• Some things we learn 20 March 2017 | View comments

  • 20th March 2017 | By David Jolley

    A colleague pointed me to an interesting article in the Psychiatric Bulletin from Professor Julian Leff, now retired but still busy and reflecting on ‘The most important things I have learnt in my career as a psychiatrist’. http://pb.rcpsych.org/content/41/1/51

    This is the week the Law Commission has released its report on a possible alternative to DoLS. Like many others, I am reading it, but it will take a while to digest and to do justice to in response. In the meantime Professor Leff’s ruminations encouraging and revealing. We shared them at a seminar for consultants and trainees in psychiatry, looking for a spark to counter the shadow which says that few doctors wish to work in our field.

    Julian Leff’s interest in psychiatry was stimulated by his experience as a medical student at University College in London. Students were expected to take on a patient for psychotherapy, under supervision. This was an arrangement I had heard about first from Professor Neil Kessel, who was professor in psychiatry in Manchester when I came here as a young trainee in 1970. Neil Kessel had also trained at University College after a period at Cambridge. It was here that he met Heinz Wolff, a talented consultant physician who himself had undergone an Analysis and was later to become a psychiatrist. It was the enthusiasm of Heinz Wolff as a physician which brought psychotherapy to the medical students and ‘converted’ both Neil Kessel and Julian Leff to the cause.

    A generation of doctors who came to this country expecting to become physicians, but who found their prospects to be so much better in psychiatry, gave us so much. Aubrey Lewis himself was one such. Felix Post, in our own field, was another http://journals.sagepub.com/doi/abs/10.1258/j.jmb.2007.05-63?journalCode=jmba

    Heinz Wolff was an odd one out, in that he became a physician but then opted for psychiatry. His interest in the subject and its processes was infectious.

    Leff’s humility in pursuing more training, is impressive. Time devoted to learning medicine, but at the same time taking in the culture of the East End. Never to stop working with clinical responsibility, to listen to the patient and their family and to respect their vision and interpretation of their condition.

    He was an important member of Professor John Wing’s Social Psychiatry research team but took himself away to the long corridors and long stay wards of Friern Hospital to establish his credentials as an independent mind. Fascinating to read his account of the corridors. Fascinating to remember his use of the natural experiment of the time, to close hospitals and find alternative services for severely damaged individuals. Wonderful to find that our younger members have not heard of Neil Kessel, John Wing, Felix Post, Aubrey Lewis, The TAPS project.

    Julian Leff’s greatest insights have come from his listening to atients and families. His work on Expressed Emotion was known to us all. It is most clearly understood in relation to schizophrenia but is at least as relevant with mood disorders and probably a range of other conditions, physical as well as psychiatric. The use of atavars in countering psychotic phenomena which are resistant to other treatments was news to me. www.ucl.ac.uk/news/news-articles/0513/29052013-Avatar-therapy-helps-silence-voices-in-schizophrenia-Leff

    It came from his willingness to listen, to be open minded, to take in ideas from other disciplines and to think in terms of complex systems, rather than along straight lines.

    There are many other wisdoms in this article but it is these very personal reflections which carry the greatest power for me. They demonstrate the importance of learning from other great men, both intellectually and emotionally and always remaining curious.

    Maybe we can bring more students and trainees to catch something of the fascination and rewards of work with older people and the mental health problems, including dementia, which come to them, if they are brought close to patients in psychotherapy from the start, and closer to the giants of the disciplines by sharing their stories rather than bury them as ‘history’.

    For me an important and moving article of similar ilk came from Felix Post as he looked back on the extraordinary changes achieved in the treatment of involutional melancholia in the 1940s.

    Some things we learn. Let us not forget

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