parapraxis

P ARAPRAXIS
March 2015, Issue 1
June 2015, Issue 2
President’s Report
Welcome to the 2nd edition of the
application pack sent out to prospective
reiteration of Parapraxis. This year has
psychiatry trainees and thought I would
seen the momentum from the VAPT
spread the message further here.
Parapraxis was relaunched this year as a
quarterly publication by psychiatric
registrars, for psychiatric registrars.
Parapraxis aims to celebrate the diversity
of experience amongst psychiatry
registrars, in their lives and in their work.
committee 2014 continue and strengthen
with a fantastic group of enthusiastic
VAPT is the Victorian psychiatry registrar
members. I would like to thank Dr Rahul
society. It is an association dedicated to
2.
Khanna, our Immediate Past President
furthering the interests of psychiatry
VAPT holds great written and clinical
for the wonderful job he did and for his
trainees in and outside of the workplace.
exam preparation nights. Our website
ongoing support. I am really excited that
We welcome suggestions for new
www.vapt.org.au includes an expanding
Dr Angela Anson has taken charge of
projects or a platform for working groups
collection of educational and exam
spearheading the rejuvenation of this
on trainee interests. We hold meetings
resources.
quarterly publication.
monthly. Membership is free and you are
We held an Underbelly-themed cocktail
Education
welcome to join at any stage during your
3.
training.
Through our social events
event at Temple Brewing on the 1st of
Connection
and Parapraxis we aim to foster
May. This was the first time that VAPT
Our aims are to improve work and life for
collegiality and as well as allowing for
has held a purely social night. I would like
psychiatry trainees in the following ways:
some creative and fun outlets.
who was charged with the organisation of
1.
I am looking forward to working and
Underbelly. As some of you who have
We have representative members from
socialising with you in the Melbourne
seen photos from the night will see, it
most Victorian training sites and
winter.
was really fun and enjoyed by many,
members who sit on various committees
myself included.
of RANZCP. We can help advocate for
Cheers,
trainees and are always wanting to hear
Gabby
Many people have posed the question
from you about what you would like us to
Gabrielle Matta
about exactly who and what VAPT are. I
pursue on your behalf.
VAPT President
to give credit to Dr Theekshna De Silva
Advocacy
recently had the privilege of including a
description of the organisation in the
UPCOMING EVENTS:
 VAPT Committee Meeting, 30th June 2015
All welcome. Please register interest with secretary@vapt.org.au
 VAPT Written Exam Prep, 7th July 2015
Featuring Dr Kym Jenkins and local trainees. Further details here.
For latest information please visit and register at www.vapt.org.au
PARAPRAXIS
June 2015 / Issue 2
EDITORIAL
This issue’s theme:
“Teach me to care and not to care”
- TS Eliot
I looked at the bruise on my arm and was
surprised that last night’s admission inflicted
such a marked injury.
I felt dismayed when I realized that I would
garner more sympathy for this visible injury than
the much greater blows to my ego whilst on the
job.
Like that manic patient that time… I felt like he
knew how to expose all my insecurities and
doubts. Reaction formation began.
One day my psychotherapy supervisor asked
me, “You keep mentioning ‘victim mentality’.
How do you feel about patients as victims?” I
realized that bruise to my ego had not healed
one year on.
Instead that idealistic resident had become a
cynical psychiatric registrar. Compassion
anxiety had turned into victim blaming.
If I really didn’t care about my patients and it
was really their own fault, why was I even
working in psychiatry? In the end I had to
confront my own ego and the reasons that I
chose to work in psychiatry.
I suspect learning to care the right amount
remains an ongoing challenge for many
We ride the raging torrent
registrars. So I think it is important to continually
remind ourselves of this quote by TS Eliot in the
We sail the holy sea
work we do and in order to maintain our own
wellbeing.
Thank you to all the psychiatric registrars who
We face the wind and weather
We make a cup of tea
have contributed to this issue and have taken a
moment to think about the work we do and the
lives we lead.
Thank you for teaching us to care, and not to
care.
In the first few months of becoming a trainee I am realising the importance
more than ever of the quiet periods in the storm and am making a
conscious effort to stop and really appreciate them.
The above picture was taken in The Gov Café in the Governor’s House in
Castlemaine Old Gaol.
Angela Anson
Editor
Helen Branson
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PARAPRAXIS
June 2015 / Issue 2
A Visit to J-Ward, Ararat
Daniel Brass
Driving back to Melbourne from a rainy weekend in the Grampians recently, we passed not only the enormous Seppelt and superb
