He's the very definition of hope...

Early this month, at an awards gala at The Carlu, The Mood Disorders Association of Ontario honoured a prominent psychiatrist for being "the very definition of Hope" – Dr. Emmanuel Persad.

He's called "Mr. Education" in an upcoming profile in the April issue of Canadian Psychiatry, – cited as "one of the main pillars of Canadian psychiatry, particularly in postgraduate education."

He's also described as a "renaissance man of psychiatry, a superb negotiator. Patient. Quietly respectful. Charming."

Yesterday, in his small, simply appointed, windowless office at Markham Stouffville Hospital, Dr. Persad and I spent an hour together, our first shared-hour since he had a much larger, windowed, plant-filled office on the eighth floor of the Clarke Institute of Psychiatry.

Our appointment, yesterday, was at 3 p.m. and at precisely that moment, Dr. Persad approached me as I wandered a little dubiously in the busy lobby of this suburban Toronto hospital. I recognized him instantly. He has hardly changed, especially in his humility, his concern that I might lose my way to his office on a subterranean level of the hospital. That caring gesture was a clue to the kind of person, Dr. Persad is.

This was our first reunion in about 25 years.

The last time we met, in his Clarke Institute office in the early 1980s, he said, "We're very proud of you, Sandy." I was a full-time feature writer at The Toronto Sun and Women's Editor at CHFI. Doing well, apparently, on the mood stabilizer Lithium Carbonate.

That meeting was a far cry from the previous time we'd shared an hour, a decade earlier.

I met Dr. Persad in 1975 when he was a professor of psychiatry at The University of Toronto and a newly-minted senior psychiatrist at The Clarke, now part of The Centre for Addiction of Mental Health,

And I was seriously troubled.

Following my graduation from Queen's University and the break-up of my short-lived first marriage, I was psychotic. Again.

Hospitalized for the fifth or sixth time since the early 1960s. Delusional. Delusions of Grandeur, actually. My thoughts racing. "Flight of Ideas," it's called. Talkative. Sleepless. Irritable. Hallucinating.

I remember how Dr. Emmanuel Persad listened to me. Very carefully. Intensely. With respect. I've never forgotten the way he listened.

"What transpires here, in the work I do, is having the person I am with know that they're being listened to and that it's safe enough with me for them to come back," he explained yesterday.

I remembered that feeling of being intensely listened to. You never forget it. Dr. Bob listens the same way. Why wasn't I surprised that Dr. Persad and Dr. Bob are professional friends. Colleagues who share the same psychiatric spirit and vision.

"There is something sacred about the interaction between a psychiatrist and a patient. Trust. Autonomy," Dr. Persad continued. "It takes courage to come into this office.

"And I avoid labels – which have a way of dismissing the person."

During that 1975 hospitalization, Dr. Persad changed the course of my life.

From 1960 to 1975, my psychiatric diagnosis was schizophrenia. At one time, in the late 1960s, catatonic schizophrenia. I was, in the words of many psychiatrists, "a revolving door case" – in other words, "doomed" to a life in and out of mental institutions. My mother recalls being told that "there was no hope for me."

Somehow, Dr. Persad saw something in me that eluded all those other psychiatrists.

I did not have schizophrenia. Manic Depression, as it was known then – Bipolar Disorders, today, a spectrum of disorders – was a more apt way to describe my behaviour back then. But it was a difficult diagnosis. I do not get clinically depressed. Ever. Just high. Ultimately psychotic.

Today, my diagnosis is Psychosis in Mania – and it's rare. I don't think about it much. It's just a label. I prefer "in recovery." Most of the time I'm simply exuberant. Hypomanic, with medication and therapy.

The point is, as Dr. Persad explained yesterday, "no label aptly describes a person's unique life experience." Furthermore, he strongly endorses the practice that whatever treatment is prescribed must be managed by the person in partnership with their therapist. "It's a joint-event."

In the 39 years since Dr. Persad more accurately understood what was troubling me, he has continued to educate several generations of medical students and psychiatrists at the University of Toronto, the University of Western Ontario and now Queen's University, while practicing his profession.

(Coincidentally, I will be delivering the keynote to the students at the Queen's Faculty of Medicine next week during their "Mental Health Awareness Week.")

Today, he continued, the tensions between the neurosciences and the mental health issues pose serious problems for psychiatrists. "The "biopsychosocialspiritual model" is almost invisible behind pressures of Big Pharma and the push to prescribe, prescribe, and prescribe.

