Working with Psychiatry, being part of MDT's, History of Mental Health & Practically Managing Risk with Prof Graeme Yorston

Hi, welcome along to the aspiring psychologist podcast. Thank you for listening as ever. And thank you for all of your super kind comments. They're really gratefully received. I'd really love any audio testimonials for the podcast itself or any of the books. Um, just so that I know that you are really enjoying, um, what you're listening to, and I'd really love to have any audio testimonials. You might be willing to leave me for the podcast itself for more information, how to do that, go to www.goodthinkingpsychology.co.uk/podcast or the link will be there in the show notes for you too. This is all about collaboration. And another great piece of collaboration is when we work as part of multidisciplinary teams also called MDTs and being part of an MDT and having had MDT experience is something which is really useful, um, for any aspiring psychologist.

01:36:

And it's something that often crops up, um, you know, for assistant psychologist interviews, I learned my a trade, um, in working in multidisciplinary teams when I was at St. Andrew's healthcare. That was the first MDT team that I had been part of. And I was so fortunate that I'd been around such highly skilled and competent caring kind, um, team members and I, and a great deal from them. And they were, you know, kind and patient towards me as I developed my stripes as an aspiring psychologist too. So when I was thinking about reaching out, um, to have a psychiatrist on the podcast, my first thoughts were of, um, a psychiatrist. I had worked as an aspiring psychologist, and so I was brave and I reached out and asked him if he would be willing to come along and record an episode for us. And he was, um, so kind and gracious and said that he would love to.

02:38:

Um, so I am thrilled to, um, introduce you to someone I knew as Dr Um, and since I have moved on to pastures new, he has gone on to become a professor. So you are going to be listening to me, chatting with professor Graeme Yorston, who is a consultant psychiatrist, and today's episode is all about working with MDTs, but also about practical ways, um, to manage risk as well, which is something that psychiatrist are really good at and something that I learned a lot from my time working at St. Andrews, I hope you find this episode really useful. Um, and as ever we welcome any, any comments, um, any questions, um, you can watch this on YouTube, but it is audio only. So you'll just have lots of nice pictures to look at if you are watching on YouTube. Um, if you are listening on apple podcast, please do great and review, um, be gratefully received. So yeah, hope you find this episode useful. So welcome along. I just want to say hi, um, and welcome our guest professor Graham Ys. Um, I'll let you introduce yourself.

03:48: Prof Y:

Hi. Yes, I'm Graeme Yorston I am a forensic neuropsychiatrist, so I've had a kinda wide range of experience in different areas of psychiatry worked in different hospitals around the country in Scotland and England, um, and different levels of security. So from high secure, medium secure, low, secure, and currently working in a rehab setting in Northampton.

Marianne:: 04:11

Wonderful. Thank you so much for joining us. Um, our paths first crossed when I was an assistant psychologist. So when I was looking at how to thicken the dial of psychiatry and psychology, you were the first person I thought of, but I am, I'm a little bit daunted to have you here.

Prof Y:: 04:28

I can't imagine why you'd be daunted. No, I it's. Uh, I think, you know, assistant psychologists do form a really important part of, of MDTs. And, um, I think it is difficult because, uh, you know, particularly if you're a brand new assistant psychologist, you are, you're quite young and everybody else in the team is, uh, usually a bit older and they may have years and years of experience, but there's absolutely nothing to be daunted by. Um, you know, most people in MDTs are very nice and very welcoming.

Marianne:: 05:00

They certainly are. And I always felt very welcome in the teams when I worked with you. So thank you. Um, I do remember you didn't really like my hair accessories at the time, and you had a very valid, very bad point. And you remember, I had some sort of crazy chopstick in my hair and you were like, someone could easily poke you in the eye with those. And I was like, yes, you may,

Prof Y:: 05:22

Gosh, I think the Alzheimer's must be catching out with, I don't actually remember that. Uh, no you've mentioned it. Yeah. I mean, it's the kind of important issue of kind risk awareness that somebody right at the start of their career just may not think about, um, things as like that could be used as a potential weapon in a, in a secure unit. It, where people, um, you know, have a history of, of serious violence.

