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ON THE SHOULDERS OF GIANTS

Celebrating the launch of new book ‘Psychiatrists on Psychiatry'


"If I have seen further up, it is by standing on the shoulders of giants. - Sir Isaac Newton
Book cover for "Psychiatrists on Psychiatry'

Discoveries are often not result of a single person but rather a team building on the knowledge that exists. Academia thrives by challenging existing dogma and building on what has come before. This building on foundations set by others also highlights the importance of institutional memory. Institutions are made of people and so often it is the people who remember, hold and record memory about the function of the organisation and the field of academics relies on sharing data, findings, observations, results, and caveats.


Institutional memory (or corporate memory) is helpful in understanding what has gone on before while building on strategies and skills and depends very heavily on what people recall and what is embedded in facts, concepts, experiences, and know-how held within an organisation. Of course, documents may not contain everything people recall and remember but institutions do hold the history and historical knowledge in a variety of locations. Minutes of meetings are just that often detailed discussions may not appear there. Furthermore, the impact of researchers, teachers and leaders be they in clinical settings or influencing policies can be significant. The institutional memory has both tangible and intangible components.


Preservation of institutional memory is crucial. In a pre-digital era, constraints of space may have made such storage difficult. In the 21st century digital age, four ways of preserving institutional memory have been described: playbooks and checklists, protocols and policies, technologies and tools, and dedicated external individuals and/or teams. In this spirit, several years ago, well-known psychiatrist Professor Norman Sartorius suggested that I ought to interview a number of leaders in psychiatry from around the world. It took nearly five years to record, transcribe, and publish the interviews in Psychiatrists on Psychiatry, published by Oxford University Press. The book is being launched at the Royal College of psychiatrists on 24th October at 3:30pm.


I had the good fortune of having three early career psychiatrists — Dr Mariana Pinto de Costa, Hussien Elkholy, and Antonio Ventriglio — who interviewed five of the leaders and I had the privilege of interviewing the rest; thus, a vast majority of the leaders. Of all the individuals who had been invited, three refused to participate for various personal reasons whereas the rest were willing to share their experiences and life histories without hesitation.


The book contains transcripts of interviews with 26 psychiatrists from around the world. Of 26 interviewees, 12 were women. Although a majority came from Europe and USA, we had three from north Africa, three from India, and one each from Thailand and Japan. Regrettably, three interviewees — Sir Michael Rutter, Dame Fiona Caldicott, and Padma Bhushan Sarada Menon — had passed away but their families gave permission to publish the transcripts for which we are most grateful.


The interviewees in alphabetical order are: Renee Binder (USA), Fiona Caldicott (UK), Silvana Galderisi (Italy), David Goldberg (UK), Billy Jones (USA), Shigeobu Kanba, (Japan), Marianne Kastrup (Denmark), Linda Lam (Hong Kong SAR China), Saul Levin (USA/South Africa), Mario Maj (Italy), Felice Lieh Mak (Hong Kong SAR China), Sarada Menon (India), Driss Moussaoui (Morocco), Carol Nadelson (USA), Amed Okasha (Egypt), Tarek Okasha (Egypt), Maria Oquendo (USA), Michael Rutter (UK), Norman Sartorius (Switzerland), Alan Schatzberg (USA), Nada Stotland (USA), Paul Summergrad (USA), Thara Rangaswamy (India), Pichet Udomratn (Thailand), Rutger Jan van der Gaag (Netherlands), and Laksmi Vijaykumar (India).


There were similarities and differences in their upbringing, development, and their attraction to the discipline of psychiatry. The role of mentors was significant and many interviewees spoke very fondly about how various mentors guided and supported them. The impact of the Second World War was very important on the childhood, early adulthood, and consequent worldview of many of the interviewees. The reason why they chose to go into psychiatry varied, as did their views on how the practice of clinical psychiatry has changed. The question remains whether leaders are born or made and whether leadership skills can be learnt. There is little doubt that for leaders to emerge and function effectively, they must have followers who believe in them. In view of changing evidence, good leaders can change their mind and decisions to ensure best outcomes. In order to do this, once again, institutional memory becomes crucial.


The book can be seen as an attempt to record history and institutional memory, but it also highlights challenges psychiatry as a discipline and profession has faced and how some of these challenges have been overcome. Institutional memory is the collective knowledge about institutions and their functioning and it can help leaders to ensure that institutions continue to run smoothly and deliver the vision leaders have. Carrying out research, as demonstrated by several of the interviewees, is about mentoring, team working, and, to a certain degree, being able to take risks.


Therefore, institutional memory plays a major role in what works and what does not. Of course, circumstances, society and settings change and good leaders have to be willing to change with these. Institutional memory is held by people and archives but nothing beats learning from individuals which can explain and express their reactions rather than relying on dry records. Thus institutional memories held by members of institutions becomes crucial to recognise that and hopefully this volume will provide that.


It is important to be aware of the inherent value of institutional memory so that we can build on its strengths and manage its weaknesses. This is embedded in a collective set of facts, concepts, experiences and know-how all of which are held by a group of people at all levels in the institution. This means that a collective memory or history can be utilised to build on what has gone on before and how we take things forward.


As people hold this knowledge and memory, it is crucial that we acknowledge their contributions and collect information in order to be able to transmit that to future generations. This will allow them to apply not only lessons learnt but, more importantly, how to stand on the shoulders of giants and look further up as Newton had so eloquently observed. As institutional memory transcends the individual, the recording and transmission are important in understanding and building on institutional cultures. I am humbled by listening to life stories of these giants of psychiatry many of whom have created innovative research, clinical, and policy programmes. Saying thanks to them is a very inadequate way of expressing my gratitude for all they have done for the speciality, their patients, and the population as a whole.


The book can be ordered from Oxford University Press.

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