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<v Jeff Goodfellow>I have two poems on youth issues. Don't call me lead. Don't call me lead.</v>

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Dad just don't call me lad. Got my hair on my bowls, dad. Then you've got,

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or had I made in years old, man. And I'll sinker. I'll swim.

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Just uncle me, lad, dad. My name is James or just Jim.

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And now that I vote, dad, my party is green. Get away with those flags. Dad,

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red and blue are both mean you can roll up your sleeves,

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dad and slip on your tie. You can wrap my guilt trips. That'll sit in your eye.

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Y'all grow some plants, dad, but I'm keeping it cool for, it's not a plantation.

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I'm not such a fool. I just can't find a job. Dad. Year 12 was a waste.

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Two friends who just died, dad too much of a taste. Yeah, I get that doll.

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Dad don't do much good, but don't call me lad. Dad I'd work.

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If I could now mellowing out, man. It's I'm grind is just wild.

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So don't call me lad. Dad. I'm no longer a child. So don't call me lad.

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Dad. I'm no longer a child.

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<v 1>[Inaudible].</v>

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<v Jeff Goodfellow>If a tougher Robbie rubber gloves, these hidden.</v>

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So the plastic bag of glue and couldn't find it. Then once he slipped on,

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on strike, sorry, lock up hard and tight. You're right. Then he had to fight,

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but he was struggling

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near the glue is not to go wrote up joints. Five papers, slow,

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choked and cough till he let go.

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But crave distraction then spotted hash on coal red Ash during

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Beckwith teenage dash split up deals to score the cash, but so much worry

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when casual work would come along, he'd pack the cone of his water.

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Bong sneak away, but not for long young red-eyed Robbie,

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slightly safer guitar wrote songs and lyrics and the bar wanted peace.

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Just like he star.

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Can you imagine then made his fingers.

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Strum a tune worked at arm each afternoon and three months was not too soon,

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but he could move it. The joints and bongs, not enough at age 18,

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all life seems tough. And when the going got too rough, he dropped the tablet.

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First trip was good. The speed was right. It barreled him through day and night.

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Set him up without a fight, but lift him reeling.

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Now five years further down the track,

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poor Robbie stretched down on his back on a script,

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scrolled out by a local quack. He's body's cold.

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He won't be back. Thank you.

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<v 2>Wow. Please give it up for Jeff Goodfellow.</v>

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What a fitting way to start this session. Thank you.

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Being here on Sunday morning.

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And Jeff is part of the peppering of poets that has been happening right across

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the festival, the Adelaide festival of ideas.

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And you can find his book in the festival of ideas, bookshop,

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it's called waltzing with Jack dancer,

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a slow dance with cancer published by Whitefield press.

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It features his daughter, grace as well,

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and it's about his survival from throat cancer. And on that note,

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let's give it up again.

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[inaudible] And it's full of really beautiful evocative imagery as well.

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So take a look at his book images by Randy Larkin,

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welcome to sick, screwed up or just lazy.

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And as you reach into your bags and pockets, can you pop your phones on silent?

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I'd be really grateful for that. And also if you're a Twitter freak,

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the hashtag is a F O I a F O I.

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It's a way to continue the conversation parallel to the festival and we'd

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love your participation there.

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My name is Natasha I'm from ABC radio national, our host,

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our program called all in the mind,

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I'm a science and health and culture sort of journalist.

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And from the title of our session today,

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you know that our speaker doesn't hold back. His intellectual punctures.

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The theme for the festival this year is planning for uncertainty

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and perhaps one of the greatest and most uncertain things is that

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trajectory from birth into adulthood. And if you're a parent,

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you know about that, you know about that anxiety, I imagine,

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but life is uncertain. And in the last few years,

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we've certainly seen that mental health,

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particularly the mental health of our young people has been put front and center

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in the public conversation, not the least because of psychiatry,

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Patrick McGarry's role as Australian of the year. Last year,

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there was the getup campaign,

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which very loudly mobilized around the issue in the lead up to the last federal

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election.

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But for some though the mental health needs of our young people are still not

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being responded to adequately for others were responding in the wrong

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way. And Jon Jureidini wants to take us, I think,

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back to basics because how we talk about how we think about the minds of

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young people today is causing him considerable concern.