Best’s wineries but also through the historic goldrush boomtown, Ararat.
Even a passing visit to Ararat is surely incomplete for a psychiatry trainee unless it includes a tour of J-Ward, a prison for the
criminally insane which became a forensic hospital and was finally closed in 1991 because it was unable to satisfy human rights
standards. For more than a century, J-Ward housed some of the most dangerous mentally ill patients in Australia. No doubt also
worth visiting is Aradale, the retired and palatial asylum on the other side of town, but alas we didn’t have time.
The stories of a century of psychiatric inmates was enhanced by the narrative skill of our guide, a retired biology teacher who has
been leading tours through J-Ward for twenty years and who seemed as well briefed on the history and current practice of
psychiatry as almost anyone I’ve met. His description of ECT would satisfy the requirements of informed consent.
John’s accounts of the people he had led through J-Ward over the years were as surprising as the stories of the inmates. There
had been several patients, several old warders or nurses and an elderly woman who had grown up in the governor’s house at the
front of the complex: her father was the governor and she had lived there for years but had never before walked through the
reinforced steel door that led out to the inmates’ courtyard surrounded by an 18-foot wall.
Each cell is set up to tell a story. A man who lived in J-ward for over sixty years and at the time of his death at 108 was the oldest
man in Victoria. There were executions and suicides, attempts to abscond and frequent violent outbursts. But, most importantly, the
tour left me with a vivid sense of how psychiatry was practised at a time when, essentially, confinement was the only treatment
available. One cell was occupied in the 1980s by a man with AIDS who could not be held anywhere else due to concern about the
spread of the illness: putting him with the mentally ill seemed most appropriate. There was a straight jacket, a gallows, a table
secured to the floor for the patients who tended to throw furniture (as well as food) at their, in the modern parlance, ‘co-consumers’.
And what were they consuming? The kitchens beneath J-ward, stained with the soot of a century and the smell of smoke strong
more than twenty years after the flame was last lit, give their own multi-sensory account. At least it would have been warm.
At the end of the tour we climbed to the top of the surrounding wall and into one turret which was restored several years ago after
donations and sponsorships were sought from local industries. It was a cold day when we were there and the wind at the top of the
wall was bone-rattling. What must it have been like to be up there for hours at a time, unable to leave? The lives of the warders
(later called nurses) would have been very hard.
I don’t believe in ghosts and certainly don’t think that our ancestors haunt their old habitations, but J-Ward is a place filled with
stories, generally sad. It is a physical reminder of the difficult path psychiatry often walks between a therapeutic alliance with our
patients and the demands of our society. Debates about whether and when we should treat people against their will, or confine
them in hospital, still preoccupy much of our thought, and it’s sometimes useful to put that in an historical perspective. J-ward gives
a sense of how far psychiatry has come but also of how far we still have to go. Seclusion, restraint, locked wards: all familiar
concepts in 2015. And in a video showing the ward in the late 1970s, everyone was equally convinced that they were doing the
right thing.
The tour offered much food for thought. And all for only $16.
http://www.jward.org.au/
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PARAPRAXIS
THE PARAPRAXIS PROUST-ESQUE QUESTIONNAIRE
June 2015 / Issue 2
The Mental Health Clinic
Theekshna De Silva
Charlotte Duncan
Apprehensive and scared,
1. What do you love about psychiatry?
She enters his lair.
I remember as an intern being far more interested in people's lives and stories
His big teeth in grin bared,
than their injuries or sickness. Psychiatry gives you the opportunity to develop a
She tries not to stare.
relationship with your patients and really investigate what makes them tick.
2. What doubts do you have about psychiatry?
I have doubts about our diagnostic system, diseases defined largely by the
symptoms being helped by medication, the ongoing biological and
He notes down her quirks,
Any deviance from norm,
Her foot taps, knee jerks,
but she maintains her form.
psychological split, the effect of labelling distress a disease and failing to
examine sometimes the roots of the distress... Suffering is a universal element
Sweating, clock-checking,
of human life and where we draw the line between using it as a signpost to
She gives bland replies.
guide our choices or labelling it illness is sometimes not well thought out. But
