15 minutes with . . .
A professor in Old Age Psychiatry
Authors: Zehanah Izmeth, Gautam Gulati
Publication date: 13 Feb 2008
Robin Jacoby is professor emeritus of old age psychiatry at the University of Oxford. He is coeditor of the Oxford Textbook of Old Age Psychiatry and chairman of the Global Initiative on Psychiatry.
Can you tell me about your career?
Initially I did a language degree in Russian and French at Oxford, and then I did one term towards a PhD before deciding to study medicine. My preclinicals were at Oxford and my clinicals at Guy’s. After my house jobs I went to Southampton, where I worked as a medical senior house officer and medical registrar. For various reasons I decided to go into psychiatry, so I went to talk to the vice dean at the Maudsley. I then applied and stayed there about 20 years.
What’s the Geneva Initiative and how did you get involved with it?
It’s been renamed the Global Initiative on Psychiatry (www.gip-global.org), and it grew out of a group of people who were opposed to the political abuse of psychiatry in the former Soviet Union. I got involved because Jim Birley, who had been dean at the Institute of Psychiatry and a consultant at the Maudsley, knew I spoke Russian. Initially, the chief psychiatrist in Belarus had approached the Department of Health and wanted to set up links. Jim Birley asked if Catherine Oppenheimer and I would like to do that, which we did successfully, and as a result I was invited to join the board of what was then called the Geneva Initiative on Psychiatry. To mark the 25th year we changed our name to the Global Initiative on Psychiatry. The reason it was called the Geneva Initiative is a rather curious one, in that the group actually met in Paris, not in Geneva. There were some German people in the group, so if it had been called the Paris Initiative the German would be “Pariser,” which means condom—the equivalent of the English “French Letter.” To prevent any confusion they decided to call themselves the Geneva Initiative on Psychiatry.
Do you think psychiatric practice has changed in the past 25 years?
The boring answer is that some of it’s better and some of it’s worse. Clearly, the improvement in taking account of a patient’s rights and how the patient feels and patient centred care is an advance, but I think there’s been one step forward and two steps back. The move into the community was badly handled in many places, with people being moved from an institution into the community, where they were often isolated.
I think the circumstances of psychiatric practice in general adult psychiatry are, in many places, absolutely appalling and I wouldn’t, if I was starting now, be a general psychiatrist for all the tea in China. Old age psychiatry is different—it’s wonderful, and I think this is recognised by the fact that, in some places, it’s easier to recruit specialist registrars in old age psychiatry than it is in general psychiatry. Over the past decade or so general adult psychiatrists have been made responsible for things over which they have no control. I think that we have become obsessed with suicide. One can certainly modify rates of suicide and, if we were careless, rates of suicide would go up. However, I think we also fail to recognise that suicide is not a preventable condition and that it is completely wrong to blame clinicians for every suicide; it is quite wrong.
How do you see the future of psychiatry?
It’s always very dangerous for old men or women to predict the future, and I wouldn’t do that, but I would go so far as to say that I think that bipolar disorder and schizophrenia, which are the main illnesses that psychiatrists have to deal with, are fundamentally organic—they’re brain disorders—and that’s the way that research has to go. For my own specialty, regarding Alzheimer’s disease or dementia I am prepared to be a bit more predictive. I think that we now understand so much about the pathogenesis of Alzheimer’s disease that, in the foreseeable future, though maybe in quite a long time, really effective drugs will come along, either to stop the process dead in its tracks (effectively to cure it) or to delay the onset so much that the incidence and prevalence will go down dramatically.
If you were a junior doctor now, what would make you choose psychiatry?
The only thing that would make me choose psychiatry would be if I could go straight into old age psychiatry. I wouldn’t train in general psychiatry; I wouldn’t do it.
Name: Robin Jacoby
Position: Professor emeritus of old age psychiatry
Biography: Chair of the Global Initiative in Psychiatry, co-editor of the Oxford Textbook of Old Age Psychiatry
What would you do if you weren’t a psychiatrist?
I wouldn’t do anything other than medicine. I’m afraid I’m one of those people who come from a medical family, a very medical family. I changed direction to go into medicine. I find it difficult to understand why anybody should want to do anything other than medicine, so I would do medicine and I guess I would probably be a physician.
Zehanah Izmeth ST3 in Psychiatry
Gautam Gulati SpR in Forensic Psychiatry