Marianne:: 05:47

Absolutely. I did give it back to you though. I did say, well, they could whip the pen out of your pocket as well. Dr. And you were like, yeah, but then I'd I'd know they'd done that. You wouldn't know if they're behind you. And I was like, All right, you're totally right. I never wore them again to work by the way,

Prof Y:: 06:05

Very sensible. I did take a pen in and you're absolutely right. So pens are a potential, uh, weapon. And in some of the, the most, uh, in, uh, high school hospitals, uh, you have to leave your pens, uh, in store and you, uh, are only allowed to use those little tiny stubby pens that, um, you know, that kind of, uh, three or four inches long,

Marianne:: 06:31

Like you steal from ASDA. Not ASDA, Argos,

Prof Y:: 06:34

That's the ones

Marianne:: 06:35

We don't, we don't advocate stealing. Um, they, they switched them to pencils. Now, you know,

Prof Y:: 06:41

You can still hurt someone seriously with a pencil. And, you know, uh, particularly if it's a really sharp pencil, you can do a lot of damage. Um, uh, and certainly in one of the hospitals that I worked at, um, it was damaged to, to people's eyes that were the, uh, was the kind of preferred that didn't sound the right, quite the right word. But, um, it was, it was a not uncommon form of attack was to, yes, stab people in the eye with a pen or a pencil.

Marianne:: 07:08

So you were absolutely right to highlight the risk of me wearing chopsticks to work. So thank you for that. But it's an important area to consider isn't it, when we're working with risk, especially not even when we're working in forensic services, you know, any setting we are working in, even someone we think we know really well could potentially be risky.

Prof Y:: 07:27

Yeah. I think this is a really important point to get across. Um, if you're working in a high secure hospital, then you're going to get a lot of induction about risk, and you're gonna be well aware that you are dealing with people could pose a risk to you, but if you're working in an outpatient setting or, um, an acute psychiatry, inpatient setting, then that's the first point of contact that people will have with, uh, with, uh, mental health services. So some of the, those people who do end eventually end up in high secure hospital have started in those services. So they might have all those, uh, kind of aggressive tendencies. They just haven't been, uh, no one knows about them yet. So you have to at least be aware of the potential for aggression and make sure that you are safe, make sure that you can get out of an interview room and not put yourself at, at risk in an anyway.

Marianne:: 08:20

Absolutely. I still remember setting up the room quite carefully. I vividly remember you dragging chairs around to make sure that, um, you know, you were gonna be able to get out of rooms and the staff were, um, if we needed to, and that there were enough escorts or people trained in restraint when we were all trained in restraint, weren't we, but, um, to be able to, you know, have the best possible outcome for any, any situation it's, it's about thinking in advance, isn't it and planning for the worst, preparing for the worst and hoping it won't happen.

Prof Y:: 08:50

Definitely. Yes. And I think, um, so, you know, you've gotta stay in control if you, um, are in a hospital or any kind of healthcare setting of, of, of getting the, the room positioned before the person comes in, always looks a bit strange if you're moving furniture around once they're in, but, you know, get yourself so that you are closest to the door.

Marianne:: 09:12

And I have done that time and time again, all throughout my career. Um, even in children's services, I was always closest to the rule because I've learned from you and from our late colleague Dr. Wood, um, how to, you know, how to ensure that your safety and the patient safety is optimized.

Prof Y:: 09:31

Yeah, these, these are very important lessons. I'm glad that, um, I'm surprised that I was the first person to, to tell you about that, but, but it, it is, those are important lessons, um, that, you know, get into a good habit early in your career and, and always stick with it. It'll just become second nature then you won't think about it.

Marianne:: 09:47

Definitely. And one of my top tips that I learned was, um, pop your diary on your chair when you go and get the the patient. So they can't sit in the, your chair and it's all, it is quite interesting when they try to, or they give you your diary back. And then you have to say, I'm gonna sit there. Um, it's a test of kinda social norms as well.

Prof Y:: 10:07

That sounds an interesting one. I don't think you learn that one from me. Uh, cause I that's a really good, uh, tip actually. I, I, I have to remember that one myself.

Marianne:: 10:16

I can, like I have, I have use useful, um, strategies as well. Um, you also taught me, um, something, um, that you may not know that you taught me, but I use every day. So I often used to do, um, the notes, um, in our ward round sessions, but sometimes you would do it and you were doing something on the computer. I, how did he do that? And you introduced me to using the delete button to delete texts that you've already typed just to hold your finger on it. Whereas before I met you, I was back spacing every, every single thing. So every time I do that, I do think of you.