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And he has some expertise.

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He's a child psychiatrist at the women and children's hospital and professor in

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the disciplines of psychiatry and pediatrics at the university of Adelaide.

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So he has a long career working with young people on some of their

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anxieties, distresses, and the chaos of that time of their life.

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He also trained in philosophy.

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So he brings a deeper framework to this conversation.

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He's a spokesperson for the organization or network called healthy skepticism

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who take aim at misleading pharmaceutical drug promotion inside and outside of

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the medical profession. He's also chair of siblings, Australia,

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and organization advocating for individuals with ill and disabled siblings and

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to illustrate he's a man of many hats and causes.

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He's also chair of the Australian Palestinian partnerships for education and

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health. So he's a great polymath.

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And can we please give him a warm welcome this morning?

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[inaudible].

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<v Jon Jureidini>Thank you. As a part of the getup campaign that Natasha has told you about.</v>

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Earlier this year,

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we were told that 750,000 young Australians are locked out

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of mental health care that they desperately need.

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That means that five young people in every classroom are

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desperately sick and that's something that I have healthy skepticism about.

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I have no doubt that there are many young people who are troubled and suffering

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and that this might be quite dangerous for them.

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They might be using alcohol in a dangerous way.

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They might be experiencing significant physical impairments, fatigue,

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distress, and so on, and they might be very unhappy,

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but none of that means that they're sick.

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Distress demands,

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explanation and sickness is unexplained a tree for the suffering

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of young people.

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And the archetype, when we think about sickness,

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what comes to mind for most of us,

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when we're thinking about somebody being sick are the cases like heart

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attacks or cancer or whatever where there's some,

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something very obvious and overt that goes wrong with the body that may

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or may not have a treatment when it does the treatments often quite dramatic in

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its impact on the person's wellbeing.

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That kind of archetype does have it play habits place within psychiatry,

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or it did have syphilis field psychiatric hospitals

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a hundred years ago by the identification of the spiral Cade and its

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treatment. We eliminated a whole range of psychiatric illness.

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And there's a huge amount of energy in psychiatry. I think,

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which hopes that one day we'll be able to replicate the syphilis story

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somewhere else in psychiatry. But we haven't yet.

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And I don't think the prospects are particularly promising.

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So most of what we call sickness is not really like heart attacks

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or cancer or syphilis.

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And I want to spend a little bit of time talking about why we think of ourselves

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as sick. What, what contributes to that?

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The first thing is that there's a repertoire of symptoms available to us.

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On average,

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each of you will have had 30 odd symptoms in the last week or not

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personally, I've had several this morning

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whether they are physical symptoms like headaches or upset stomachs or

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psychological symptoms like axed or despondency,

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they tend to come and go throughout the week and we give them more or less

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attention, according to our circumstances

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at the same time we have feelings, emotional feelings,

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sadness, anger, and fear and so on.

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And each of those has a bodily manifestation.

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So we're experiencing churning,

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stomach sweatiness fatigue,

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whatever it is that might be a somatic manifestation of our

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ordinary emotional feelings. And then there's,

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I think if this is a particularly modern thing the idea that everything we

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experience in our body is medical in the domain of doctors. So that,

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I mean shyness would be a recent example of something that has

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a very intense medic experience associated with us.

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I don't think anybody ever really thought I was any kind of illness or disease,

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but increasingly over the last decade or so has been

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co-opted into, into disease structure.

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Now all of those symptoms and experiences that come and go tend to have a fairly

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transitory effect unless we're in some kind of altered

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state of arousal.

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And that might be something that's brought on by tiredness or by emotional

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distress or by intoxication. And in those circumstances,

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those little feelings that we hardly notice in our body might become a focus

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for our attention and the pre our preoccupation with the may lead to their

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persistence.

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And then there's a range of social forces that have an impact on how we

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interpret those bodily experiences and,

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and experiences in our, in our minds and in our machines.