He questions and probes,
these issues fascinate me as well!
To fault her, he tries.
3. What keeps you going?
Holding in her breath,
I love what I do. I've thought many times about doing something else but I
She smiles and she nods,
actually love what I DO - I enjoy seeing my patients, I leave an interview or
"Please see I'm okay",
therapy session feeling my world has expanded in some way. If I didn't get that
She prays to her Gods
I would have left long ago.
4.
If you weren’t doing psychiatry, what would you be doing?
Maybe stepping out of the rat race and being a travelling bum on the
backpacking circuit, maybe something literary, maybe something connected
with sustainability and the beautiful world we live in.
Conclusively, he stands,
"Well things seem to be fine".
Relief floods as she leaves,
Safe, until the next time.
The Hoarse Whisperer
Lior Chait
Before his first patient of the day the psychiatrist prepared himself in his room. He stared into the vanity mirror on his desk
and stretched out his face into maniacal grins, grimaces and yawns. ‘Puhh tuhh kuhh tuhh’ he breathed onto the mirror,
fogging up the glass and obscuring his reflection. An eternity of speaking and a night of modest drinking had tenderized his
magnanimous vocal cords. He closed his eyes and slowly rotated his head left and right and left again. In the mirror it
appeared as though he was saying ‘no’ under water. But the psychiatrist almost never said ‘no’ in a session. In fact he
always responded in the affirmative. He often did this by liberating a soft, protracted ‘mmm’ sound. In the interview, one
such noise reverberated somewhere in the psychiatrist’s chest – the distant sighing of a sacred cow. The tone appeared to
melt all disquiet in the room and anxieties hid between the ticking of the clock. In that instant all aggression and suffering
in the patient had been temporarily arrested in time, filed away in an illegible dossier. Of course the psychiatrist, who had
been feeling the draught of the air conditioner in his mouth and the stale malaise of the office sanctum had only been
clearing his throat and was finally ready to speak.
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PARAPRAXIS
June 2015 / Issue 2
A Love Letter Without Words
Sam Pang
Meandering tourists navigating the narrow, crystal-lit streets of Prague are often drawn by spruikers to attend a pricey
orchestral performance. While at the World Psychiatry Association conference in 2012, I found myself lured to such a recital,
performed in a crumbling concert space in Old Town. A staple in the repertoire of Czech composers is the fourth movement
of Gustav Mahler’s Symphony #5 in C Sharp Minor (1902), the Adagietto. Even with the recent rise in Mahler’s popularity,
with Martin Scorsese’s thriller Shutter Island (2010) and the Melbourne Symphony Orchestra’s annual feature (the Fourth
Symphony opens 20 June 2015), the Adagietto still remains Mahler’s most celebrated piece. Much hot debate has
concerned modern renditions being far too slow, giving the Adagietto an inappropriately melancholic feel. Mahler composed
the symphony during his courtship of Alma Schindler, also a notable composer. In the lead up to one of the fifth symphony’s
first performances, Alma emphasized to the Dutch conductor Willem Mengelberg that the Adagietto, scored only for strings
and harp, was sent originally by Mahler to her as a love letter without words. Secretly copied onto Mengelberg’s original
conducting-score is Mahler’s short poem to Alma (translated from German):
“How much I love you, you my Sun,
I cannot tell it to you with words.
I can only lament to you my longing and love.”
In 1910, Mahler submitted to a four-hour walking consultation with Sigmund Freud to discuss his marital conflict, Freud
attributing the difficulties to obsessional neuroses in both Mahler and Alma due to unresolved Oedipus complexes. Freud
had posited that artistic creation is a transmutation of neurotic conflicts, or a sublimation of an unsatisfied libido. Whilst
Mahler’s marriage became tenderer following the analysis, the effect of Mahler’s working through on his creativity was never
discovered due to his physical decline and death eight months later from bacterial endocarditis. That the beauty, intimacy
and angst of the sighing motives and long suspensions in the Adagietto are a mere sublimation of Mahler’s desire for his
mother is a sobering thought. However as Kuehn (1965-1966) describes, “The emotional quality of a work of art always
relates at bottom to some desires or needs, real or fantasied, which are the collective heritage of man. However, that which
is individual and not shared is the ability to express the desires and feelings symbolically in some way which is at once
personal and yet somehow congruent and meaningful to others.” It is clear the Adagietto resonated with Alma, as it
continues to with all Bohemian adventurers that have not yet consumed too much absinthe for the evening.
References