Prof Y:: 10:51

It happens me teaching someone that it, that sounds highly, but I'll take your word for it.

Marianne:: 10:57

You have to tell your children, they'll be delighted.

Prof Y:: 11:00

Yeah. Back in the day, I, you know, I was, you know, uh, a relatively, um, new adopter of, of information technology, but I'm feel like a dinosaur nowadays, cause it's all moving way too fast for me.

Marianne:: 11:12

Well, you were an influencer when it came to me and a delete key. So thank you. Have you learned, and the thing, um, along your career from a random source that's been really useful or something that you can think of that you think, oh, well that was, that was really important for me. Or I use that all the time and you wouldn't necessarily have known that you were planning to learn it at the time.

Prof Y:: 11:32

Yes. I mean, I think, you know, uh, training as, as a doctor, um, is very much an apprenticeship. So, you know, obviously a lot of your, your facts, your knowledge comes from books and papers and things, but actually how to deal with, with people, how to approach people, how to interact with team members is very much, um, about seeing, you know, being in teams, observing how those teams interact and then going, yeah, I like the way this person is, is, uh, running, you know, his or her team. And that's how I would want to be an equally, um, seeing be people doing it, not so well, uh, and being a little bit too formal or whatever it might be, I'm thinking. Yeah. That doesn't, I don't wanna do it that way.

Marianne:: 12:21

Yeah, absolutely. And how to position yourself in teams can be so important content. Definitely.

: 12:28

Prof Y: I think this is one of the key issues for, for assistant psychologists, um, because you're coming into a team, um, you, you probably don't know people very well. Uh, the team may be very established and have been, you know, going on for years or good relationships. Um, there might be people with years and years of clinical experience, um, and you know, on your first day you go into this war and see the sea of faces that you don't know, how do you fit into that team? What do you do? Do you, uh, do you be a big personality and kind of, you know, introduce yourself at full volume or do you kind of just sit in the, in the back row and be very meek and mild and hardly say a thing. And it's very difficult, I think, think to, to break into that team and to be aware that that's, you know, that that requires effort and work and thinking about, I think is important.

Prof Y:: 13:24

Um, I think the more that you make a conscious effort, uh, to think about, well, how am I gonna do this? Um, you know, the, the better it's likely to be and, and every team's gonna be different. Um, so as I say, you know, I've worked in, in, in a huge number of, uh, different, uh, environments. Um, and the, the extent to which the medical model is dominant, uh, varies between teams and therefore the, the, the extent to psychological input into those teams is going to be absolutely integral or slightly peripheral is, is going to, is also going to, to vary. And I would say, you know, as a new AP, uh, joining a team, listen, observe, uh, relatively quietly, you don't wanna be completely anonymous. Um, but you know, don't go in with a big personality and big opinions, uh, straight off, because like, people are just gonna gonna look at you and think, Hmm, who is this person?

Prof Y:: 14:28

So, you know, observe be helpful to the team. So, um, I always, uh, one of the things I've always done is occasion and you make coffee. So that absolutely everybody in the team is, is, you know, is part of that rotor. No one is above going and making coffee for everybody else. And that, uh, helps, uh, bonding. Um, so again, depending on how the, the kind of MDT meetings are, are organized, um, usually patients will be brought into those, uh, meetings. And I think it works really well if right from the beginning, um, as assistant psychologist, you, you say, oh, you know, would you like me to go and get the patient, uh, rather than on, on, on one person to do that. Um, and also I think understanding what the, the model of, of the psychology input to the team is, is it a totally integrated approach?

Prof Y:: 15:24

Are you there every week for every, uh, MDT meeting or ward round, um, every CPA, are you there or on that ward and it's your ward, or is it more of a, a kind of referral model? Um, and if it's a referral model and you just go into occasional ones, then that's fine to then ask for referrals, but if you're in part of an integrated team, um, then there's nothing worse than, uh, if, if, if somebody in the team is saying it would be really helpful to have a psychology opinion on this to then say, all right, great, thank you. Can you do a referral, please? It is probably the thing that gets me, uh, not irritated. It's not as strong as that, but just frustrated more than more than anything else.

Prof Y:: 16:14

Yeah. I think it's tricky, certainly community services, or I've worked, you kind of can't launch in straight away. Um, but when you are on an inpatient ward and you're all there anyway, you know, it feels like you can come to the floor a little bit more quickly, you know, and, and, um, yeah. Support on the ground, um, with, without additional forms.

