In this honest chat with Paul, he helps to bust some myths about common misconceptions in the medical world. Paul speaks about the value of humanizing people’s experience rather than medicalising it and how including people’s loved ones in their care can make a real difference.

Come and listen with:

Lucy (She/Her) – A big fan of ice cream and storytelling

Rachel (She/Her) – Social Worker, Dialogical Practitioner, mad footy fan and wildly passionate about transforming the culture of mental health services to be person-led and human rights informed.

Incredible artwork @sharleencu_art

EPISODE TRANSCRIPT – Is this really radical?

[00:00:01 ] Lucy: This podcast has conversations around different mental health experiences that may be distressing for some people. If that doesn’t feel like something you want to explore today, you might want to visit another podcast and come back to us another time.

[00:00:14 ] Rachel: discovery college acknowledges the traditional owners of country throughout Australia and recognises their continuing connection to lands, waters and community. We pay our respects to Aboriginal and Torres Strait Islander cultures and to the elders, past and present. They have never ceded sovereignty.

[00:00:32 ] Lucy: In this podcast, we share stories that help us learn from each other, connect us and inspire growth. We want to acknowledge that this way of being, of coming together to share knowledge and stories, is a tradition that has already existed on this land for hundreds of thousands of years as a part of the culture of First Nations people.

[00:00:51 ] Rachel: discovery college acknowledges the views shared in this podcast are about mental health experiences, but are not a substitute for professional mental health advice and support. The views in this podcast are not the views of Alfred Health, but are the views of the individuals we’ve had conversations with.

[00:01:07 ] Lucy: The stories we share on this podcast aren’t just stories, but memories of the people who have bravely shared their experiences with us. Remember to take care of yourself as you listen, as well as to take care of the stories that you hear.

[00:01:33 ] Rachel: Extremely Human is a conversation about the profound experience of extreme states. When we speak about extreme states, we want to explore a more humanistic way to understand people’s experiences that aren’t always shared by others.

[00:01:47 ] Lucy: Each extreme state holds different meaning for each person, including those related to psychosis, depression, grief and addiction. As we chat with a variety of humans, we explore the important question how can we respond to distress with greater compassion and humanity?

In this honest chat with Paul, he helps to bust some myths about common misconceptions in the medical world. Paul speaks about the value of humanizing people’s experiences rather than medicalizing it, and how including people’s loved ones in their care can make a real difference.

[00:02:33 ] Lucy: Here we are again, Paul. Thank you for joining us in our humble little studio.

[00:02:38 ] Rachel: Pretty excited to have you here, Paul, and to talk with us about.

[00:02:42 ] Paul: Don’t give me too much pressure.

[00:02:43 ] Rachel: Yeah, no pressure.

[00:02:46 ] Lucy: For those who don’t know you, Paul, can you just tell us a little bit about yourself?

[00:02:50 ] Paul: Sure. Well, I’m a child psychiatrist and I actually came up to 20 years working at the Alfred a few months ago, so I’ve been in my job as like clinical director of Alfred Kim’s for that time.

[00:03:04 ] Lucy: Wow. Long time.

[00:03:04 ] Paul: Long time.

[00:03:06 ] Lucy: A lot of knowledge.

[00:03:07 ] Paul: Well, you might say it’s too long.

[00:03:10 ] Rachel: This is totally putting you on the spot. But if you had to give one sort of short statement to say what you stand for as a psychiatrist, what would it be?

[00:03:18 ] Paul: Wow. I don’t know if I can do it in one statement, but like anyone, you’re hopefully going to try to make the system better. I mean, I’ve got quite a privileged position because I’m in charge of, I think we’ve got about 200 staff. So really, my job is hopefully help people get the best out of themselves. That’s my job. And it is something you can’t take lightly, because I do actually have power. And if you’re not going to use that for good, then it’s a shame.