Admiraal, D. (2007). Mahler-5 Adagietto, its historic tempo and changed emotional content. Daan Admiraal website.

Freud, S. (1911). Formulations on the two principles of mental functioning. In: The standard edition of the complete
psychological works of Sigmund Freud: Volume 12 (p. 213). London: Hogarth Press.

Hansen, K.D. (2015). Mahler’s “Funeral march to joy”: The fifth symphony. Colorado MahlerFest website.

Kaplan, G. (1992). Classical music; A dirge? No. It’s a love song. The New York Times, July 19.

Kuehn, J.L. (1965-1966). Encounter at Leyden: Gustav Mahler consults Sigmund Freud. The psychoanalytic review,
52(4), 5.

Painter, K. (ed) (2002). Mahler and His World. Princeton, New Jersey: Princeton University Press.

Starcevic, V. (2013). Gustav Mahler as Freud’s patient: A note on possible obstacles to communication and
understanding. Australasian Psychiatry, 21(3), 271.
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June
2015
/ Issue 2
PARAPRAXIS
Lorem
Ipsum
June 2015 / Issue 2
Porsche Macan S Review
Leon Turnbull
The Audi Q5 is dead, it is pointless. It had been the object of desire for flirtatious young and generally attractive
buyers, but is now a frump. Its tyres are glad wrap thin and shred off road, its size is nonsensical, and its looks, once
refined, are now bulbous. The badge is now driven by nobodies. I feel sorry for people who buy Audi’s. Round, underangulated cars are cool for three months then look like a Nissan Bluebird. Trying to be cool is a waste of time. It never
works.
Somebodies are driving the Mercedes C-Class. But this is soft mush to drive. It has no steering, and the engine lineup is ten years behind the BMW 3 series. Anybody with any sense will buy the 3. You can eat from a charcuterie
board, drive it one handed, and point it at any speed around a corner with incalculable confidence. It is currently the
best mid-sized sedan on the road.
If infidelity is your thing you will buy the two seater 4 series. This is not a good car. It is squatter than the 3 with a wider
wheel-base, thus less nimble, and the doors are huge. So huge you cannot use any conventional car park without
denting your neighbours Lexus. I know.
If you have lost the prescience to buy a four door sedan you must buy the Porsche Macan S. Don’t buy theTurbo, it is
too fast and harsh. The diesel is not an option, the engine sound is embarrassing - I started one in the Porsche
showroom and wanted to leave.
The Macan S is wonderful. It reaches 100 in less than 6 seconds. I tried to do this full throttle at a T-intersection
turning hard right using the grip through the all-wheel drive. It made scary squeaky sounds, people on the street
grasped for their children, but I was very comfortable and started going very fast, comfortably.
The dash has one zillion buttons. The most important are for changing engine and suspension settings. The perfect
combination is soft suspension with sporty engine. All other settings will injure you or make you feel slow.
When you buy a Porsche Macan, which you will, pay extra and get the Chrono package with a stop clock on the dash.
This is very expensive but will make you very happy. You will be able to get huge discounts on Audi’s in the coming
months. Don’t.
These experiences have taught me to care, and not to care. Angela Anson
Watch: The Salt of The Earth
Equal parts harrowing and
inspiring documentary about the
life and work of Sebastião
Salgado, a social documentary
photographer.
Listen: Kendrick Lamar’s
good kid, m.A.A.d. city
Sonically audacious
autobiographical album
about growing up in
Compton, trying to escape
and being pulled back.
PARAPRAXIS
Lorem Ipsum
June 2015 / Issue 2
Welcome to the following newest members of VAPT…
Where do I go for help?
TRC Representative: Daniel Brass (Austin)
Service Representatives:

St Vincent’s: Dan Hubik

Barwon: Kimberley Adler

Eastern: Hortiu Selegea.
We are still seeking representatives for:

Bendigo

Shepparton.
VAPT Welfare page now
online here.
VAPT has compiled a list of
contacts for trainees to use as
a starting point for concerns
related to

Personal Health and
Wellbeing

Training

Industrial Relations

Medico-Legal Issues.
If you are interested, please email secretary@vapt.com.au for
more information.
Coming up in September 2015 / Issue 3
Theme: “If you cannot get rid of the family skeleton, you may as well make it dance”
(George Bernard Shaw)
All contributions welcome!
Closing date: Friday 11th September 2015
Email: parapraxis@vapt.com.au
Website: www.vapt.org.au