Prof Y:: 16:36

That's it? Yeah. I mean, um, so, so being aware of, um, I mean, everybody is time pressured. I'm not saying that that any one professional group is less time pressured than any other, but, um, particularly for, for nurses and doctors, you are constantly reprioritizing and that is something that happens less. I think, in, in psychology, you you're often able you have a luxury, um, of being able to kind of work through a, a kind of a to-do list, um, without constantly having to, to put things on a, uh, I've gotta move this one forward and that one back, um, at least that, that's my impression. Tell me a, if I'm completely wrong on that, but, uh, that, that's my impression. And so, uh, the, the kind of the urgency of things sometimes feels more from people from kind nursing and medical backgrounds and just being aware of that really, I think is important.

Marianne:: 17:29

Yeah. I think even since when I was working alongside you, the expectations unqualified psychologists has gone through the roof. So I didn't hold my own caseload when I was working with you. I was very much to support the psychologist and the psychology functions, but also the MDT. Um, so, you know, I might have done the odd bit of neuropsych here and there. I was doing, um, you know, the, uh, the monitoring and the recording of all of the, um, sexually inappropriate behaviors and the, um, you know, the aggression and reporting on those for the ward rans and things. But I didn't hold my own caseload, whereas actually what's happened in the time since I was, um, an aspiring psychologist is that people are being encouraged to hold their own caseloads as well. And people are working, you know, sometimes even as much as, you know, 80, 90% of their, um, whole time equivalent hours are face to face client times.

Marianne:: 18:21

Um, and that is, that's a big pressure. It's a big change. And the level of even the level of risk and responsibility that, and psychologists are being asked to hold these to, you know, these times I grew into that responsibility. Um, and we are asking a lot more, a lot sooner, I think, um, which gives you less room for a little bit of playfulness and less room to, you know, to make those mistakes and to learn by watching other people do it because there's more pressure on you, you know, like you said, it's nice to come in and grow into a role, but actually a lot of aspiring psychologists are finding that they're kind of being, you know, farmed out and put on the production line and expected to perform almost from day one. And it's, it's very difficult.

Prof Y:: 19:05

Okay. That really does sound like being thrown in at the deep end. And, um, my sense is that, uh, that, that, that is how I learned as a doctor. Uh, and I think most other people, you know, learned that the old kind of maximum see one, do one, teach one, you, you know, you see, uh, some procedure once, uh, you then expected to be able to do it yourself. And then once you've done one, you're expected to teach everybody else how to do it. Um, and I don't think that's right, but it, uh, you certainly, your, your pace of learning, uh, is, is much more than if you, if you, you start off very cautiously and, and spend a lot of time serving you're gonna, and an awful lot more from doing than you are from, uh, watching someone else do. So, I mean, it's interesting that, that you're saying that I, I perhaps hadn't, hadn't realized that that there'd been that change. Um, so it's tough. Um, but it will definitely, you know, help people decide more quickly if, if they're in the right career and, and if it's a it's them,

Marianne:: 20:13

And there is that isn't that there is burnout in our profession as a mental health professional, um, especially during the pandemic, you know, because there wasn't any working from home when there's patients to go in and support who are living and inpatient units. It's very difficult. How's your experience of burnout been in the profession and how to support nurture members of the, a team to try to reduce burnout?

Prof Y:: 20:34

Yeah, I think it is very important. Um, and it has been very, very tough. I mean, my, my current job, as I say, is, is a rehab unit, and we're trying to all the time help people become reintegrated into the community, uh, and to then try and do that when they were literally were not allowed outside the hospital, the kind of, there was the national guidelines and then the local public health guidelines that said, um, actually you are a hospital, therefore your patients aren't allowed out. And that was for months on end. And it was very tough for the patients. Absolutely amazingly well in, in coping with that. Uh, but it was also tough on staff because it meant that they were having to be constantly thinking of new things to do, to, to stop people, getting bored and to try and, uh, you know, uh, recreate some of the things they will be doing if they were in the community.