[00:03:48 ] Rachel: That kind of reflects why we thought you might be a good speaker today, because the issues that we’re talking about is really about how do we make the system work better for people who are in extreme distress. Before we get to that, we have a bit of a standing opening question.

[00:04:02 ] Lucy: Yeah, Paul, I’m sure you have across your time, but have you or anyone you know had a disproportionate reaction to anything? Anything at all?

[00:04:12 ] Paul: Yeah, I think it’s hopefully, this is supposed to be a bit light hearted, because I don’t want it to sound trivializing what we are going to be talking about. But I did think about this question before I came, and I did burst into tears after Richmond won there, or actually before Richmond won the 2017 grand final. I think some people think it’s a game and why you’re getting so emotional about a game. But we actually hadn’t won a grand final for 37 years. And I don’t know, just the way it happened as well, underdogs and what it meant to a lot of people. So I’m trying to justify why it wasn’t disproportionate, but I think a lot of people would think that’s pretty extreme disproportionate to us when you’re game of football.

[00:04:52 ] Paul: We sort of interested, Paul, when we talk about the word or the phrase extreme state, what comes to mind to you? What do you think about?

[00:05:01 ] Paul: Honestly, I didn’t know that term until I attended the discovery course that you guys ran, because as a psychiatrist, you get trained in using more medicalized language, like psychosis, or in fact, we talked about schizophrenia. So what comes to mind when I hear that word is what I learned there, which is a more humanistic way of describing an experience for people when they’re out of touch with reality or their emotions are out of control or their feelings are out of control. And that’s actually a new concept for me. It’s probably trying to be a bit less prescriptive or a little bit certain about what’s behind it.

I think that language, using that language helps humanize the situation. Also having people not jump to conclusions about what might be behind it.

And also, I think it helps less medicalize it.

[00:05:57 ] Rachel: Can you say a little bit more about what you mean by medicalizing the extreme states and what’s the problem with that?

[00:06:06 ] Paul: Yes, I think there is a problem that in our Western culture, I believe that over a period of time, lots of emotional distress or mental distress has become too medicalized, and it leads to a real narrowing of being able to help people. And it’s also very. I think it’s part of our culture, too, which is very individualistic, and the responsibility for everything lies within the individual.

I think it causes heaps of problems because it particularly often leads to unhelpful solutions like that. An expert knows best that drugs are the way to help with these things, only that there’s some underlying medical problem, which is usually not the case. I mean, it’s sort of comforting in a way, and helps reduce guilt and shame and things. So there are some tempting things about it, but the negative is that it’s actually not really based on an actual factual basis. The best example I can think of is recently what I learned is that 90% of people in Australia believe that depression is caused by chemical imbalance. That’s a cultural view. So 90%. And in fact, it’s been shown that that is actually not the case. There is no evidence for a chemical imbalance. So that’s a big problem. And a lot of the drugs that have been manufactured or designed to help with that problem are based on that idea that there was a deficiency of serotonin or some sort of chemical imbalance, which means the whole thing, for me, becomes quite problematic. Not saying sometimes people aren’t helped by medication, obviously, sometimes they are. But the basis that it’s a medical illness is a problem for me.

[00:07:53 ] Lucy: Sounds so absurd when you say it like that, because it’s like, how are we treating people properly if we don’t even know what the issue is to begin with?

[00:08:03 ] Paul: Yeah, I agree with you, Lucy.

[00:08:05 ] Lucy: So it’s like, as a collective, I think we’re getting misled.

[00:08:09 ] Paul: It’s definitely getting more and more as well, because I’ve obviously been around a long time. What used to be the focus with schizophrenia is there was a massive search. I think millions and millions of dollars have been spent looking for a genetic cause, or it’s not quite the same as a chemical imbalance, but a belief that there’s some genetic thing and none has ever been found.

And because it’s such a… I think the word extreme states is helpful because who would be looking for a genetic basis of an extreme state?

That’s what I mean by the language that’s used. If you’re calling schizophrenia, it leads to a whole pathway of thinking there must be some genetic or biological basis