Sidney Bloch

Sidney Bloch is Professor of Psychiatry at the University of Melbourne. He trained in the Universities of Cape Town, Melbourne and Stanford. His special interests include the psychotherapies, psycho-oncology and psychiatric ethics.

If you were not a psychiatrist, what would you do?

An impresario in the musical world. I have sung in choirs since I was a teenager and continually wonder at the creativity of bringing a chorus, soloists and orchestra together to perform great classics.

What has been the greatest impact of your profession on you personally?

The realisation that everyone has a story to tell. My encounters with people from all walks of life and from diverse cultural backgrounds have taught me that humans are unceasingly fascinating. The uniqueness of each individual with which I become intimately acquainted never ceases to amaze me.

Do you feel stigmatised by your profession?

On the contrary. I feel privileged to have contributed to the well-being of my patients and of many of their families. When they have expressed any concerns about the shame they feel about having a mental illness, I have encouraged them to join forces with me to help change the attitudes of members of society. The vast majority respond positively to the invitation.

What are your interests outside of work?

Music is my passion - choral singing and opera in particular. Also literature, bush-walking (Australia is a great country for this pastime) and Jewish Studies (I belong to two groups in which we read the Old Testament and Rabbinical commentaries).

Who was your most influential trainer, and why?

A tricky one. I have benefited from a few mentors. Irvin Yalom has probably influenced the way I work: he taught me how to engage with individuals who are vulnerable and in need, and, above all, of empathic understanding. I also learned from him that we should respect many pathways to acquiring knowledge about the mind and none trump the others; science, literature and clinical observation are but a few.

Which publication has influenced you most?

Erik Erikson's Childhood and Society. I have always required a framework to facilitate an understanding of how people at different stages of their lives deal with the‘slings and arrows of outrageous fortune’ and how their inner psychological experiences interdigitate with the human environment in which they function. Erikson's classic succeeds admirably in this regard.

What part of your work gives you the most satisfaction?

Getting to know people. Earning patients’ trust sufficiently so that they feel comfortable to share their inner lives is most gratifying. In effect, I am referring to individual psychodynamically oriented psychotherapy, as well as to the form of family therapy I was trained in by John Byng-Hall at the Tavistock and Helm Stierlin, formerly Professor of Psychoanalysis and Family Therapy at Heidelberg University.

What do you least enjoy?

Administration, especially budgets. My older brother trained as an accountant, my younger one as an economist. They are welcome to the world of finance.

What is the most promising opportunity facing the profession?

Achieving genuine complementarity between the sciences and humanities, in juxtaposition with the impressive advances we are making in neurobiology, the social sciences as they pertain to the mentally ill, and the refinement of the psychotherapies. The caveat is that we remain open-minded and flexible.

What is the greatest threat?

Rigid thinking and being derailed by ideology.

What single change would substantially improve quality of care?

Someone would have given us the answer if it were that simple. Alas, there has never been a panacea available to doctors and there are certainly none on the horizon that I can spot. Community psychiatry, a wonderful concept and one many of us would want to see implemented optimally, continues to be elusive.

What conflict of interest do you encounter most often?

Wanting to know how my patients are faring following their ‘graduation’ but knowing full well that they are entitled to complete privacy. I frequently wonder what they are up to and have to restrain myself from trying to satisfy my curiosity.

What is the role of the psychiatrist in countries emerging from conflict?

Participating as decent, ethically minded citizens. I have always been wary of psychiatrists as social visionaries, a concept I first encountered in Raymond Waggoner's 1970 presidential address to the American Psychiatric Association. Since we are much too ignorant about the ‘bigger picture’, we should confine ourselves to humble clinical and research roles. If someone desperately wants to change the world, he or she should stand for public office.

What is the most important advice you could offer to a new trainee?

Get to know your patients as human beings no matter how difficult this may be in some cases and then recruit them explicitly to serve as your foremost teachers and guides.

What are the main ethical problems that psychiatrists will face in the future?

So-called cosmetic psychopharmacology! We are poised to enter an era in which chemical agents that have the potential to enhance various psychological functions will become readily available. What will be our role in prescribing, if any, and how will we determine what agents can be of benefit are ethical questions that cause me to shudder!

Do you think psychiatry is brainless or mindless?

Neither in recent years, I hope! My symbol for psychiatry is a modest piece of furniture - a three-legged stool. The psychiatrist respects the brain and mind (and the interpersonal realm) when sitting comfortably, supported by three legs of equal length and strength: science, the humanities and ethics.

What single area of psychiatric practice is most in need of development?

Genuine community psychiatry: that is, achieving the integration into society of our patients, no matter their diagnosis and level of impairment. Merely keeping someone out of hospital seems an inappropriately limited goal to strive for. Instead, we should devise the means to promote a satisfying quality of life that enables even the most severely ill person to obtain basic satisfactions that we tend to take for granted.

How would you like to be remembered?

I would be acting arrogantly if I were to even think in such terms. The great Jewish medieval physician Maimonides highlighted the attribute of humility as paramount for the doctor. I could not agree more.