t feel the need to filter anything – other than perhaps his coffee. Known for his eloquent insights into the minds of humans at their extremes, Paul is respected worldwide, and rightly so, for his unique observations of those that stalk and those that kill. His personal charm and lilting banter disguise a self-confessed lack of empathy, a deficiency that he regards as a strength, noting that it is a necessary tool for clarity of vision. Perhaps it is this and his tireless obsession with inquiry that have made him an academic beast to behold.

• What drives me? I had only one driving ambition. I don’t remember when I decided I would become a doctor, but by the age of 10 it was established as my life’s focus. A focus which found expression over the next 8 years in reading numerous novels about doctors and memoirs by doctors. At 23, I found myself a registered medical practitioner and my drive was over. Henceforth, it would be external demands, not internally generated ambitions, which directed my course. Doing research was, for me, a disease that I caught young and never managed to cure. It was more like being ensnared than driven.

• What advice would you give your younger self? Probably none. My unwise choices often led to valued outcomes. Perhaps I might suggest being more consistent and goal oriented, forgoing some cleverness in favour of more scholarship, and avoiding cloaking uncertainties in an appearance of articulate arrogant assurance. Nietsche suggested that the judgement of a life was the willingness to live it all again without change, regrets and all.

• As a psychiatrist, what have you learned about the human condition? My understanding of the human condition is rooted in what I read; novels, political theory, philosophy and history. The experiences of my patients only become revelations about the human condition when placed into a pre-existing intellectual framework. Cleckley wrote that the essential failure in the psychopath was attempting to understand others intellectually rather than through emotion and sympathy. If he was right we need more psychopaths and less emoting sympathisers in psychiatry.

• Research is fundamental to psychiatry because we are so woefully ignorant about the nature, cause, and cure of serious mental disorders. The status of knowledge in any science is determined by the quality of the methodologies used to generate the basic data. All too often we accept as established fact that which flows from patently inadequate research. Even the very basis for much of our research rests on shaky foundation thanks to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD), which are largely made up of operational definitions in which authority substitutes for the necessary pursuit of knowledge. The criteria for schizophrenia are what the committee says they are, and don’t ask about any external validation, just admire the circular dance. Genetics was to be the key. Recently, the massive genomic study of schizophrenia published in Science by an army of authors involving thousands of sequenced genes led, let’s face it, to a lemon. Please oh research bring us light in our ignorance and deliver us from our clinical impotence.

• The topic in psychiatry I am most passionate about is psychiatry itself. We may not know what serious mental disorders are, or their causes and cures, but we can lessen the burden and alleviate the misery they thrust upon sufferers. Providing the best possible service and the best therapeutic engagements is the name of the game.

• What is the future for psychiatry? Psychiatry as a profession thrived for over 200 years mired in ignorance and beset with enthusiasm for the fallacious ideologies that Jaspers called the neuromythologies and the psychomythologies. We have been left behind by every medical discipline with the possible exception of dermatology. Yet we survive because we took responsibility for the care, and sometimes the control, of a group of sick people nobody else wanted to accept.

One of my fears for psychiatry is that we are allowing clinical practice to degenerate into a process which starts with a brief and superficial assessment, measured in minutes not the requisite hours, leading to a prescription, with continuing care often handed over to case managers of various professional hues. Anyone can do that, and they are welcome to it.

If psychiatry is to survive it has to stop patting itself on the back, stop allowing academics innocent of clinical experience to define its disorders, stop being agents of Big Pharma, be more informed and critical about research, use managers effectively while preventing them from determining clinical decisions, and, above all, stand up alongside our patients to demand the resources to provide decent services. Rebel sisters and brothers, speak up, act up and insist.