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So I'm not going to have time to go into a range of the,

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of the broad social first forces that shape our investment in

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newness,

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but just to talk a little bit about some of the new diseases that we doctors

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have made available for you throughout the lifespan starting

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from gastroesophageal reflux disease in infants

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through attention deficit disorder in children irritable

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bowel syndrome, chronic fatigue syndrome, all of these conditions,

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which when defined very rigorously might not include

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terribly many people,

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but pretty much available for anybody who wants to join the club.

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If you take them a little bit more loosely and I'd probably want to

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add to that list depression,

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as we understand it today now in English the term

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depression was applied to the very

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severe disturbance that very few people had that resulted in

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hospitalization and a great deal of disability. And, you know, 50,

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a hundred years ago, that was what depression looked like.

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It was something that was really talked about except amongst people who were

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hospitalized had very high suicide rates and very high levels of

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dysfunction associated with it.

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But what we talk about when we label something,

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depression today is quite different from that.

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And but the difference is kind of hidden and we have to go to other

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cultures to see that spelled out more clearly.

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And in Japanese culture,

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the term that was used for that severe form of depression was something that

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didn't lend itself to be used to describe the much

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lower level feelings of,

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of distress and suffering that we use the label for analysis ADI,

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and the effect of that was quite dramatic.

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Antidepressants didn't take off in Japan.

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And it wasn't until somebody somewhere probably in marketing came up

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with the notion that apparently translates roughly to cold of the soul.

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And this term was something that Japanese society could

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embrace in much the way it,

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same way that as society embraces the concept of depression as something that

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everybody can have and that we mustn't be ashamed of,

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and that there are good treatments for,

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and that life can be made better for you all acknowledge our depression and

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and traded appropriately.

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Another social force that I think is really important in shaping the

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epidemic of,

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of mental illness is our own intolerance of

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uncomfortable feelings.

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Our intolerance of suffering our intolerance of ordinary unpleasant

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feelings. And, you know,

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actually only takes you two weeks to get a diagnosis of depression.

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You don't have to feel bad for very long to get that diagnosis.

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And there's this whole idea of,

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of pursuit of happiness as an end in itself. And in fact,

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I think the thinker in residence who's coming to Adelaide this year

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makes makes it his business to have us all pursue happiness.

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And there's a a wonderful book by Barbara.

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I can write called smile or die which talks about the,

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the pressure on people to be happy. And in particular,

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she was somebody who had breast cancer and really got the message that many

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people with cancer get, which is that you know,

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the kind of Lance Armstrong view of it, that if you,

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if you're a good enough person and you're strong enough and you're positive

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enough, you cancer will go away. And if you ha, if it happens to kill you,

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that's because you haven't tried hard enough. And I think I can,

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Reich's work is a, is a wonderful antidote to that kind of thinking,

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but it also taps into this idea that happiness is

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an end in itself, something that we should pursue. And I, I think that's a,

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a real misperception of what it is as an emotional state.

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And happiness is a marker. It's something that,

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that that we experience in certain circumstances in

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life. And it's not something that we pursue for its own side,

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what we should be pursuing is a good life, whatever that is.

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And that's probably the subject of another whole series of seminars, but and,

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and if we pursue a good life and we're successful and lucky in our pursuit of a

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good life, then for large periods of our life will feel happy.

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But part of a good life is also to feel sad and miserable and upset and angry

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and all of those other feelings. And, you know,

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I'm not advocating joy in suffering or any sort of extreme Calvinist approach to

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life.

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00:16:01.100 --> 00:16:05.810
But I am saying that we have to be much more open to and

240
00:16:06.280 --> 00:16:11.000
accepting of uncomfortable and unpleasant feelings and not just in

241
00:16:11.001 --> 00:16:13.100
ourselves, but also in our children.

242
00:16:13.250 --> 00:16:17.960
And most of us have had the experience in parents of getting panicky about our

243
00:16:17.961 --> 00:16:18.351
children,

244
00:16:18.351 --> 00:16:22.010
feeling the slightest bit unhappy and feeling that it's our obligation to make

245
00:16:22.011 --> 00:16:22.940
things right for them.

246
00:16:23.360 --> 00:16:27.080
And maybe that's not the kind of parenting that they always need.

