What makes a good psychiatrist? Is it a bonus to like your colleagues? What does depression mean? What is it like to be a professor of psychiatry? Disparate questions find disparately satisfying answers in this lively but disjointed book, part memoir, part polemic, by a grizzly Australian academic who early on defines his role with consummate clarity as one of ‘a prickly bastard who keeps asking questions and won't shut up’.
The biographic opening speeds through early decades, carried by a fluent, informal style. Parker's emotive recall of events is interesting; his use of ‘closure’, for example, seems to overlap with justice and satisfaction. En route from medical school to professorial chair, via a detour into comedy writing, he paints a fondly detailed picture not only of Australian psychiatry but of Australian culture at an interesting time. Readers familiar with the world of psychiatry – not necessarily Parker's target audience – may take perverse comfort from the fact that stigma, petty managerialism and vested interest have long bedevilled the efforts of psychiatrists all over the planet. Parker delights in bringing them to book, although his method is curiously unfunny for a comedy writer.
His definition of a good psychiatrist is unashamedly Hippocratic. Like any other branch of medicine, he contends, the art and science of the craft lies in pattern detection; the recognition of shifts and signs in the suffering that enable a physician to do something useful. Where the suffering is mainly mental, the patterns may be much harder to recognise. He expands on this idea as he approaches his main theme, the diagnosis and treatment of depressive disorders. Here the relaxed, thoughtful tone gives way to a didactic voice which is clumsy at first. A résumé of the research paradigms that led to his grand oeuvre reads like a cut-and-paste from 20 years’ worth of grant applications, but over the next 60 pages the scholarly style finds its stride in a cogent analysis of depression as an illness. Those who worry about the medicalisation of distress in the DSM era will find much to support the growing concern that the diagnostic shift from validity to reliability may be more costly than we realise. Parker responds by sketching out a return to an evidence-based diagnostic formulation, based on pattern recognition. A portrait rather than a sketch would have been welcome here.
Finally, he describes how his disillusion with the psychiatric establishment prompted him to approach businessmen and politicians directly, setting up an institution dedicated to mood disorder treatment and research that practised as Parker preached. His Black Dog Institute has evidently gone from strength to strength. The same cannot be said for his fluency in the last section of the book. He serves the reader with a salad of opinions, vignettes and excerpts from earlier publications, sprinkled over an essay on the style and substance of psychiatric practice that feels incomplete, but consistent with a life spent giving people a piece of his mind.
The true hero of this biography is Australia itself. Parker paints a picture of a rich, creative Western culture that for all its success retains a willingness to care for its mentally ill and do something about it, all the way from clinic to parliament. The understanding of mood disorders and their management has a long and troubled history. Anyone with an interest in its future will gain from this idiosyncratic book.
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