An erudite encounter with: Scott Henderson,AO

What makes you you? This question assumes a level of insight that few with any modesty would ever wish to reveal. Put succinctly, I would say that I am an explorer of sorts. It is enjoyable to explore this and that and to have the privilege of choosing. It doesn’t really matter very much if the topic is about humans or other forms of life.

My favourite idea in psychiatry is … John Bowlby’s attachment theory, one of the bigger ideas in 20th-century psychiatry (Bowlby, 1980). He was very keen on bird behaviour while also having had heavy exposure to psychoanalysis at the Tavistock Clinic in London. He brought the two worlds together. Bowlby saw that something very remarkable was taking place between very young animals and their mothers, and that it persisted into adult life. His attachment theory had the advantage of being open to testing by observation. Bowlby visited me in Hobart in 1973, after which I began to wonder if deficiencies in the social environment, as in close personal relationships, might contribute to common mental disorders and if this could be investigated epidemiologically. Well, I was very fortunate to do so later in the NHMRC unit at ANU. The rest of the story is in Neurosis and the Social Environment (Henderson et al., 1981). It’s still not clear to me what humans exchange in close personal relationships, how this can be measured and what happens to mental health when the process goes awry.

The best career advice I ever received was … ‘You’re not cut out to be a neurosurgeon, or indeed any type of surgeon’. Later, my very psychoanalytic professor in Aberdeen suggested an academic track, and, on this occasion, he was spot on. I am not attracted to a life with no opportunity but to treat patients and then go home, day after day.

What makes you tick? This has not yet been fully revealed to me. I suspect that Priscilla [Scott’s wife] may have more insight. But being with bright people has usually been very enjoyable. I’ve always found research more attractive than clinical practice: trying to work out how things come about. Taking others aboard in such efforts is very important, especially bringing in younger people. My best times, I know only now, have been in Edinburgh and Canberra – in both of which I have had time to think.

One important but soluble question in psychiatry is … This may risk sounding rather pretentious: let’s start by acknowledging that the human brain is probably the most elaborate piece of matter in the Universe as we presently know it. It has been evolving over several million years. Next, consider each of the mental disorders that come before us as clinicians. It ought to be possible one day to ask what components of brain function go wrong, in terms of its evolutionary development, when a mental disorder emerges. Some of the process will involve harmful exposures from the environment, as happens in the development of cardiovascular disease. The contemporary human environment is very different from the Late Pleistocene, bringing about what Stephen Boyden calls an ‘evodeviation’ (Boyden, 2004). So what are the consequences for the human brain? Even a little information on this could have value for prevention at the population level.

What is the future of psychiatry? Surely the prospect is obvious? Look at the typical content of the main journals compared to last century. I am deeply envious of our youngest colleagues because of the diversity of knowledge being set out before them. In a few years, they will be able to listen to patients describing symptoms, what experiences they have had in the past, then look at pictures of what is taking place in both their grey and white matter and, last, what can be done to put that right. What I’m envious of is the beauty of marrying human interaction as an empathic clinician to appreciation of molecular events in the brain of the person opposite you. But at the same time, these younger psychiatrists will have to live with further unanticipated changes in medicine and in society that curious proclivity people have to poison their own brains and increasingly inimical administrative conditions in our health services.