The 2023 Oration, titled “The privilege of the mental health clinician entering the seriously playful world of the child within the family: A legacy of Winston Rickards” was delivered by Associate Professor Campbell Paul on 27th March. The appreciative audience at Melbourne University was supplemented by many more attending remotely by Zoom.
Professor Paul began the oration by recalling the multidisciplinary collegiate ambience of working in Dr Rickards’ Department and the impact he had on the emergence of the specialty of child psychiatry and especially the superspecialty of infant psychiatry. This was followed by discussion and videotape examples of clinician and mother-child interactions.
Everyone knows that infants and children will be profoundly affected by parental incapacity through post-partum depression, psychotic illnesses, severe substance abuse, domestic violence and similar dysfunctions. However, what shone through the presentation was how much further the skilful clinician is able to explore the interactional world. Colouring the relationship between infant and mother is not only the reality of the child-rearing circumstances but the “ghosts in the nursery”, the emotional meaning of the child to the mother. It is a major achievement for those ghosts to be exposed and disempowered.
The presentation was recorded and will be posted on the MHYFVic website in the near future. We are grateful to Professor Paul for his fine oration.
I was privileged to attend the recent workshop on Mental Health and Wellbeing sponsored by the State Government Department of Health. I was there representing my community-based lobby group, Mental Health for the Young and their Families (MHYFVic). My participation was made easier because of previous work done preparing the Prevention section in Guide to Best Practice on our website mhyfvic.org.
We see mental health and wellbeing as having a structure like an onion. The core is the fundamental necessities of food, shelter and safety. Without these, no other attempts to improve wellbeing can succeed. This is in keeping with the clear scientific evidence that poverty is the strongest negative correlate of mental health.
The surrounding inner layer of the onion is secure attachments to primary caregivers, usually within the family. The next layer is socialisation within a supportive community or, broadly speaking, “culture”. Other layers provide education to reach potential, opportunities to contribute to society and to be recognized for it, “self-actualisation”. The outer protective skin is to guard against toxic influences like stigma, bullying, trauma and adverse environmental impacts.
The workshop was centred around the lived experience of indigenous communities as a focus for thinking about what could be done to promote wellbeing. This choice was presumably because indigenous Australians have suffered catastrophic disruptions in every level of the wellbeing “onion” and are a sufficiently identifiable group to serve as a model for what we should do to improve not only their wellbeing but everyone else’s as well. It was a successful inspirational decision.
Presentations by indigenous speakers on the opening panel understandably referred to the dispossession of their land, the trauma of the stolen generation and the ongoing structural biases of shorter life expectancy and higher rates of incarceration. However, there was more emphasis on ways of moving forward. Truth telling, greater self-determination and moves towards a treaty were the important issues highlighted. There was clear recognition that these are complex issues for which there is no quick fix. Much ongoing work is being done by the Treaty Commission and development of the First People’s Assembly. There are difficult decisions to be made about how spokespersons can be elected for the “Voice”.
A hugely important theme for all participants was the healing power of culture. The most vivid exemplar of this was connection to country. All the speakers identified themselves as people from their respective “countries” and of their respectfulness towards location on other peoples’ countries. There was considerable joy in sharing their kinship connections across the different countries. It reminded me of the aphorism that in Western cultures land belongs to people but in aboriginal cultures the people belong to the land.
The healing power of culture was shown in many ways, particularly in how it comforted indigenous people in situations of adversity. In Western societies nationalism is also a strong, although different, influencer. It does not seem to have comparable supportive power except, perhaps, under extreme pressure as in the Ukraine. More often, it seems, nationalism has an adverse effect on antisocial behaviour. Whether cultural attachment to the land equates with nationalism is something that possibly needs proper anthropological study.
This awareness of cultural differences also bears upon the issue of stigma. Stigma is a rejection by the dominant in-group of a feared out-group. This may, for example, be race, religion, politics, colour, disability, appearance or mental disorder. To counteract stigma we need to study what is feared. What anxiety has to be overcome to enable the feared group to be included within the in-group?
Similarly, study is needed into the changes in community cohesion in various societies. Traditional extended family living, such as in Greek, Italian and Chinese cultures, has been largely supplanted in contemporary Western cultures by nuclear family living arrangements, often geographically dispersed. Our model, emphasising strengthening family, social and cultural attachments, suggests that we have a lot to learn from the indigenous cultural example.
One example cited in the discussion was how hospitals pay attention to religious affiliation by facilitating visits of clergy, but do not facilitate visits by elders promoting connection to country.
A cartwheel diagram representing strengthening indigenous identity is actually a specific application of principles applicable to every person. It says that the individual needs to be:
These connections are all influenced by Social determinants, Historical determinants and Political determinants. Sadly, the workshop did not address the central core of our “onion”, but did do an excellent job of addressing the surrounding layers. Our plan for improving mental health and wellbeing must include methods of helping everyone achieve the above connections.
Dr Allan Mawdsley
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Working with children who are experiencing or engaging in bullying.
After much thought our website has been significantly revised to give casual visitors immediate information about what we do and what we stand for, whilst at the same time allowing members to go straight to specific sections such as Projects or Newsletters or Events, without having to navigate past reams of information.
Now that the main revision has been implemented we are working on tasks of development of Projects to give us the evidence base for our advocacy. There are quite a few items under development at the present time which are not yet reflected in the website but over the next few months we expect to see a burgeoning of activity.
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