Prof Y:: 21:29

So we had about 1,000,001 barbecues and things. Um, and, uh, you know, just, just trying to, to keep fresh, um, was, was a real challenge. But I think burnout generally is, is an important issue. Um, it's, it, people do talk about it, uh, often slightly reluctant to talk about their own problems. I've certainly had problems in my own career times where things got very difficult and, uh, you need to be able to talk to someone if, if you feel things building up, if you're not enjoying your work, if you, you know, you kinda wake up in the warning and just think, oh God, I, I can't, I don't want to go in, I can't face it, then that's a problem. And you need to talk about that. And there's usually resolutions to these things. Um, and it may be that, uh, you know, a change of scene, um, a change of team.

Prof Y:: 22:24

Um, and we, uh, I think we've both lucky that we've worked with, with great teams and great team members, but sometimes teams don't function very well. And if you're in one of these, uh, well, that's called a toxic team, they do exist. Um, it's, it's horrible. And sometimes the only thing you can do is, is get outta that as quickly as possible, or at least limit your kind of exposure to the, um, so absolutely talking to your supervisor and being kind of open and honest about things. Um, honesty is always the best policy. You know, people worry, oh, if I kind of worry or sound like I'm moaning, then I might not get a good reference. Um, but it's far better to, to be honest, I think, and, and, and deal with, with problems, you know, that you can get, you can get bullying, you can get inappropriate attention, all sorts of issues can arise. Um, and, and you have to deal with it. I think you have to deal with it.

Marianne:: 23:24

Yeah. I love that idea actually about thinking about maybe it's not me, you know, maybe I'm okay. Maybe the problem is the environment here. Maybe this is a toxic team and people often say to me, well, I'm a bit worried about just having like a six month post or a four month post on my CV and how that looks. And it's like, actually, no, you are the golden goose. You have to look after you. And if this isn't a good fit for you, it's okay to say no, it's okay to say, actually I'm going elsewhere because this is not okay for me. This is not how I, you know, like your values of how to treat people. This is not how I think it's okay to treat people and I'm gonna vote with my feet. You know, I'm gonna use my voice. And if, if saying no is not making a difference, you can be empowered and you can make different choices to go elsewhere.

Prof Y:: 24:09

Yeah, absolutely. Um, and it, it is tricky. I think it's, it's it maybe, well, in some ways it's slightly easier towards the end of your career, or once you've had a few years under your belt, because you've got some experience to draw on at the start of your career. It, it's very hard to say, actually, this just is not working for me. Um, but you know, trust yourself and, um, yeah, follow, follow your instincts is what I would say. And if, if it just feels horrible, when you go to work, that is not normal, it's not right. And you shouldn't put up with it.

Marianne:: 24:46

Absolutely. I'll have to say working with you was not a toxic environment. I really, really enjoyed it Leaving, leaving, um, St. Andrews was really difficult for me from a really supportive, really cohesive, really big and broad team, um, to then going somewhere very much smaller in the NHS where I was the only assistant that was one on qualified forensic psychologist. It couldn't have been, you know, tiny little, um, healthcare building couldn't have been more different. And I really mourned for all of you when I left. Um, you know, still it's important to build different portfolios of your work across the, across your career. But, um, yeah, it's really D hard to replicate what, what you guys were offering in terms of experience and nurturance as well, and really good staff parties.

Prof Y:: 25:34

I'm glad you enjoyed those. Yeah, no, St Andrews, I would say, um, at the time you were there most of the time that I was, there was a fantastic place to work. Uh, and I, I I'm, I, I know that it, you know, it helped, uh, kind of, uh, psychologists go onto bigger and, and better things. Um, it was a great place to do research, um, and, and, and just make those kind of take those first footsteps towards, you know, just ex you know, having a bit more on new CV than just clinical work. Getting involved in research is, is so important. Um, my current, uh, post at St. Matthews healthcare, um, that's one of the things that I've been trying to do is, is get, uh, and encourage, uh, assistant psychologists to, to be involved in very simple little research projects. I mean, it doesn't have to be some massive international, uh, collaboration study, just, you know, uh, case, um, getting that done as a poster, um, or, uh, kind of writing up an audit, all those kind of things just gives you a bit more on your CV. It also, yeah. Helps, helps build relationships. And, um, however, um, and I'm a great believer in, in research and, and, and the, the advantages really that research brings to, to helping you think about, about anything really. Um, obviously if you're writing a paper, it'll be about that particular topic, but it's how you approach any topic, um, in, in your career. It's important, I think.