The reasons are too complex to deal with here.

"We're part of the problem," Dr. Persad admitted. "We perpetuate the undesirable nature of our profession. We treat the person as less than a person."

He envisions a re-introduction of psychotherapy – talking therapies – into the treatment of serious mental illnesses, like schizophrenia. He's completing a text on this subject right now, stressing instead the far more powerful impact of listening and respecting the integrity of the person who needs and/or seeks help.

"As psychiatrists, we seem to have lost the intellectual rigor, to be comfortable with the ambiguities of people, and this needs to be resuscitated," he says referring to this return of "talking therapies" and a re-examination of the overemphasis on medications-only as therapy – the all too ubiquitous "15-minute appointment and prescription" which plagues the practice of psychiatry today.

"I've always felt there's a kind of giftedness to people with mental illnesses – not just moments of insight," he said. "But people are often frightened by that kind of expansiveness."

Dr. Persald, now 72, is committed to changing the way psychiatry is practiced and perceived. For his entire career, which began in the mid-1960s, he has actively involved himself in the academic world, in teaching young medical students – stressing the inherent humanity of psychiatry. Teaching is learning.

His humanity – in a word – is hope for all of us.

Comments

[Tammy MacKenzie]

Wow, Dr. Persad sounds awesome.
You are so right, Sandy - people like him give hope in a world when all too often we hear of, or encounter, those who seem not to have an understanding or consideration for ALL we are.
Thank you for writing about him.

Hope you have had a good week - I am really looking forward to Thursday!
xo Tammy

[Wellness Writer]

What a nicely-written piece! What a terrific man! How lucky for you that you found him when you did. I couldn't agree more about the problems within the psychiatric profession.

All of the best "physical illness" doctors who write books talk about how important it is to listen to patients. So many illnesses are caused by stress. It's amazing to me that most psychiatrists have become pill pushers and little else. And once they label you, that's usually it for life.

Within the United States, our treatment seems to be determined by the big insurance companies who will pay for medication, but reimburse so little for therapy (and there's usually a cap of 20 visits a year) that it's difficult for most people to afford.

Alas...but it always makes me feel good to know there are really good psychiatrists out there!

Susan

[Sandy Naiman]

Thank you, Susan, for your excellent comment.

I must admit, it perplexes me. Saddens me.

Here, in Canada, I know people who see psychoanalysts five times a week and are covered by our universal health care – as long as their psychoanalysts are medical doctors.

Unfortunately, psychologists and other psychotherapists are often far better trained and skilled in the "talking therapies" than the majority of psychiatrists.

But only treatment from a medical doctor is covered – unless you have private health insurance. That private insurance is only for a certain number of visits. Not many, at $150 per hour.

What I find interesting in your comment is the disconnect between doctors who treat "physical" and "mental" illnesses.

One reason Dr. Persad is so special is that he listens so actively, with all his senses, including his heart. His soul. He hears the whole person. He's sentient.

There is a mind/body connection the neurosciences have lost sight of – a context to everyone's life unique to them – that is ignored by far too many psychiatrists who don't or won't or can't deal with the "mental health issues" in a person's life. Their lives.

Psychiatry should be a holistic specialty. Mind and body. How can you possibly separate the two and treat only one! That's why mental health recovery is so important – where peer support is essential and people feel a sense of connection, community and hope.

That's also why a resuscitation of the "talking therapies" is so crucial for recovery. How much hope is there in a pill bottle?

For Dr. Persad, a person's recovery is paramount.

I'm very happy you commented here and shared your American perspective with us.

Again, many thanks.

[Wellness Writer]

Dear Sandy,
Since this is such an emotional topic for me, I'd just like to briefly respond to your response (and you're welcome!). I completely agree there shouldn't be a disconnect between mind/body medicine. It makes no sense whatsoever.

In terms of listening, Bernard Lown,M.D., a Nobel Peace Prize recipient and author of "The Lost Art of Healing" writes, "In the brief time available to take a [medical] history, the aim is to obtain, in addition to essential facts, insight into the human being. This seems easy, but listening is the most complex and difficult of all the tools in a doctor's repertory. One must be an active listener to hear an unspoken problem."

FYI...In Los Angeles, I now pay $150 for a half-hour psychiatric session; insurance used to pay $30 per session. When my husband retired and we had to switch to COBRA, my insurance alone cost $12,000 a year, and yet paid so little for my treatment. I could go on and on, but it's unconscionable!

Susan