Marianne:: 27:04

Yeah, absolutely. And, you know, research is so important. It's one of the key aspects for aspiring psychologists and it's, you know, you get separate points on your forms, um, for research. So I did, my first piece of published research was at St. Andrews. And if Dr. Yorston, as you were at the time, you're now professor had asked me to get involved. I’d have just snapped your hand off really!

Prof Y:: 27:26

I can't believe I didn't ask you. I'm always asking, but

Marianne:: 27:29

I’d have I've written it up for you! But this is one of the advantages, you know, you can approach people and say, do you need any help with writing up this research? Cause then you get your name on a paper, which is amazing, amazing, and research is useful for the now, but what this on quite nice to do the next area of conversation is it is really useful to reflect upon as well. And to help us learn about, um, what went before us and what people's previous assumptions were about mental health, and this is really a specialist area of interest for you as well. Do you wanna tell us a little bit about why and what I'm talking about?

Prof Y:: 28:02

Yes. That's a very nice link! Thank you very much. Yeah. Um, so I've always been interested in the history of psychiatry. My, I think my very first paper actually was, uh, was, um, a history of psychiatry paper. And I just always believed that it's important to, to have a full understanding of, of what, uh, I ideas out, uh, mental health problems and diagnoses are. Now we have to understand how those ideas have evolved over time and in for some disorders, it goes right back to ancient Greece and ancient Egypt and, uh, kind of, uh, you know, uh, early China and in India. So the very, very long route to, uh, of the, our mental disorders, others are very modern. And unless you, you have some understanding about that. It's very difficult, I think to, uh, to, to, to fully grasp the, the importance of, uh, you know, of diagnosis and, and, and, and why words are important.

Prof Y:: 29:07

So, um, as I say, I've been doing interest in that all my life. Um, just in the last, uh, six months, I have started a, uh, YouTube channel on the history of mental health. Um, I I'm honest, I probably wouldn't have done it if it hadn't been for the help of my son doing all the, the technical stuff. Um, uh, we've so far put out, uh, I think it's nine, uh, nine videos on, uh, a kinda wide range of history of mental health topics. Um, and they're quite unusual, I think, looking at other, uh, videos out there, um, that would, we're definitely trying to aim for them being quite academic. So there's lots of, uh, kind of references to papers. Um, and, uh, in the, you know, the, kind of the, about section of the videos, I do include a kind academic reference list. So they are, they are, are meant to be understandable to the general public, but, but to be a particular interest, I think to, to people working in mental health,

Marianne:: 30:08

Well, I've watched two of them so far, and honestly I find them really interesting. I think it's really useful to have the theory behind it, but from an expert as well from someone that gets it in the modern context, um, and can portray it in a really relatable way. It's really unique.

Prof Y:: 30:23

Yeah. I, I think they're quite good. Um, and, um, in terms of kind of viewing figures, it, it's, uh, it's interesting that, you know, it's is building, um, and, and also just looking at some of the other videos out there on very similar ranges of topics, some of them, you kind of realise that this person has really just read out a wi a Wikipedia, um, uh, entry, almost word for word. Um, and, and that's okay. And that's often where I start, it's a topic I don't don't know much about that. That's usually my starting point, but I will definitely try and add a bit more context. And what I will always try and do is, is, is talk about how ideas have changed over time. And it is, that's particularly interesting, I think for, for more recent history, so that I've done a couple of videos on, uh, uh, well, one in particular, I think, um, Rosemary Kennedy, uh, the sister of, uh, Kennedy, um, and, uh, she had probably a kind of mild learning disability might even not have been below the kind of, uh, diagnostic threshold if she was formally tested.

Prof Y:: 31:36

But at the time there was huge, uh, stigma associated with that. Some, you know, terrible old fashioned phrases that we, you know, it it's really hard to speak them out loud. Nowadays, feeble mindedness, morons, all this kind of terminology was, was in the medical and psychological literature. There were people writing papers about this, um, and suggesting that, uh, they should be compulsory really sterilised. Um, and in the us, there was 60,000 people were, were, were sterilized because they were thought to be unfit for, for breeding. Um, and obviously that went to these furthest extreme in, in Germany where people with mental illness and mental, uh, and learning disability were killed, were murdered, um, thousands of them, 300,000. So it's important to, to know. So this is, that's just about within living memory, um, 1930s, obviously the war, uh, the war period that there are, you know, fewer and fewer people around that actually remember that, but the, the, um, uh, the kind of, uh, folk memory you like of, of ideas and, uh, and stigma and, uh, you know, lives on.

Prof Y:: 32:56

And, you know, even within my career, I can see changes in, uh, uh, the way mentally ill people have been, uh, uh, regarded the way psychiatry is, you know, viewed by other members of the medical, uh, profession. Um, and if I'm honest, you know, I, I probably would've shared some of those I'd years at medical schools, like who wants to be a psychiatrist, you know, that's, that's terrible, you know, he'd never do anything very much, never cure anyone. Um, would've been the kind of rhetoric, uh, back in the, the 1980s. And, uh, it's been, uh, you know, over the last 30, 40 years, there has been a, a gradual move, a gradual acceptance that, that mental illness, isn't something to be ashamed of. Um, and I think, you know, particularly in maybe in the last 10 years, we we're gradually moving towards this, this greater acceptance, but there's still a long way to go. There's still a lot of those ideas that were still there. Um, you know, in the thirties, forties, fifties, uh, they're still there. They still affect people's thinking,

Marianne:: 34:04

Thank you. That's so interesting. And I love the breadth and the depth of your experience, which I think is what your competition do not have, um, because, you know, you've earned your stripes. Absolutely. And there's something to be said about aspiring psychologists learning that breadth and that depth, as well as isn't it and learning about the importance of the theory.

Prof Y:: 34:24

Absolutely. Yeah. So, um, you know, one of the things that, uh, a lot of assistant psychologists, uh, talk about is, is diagnosis. And obviously that's, that's not necessarily a word that is, is the, the right word for psychology. Um, but it is the way, uh, doctors work, um, and have done, you know, for probably 2000 years. Um, so you've gotta at least understand what, what a diagnosis is. And sometimes I get asked questions, like what is the official diagnosis? Um, and that one always prompts a little bit of discussion. And, uh, from, from, as I say, well, you know, a diagnosis is just an opinion. And even if we say, well, they, they fit the criteria of DSM or ICD 10, those are just our current ideas on, on what the criteria should be. And those have changed over time. They've changed, you know, over the last 50 years and, and certainly over, uh, longer periods of history. So, so a formulation actually is, uh, a more valid individualized way of thinking about a person, but, um, everyone's always interested in diagnosis. Uh, so you have to, to, to fit your, uh, or be willing to at least accommodate, um, a diagnosis in, in formulations.

Prof Y:: 35:48

Yeah. I mean, diagnosis is, are really useful because it, you know, like you said, it gives us an understanding of how best to understand someone's difficulties and what might be robust evidence based treatment plan, but it doesn't define somebody.

Prof Y:: 36:02

No, and, and that's the, that's the big downside obviously, of, of diagnoses. Um, and, uh, it, it puts people into boxes and we're dealing with individuals. And, uh, so whilst I would always, uh, have a diagnosis for a patient, you know, I also make sure that I have a lot of information on their, their early development, their, their personality, um, so that, you know, you're saying, well, this is the diagnosis, but then this is the, the, the individual with this diagnosis and how it has affected them.

Marianne:: 36:36

Yeah. I think it's really useful to discuss with people as well, what their diagnosis means and how they feel about it. So I work a lot with developmental trauma. I, I should say people who have had, um, developmental trauma experiences, um, and a lot of them are diagnosed with borderline personality disorder or emotionally unstable personality disorder. And they really aren't okay with that because they have already been through awful, awful things, you know, pretty much from the point that they were conceived. So then to be labeled with E U P D feels like a real kick in the guts. And so it's, it's a useful conversation to have

Prof Y:: 37:12

It. Absolutely. Yeah. So I always discuss diagnosis with, with, with patients, whether they remember it, whether they want to remember it is, is another thing entirely, but for something as as E U P D is, is such an important diagnosis. Uh, but also on, you know, helping patients understand that, you know, if what that actually says to other people who will be reading that diagnosis and sadly it it's, you know, it's not going, um, You know, people are again think, oh right. Uh, difficult patient. Um, uh, and, and they, and I think it's useful for patients to know that that diagnoses are going to evoke emotional responses in, in, in other healthcare professionals.

Marianne:: 37:58

Definitely. I have loved speaking with you today, and I honestly feel like I could speak to you all day. Um, but we tried to keep these episodes about 30 minutes. So we're gonna need to draw it to a close, have you got any final points or kind of, um, questions or observations that you want to make?

Prof Y:: 38:15

Yeah, no, just really, um, you know, work hard at becoming part of the, the team, as I say, make the coffee go and get the patients. Um,

Marianne:: 38:25

But you will also sometimes make the coffee. Absolutely. You

Prof Y:: 38:27

Not being no, definitely not. So, um, you know, if there's any psychiatrist listening to this, then do not expect people to make coffee for you, be willing to go and, and, and make it. So it's, it's, although usually the, the psychiatrist is the, uh, the unelected leader of the team. There's no real reason for that. There's no management responsibility that says, oh, the doctor has to be in charge, but that's just the way most teams work, not every team, um, but the way most teams work and just being aware of that and working with it, and with the, uh, being aware of the, the, kind of, the history of, of how psychiatry psychology and other professions have developed and all worked together. I

Marianne:: 39:10

Love it. It's been such an interesting episode and been a pleasure to speak to you. How can people, um, get, um, get connected with you? Where, where are you at with your YouTube channel,

Prof Y:: 39:21

YouTube search, putting professor Graeme Yorston or history of mental health that will lead to, to my videos. Um, and that's probably the easiest way to get hold of me. I think my son's even opened a TikTok form for me, but I don't really know what's on that yet. Don't really understand to, I'm not doing any dancing, safe with that one. Um, so that's probably the easiest place to, to see me. Lovely.

Marianne:: 39:41

Let's have a practice. What should people do when they get to your channel?

Prof Y:: 39:46

Uh, oh, yes, they should. Now, what is it called again? Subscribe. Yeah. So subscribe

Marianne:: 39:53

And comment

Prof Y:: 39:54

Like, and comments is I, um, one of the things you, uh, you do have to be aware of though, is you have to develop a thick skin. So it's overwhelmingly positive comments so far, but by gum, there's a few absolutely horrible ones. So you have to learn to kind of, uh, not focus on those, which is, you know, it's important in life to, to be able to do that. So like subscribe and click on the notifications so that when the new ones come out, it goes, you somehow know about it. Miraculously. We're the wonder of technology.

Marianne:: 40:25

I love that. Honestly, do it, do it and do it for this channel as well, because this one's good too. It's been an absolute pleasure to reconnect with you and wishing you all the best with your YouTube channel beyond and book writing and all of those good things are gonna be coming imminently. Thank you so much for joining me

Prof Y:: 40:43

And thank you for inviting me. It's been a pleasure.

Veronika:: 40:46

Hello. My name is Veronica. I live in Edinburgh, and I just graduated with the masters in psychology of mental health. Maria recommended me the clinical psychologist when I was not working on LinkedIn. And I must say, I love it. Um, it is one of a kind, it's like a window into the lives of people on the path of becoming a psychologist. The stories are unique, honest, and filled with the kind of intangible wisdom on the personal storytelling can uncover a common thread in the stories I valued most was to be compassionate, not only with others, but with myself too, also not fixating on becoming a psychologist, but enjoying life grow. And the final results will come as a Maria. Thank you for taking the time to collate all the stories. The book is a true gem, and I think every aspiring psychologist should have a copy on their shell. Thank you.

Marianne:: 42:35

Thank you so much for listening. I really love to connect with you over on socials. LinkedIn is Dr. Marianne Trent YouTube is good thinking psychological services. Facebook is also good thinking psychological services. Twitter is good thinking at PS one, Instagram doctor Marianne, Trent, if TikTok is your jam, I'm also on there to, uh, Dr. Maryanne Trent being a well supported during a psychology application season is so important. We have got one final date planned for, um, a compassionate Q and a, which is going to be taking place on the 9th of May Monday day, the 9th of May at 7:30 PM UK time. And that is free to attend. If you would like to watch any of the replays from the three previous, um, episodes, then you can do so by going along to good thinking psychological services on YouTube. And then if you click the playlist compassionate Q and a, you'll be able to find the three previous, um, episodes there. Hope you'll find it useful. And as ever we'd love any feedback, you've gotten any of our free resources. If you are finding this podcast helpful, please do talk about it on social media, tag me in tag. If friends do all of those good things, and I will look forward to catching up with you on our next episode, which will be along, um, on Mondays at 6:00 AM UK time. Thank you so much.