247
00:16:33.250 --> 00:16:35.330
[inaudible]. So with that background in mind,

248
00:16:35.331 --> 00:16:39.080
I want you to imagine a child who's in you know,

249
00:16:39.740 --> 00:16:43.700
I want to go back now to that the idea of us having a range of symptoms that are

250
00:16:43.701 --> 00:16:47.570
available to us from our body's feedback from our bodies all the time,

251
00:16:48.170 --> 00:16:52.230
and that if we're in a state of what you might term disarray,

252
00:16:52.540 --> 00:16:54.050
that is some kind of

253
00:16:55.730 --> 00:17:00.440
intoxication or unhappiness or anxiety or distress

254
00:17:00.800 --> 00:17:04.940
that we're in, we're inclined to become preoccupied with those symptoms,

255
00:17:04.941 --> 00:17:08.690
whether they're coming from our body or coming from our emotions or from our

256
00:17:08.691 --> 00:17:12.320
mind. And if you imagine a child who's in some kind of a predicament,

257
00:17:12.350 --> 00:17:15.140
maybe her parents are fighting a lot,

258
00:17:15.470 --> 00:17:19.040
and she's very uncomfortable about that. And you know,

259
00:17:19.041 --> 00:17:23.030
children have a really limited number of ways in which they can tell us that

260
00:17:23.031 --> 00:17:24.500
things aren't right in their life.

261
00:17:24.500 --> 00:17:27.950
And ideally we'd like this little girl to come to somebody and,

262
00:17:28.220 --> 00:17:31.490
or go to her parents and say, look, I can't be you fighting anymore.

263
00:17:31.670 --> 00:17:34.160
And it makes me sick. And it gives me a tummy tuck when you do it,

264
00:17:34.580 --> 00:17:37.160
and I want you to stop, but most kids can't do that.

265
00:17:37.220 --> 00:17:41.780
And maybe the Tommy act doesn't go away when they do.

266
00:17:43.490 --> 00:17:44.323
But

267
00:17:45.560 --> 00:17:48.500
but let's imagine that that it's a tummy act for this girl.

268
00:17:48.590 --> 00:17:50.850
It might be behavior problems for another child,

269
00:17:50.851 --> 00:17:54.570
or it might be withdrawal and apparent depression for a third child.

270
00:17:56.040 --> 00:18:00.270
And this will go it becomes increasingly

271
00:18:00.330 --> 00:18:04.770
preoccupied with her tummy pain, which is very real and very distressing to her.

272
00:18:05.250 --> 00:18:09.960
And if things go for, if the cards fall in a certain way,

273
00:18:09.961 --> 00:18:13.320
she finds herself in an emergency department or in a doctor's surgery.

274
00:18:13.770 --> 00:18:17.250
And the doctor gets worried about the pain that she has and investigated

275
00:18:17.251 --> 00:18:20.760
extensively. And we've got an illness.

276
00:18:21.000 --> 00:18:24.480
What we have is something it's a series of symptoms,

277
00:18:25.020 --> 00:18:29.820
which would be better thought about as symptoms of a predicament actually

278
00:18:29.821 --> 00:18:32.220
being interpreted as symptoms of a newness.

279
00:18:32.610 --> 00:18:36.540
And it's not until somebody can grasp the meaning of those symptoms

280
00:18:37.680 --> 00:18:41.400
that this is a gut sack that's brought on by mum and dad fighting.

281
00:18:41.850 --> 00:18:45.270
And that doing something about mom and dad fighting is the intervention that's

282
00:18:45.271 --> 00:18:47.550
needed. It's not until that happens,

283
00:18:47.940 --> 00:18:51.600
that we've really explained what's going on for the little girl.

284
00:18:51.601 --> 00:18:54.030
We can put all kinds of labels on her experience,

285
00:18:54.330 --> 00:18:56.550
but they don't constitute explanations.

286
00:19:01.550 --> 00:19:05.120
So I'm suggesting that a lot of mental health,

287
00:19:05.150 --> 00:19:07.700
mental illness is socially determined.

288
00:19:07.701 --> 00:19:11.900
There's nothing very controversial about that. And it's not, of course,

289
00:19:11.930 --> 00:19:15.080
just mental problems that are socially determined.

290
00:19:15.441 --> 00:19:17.930
And it doesn't mean that something's not real if it's not.

291
00:19:17.960 --> 00:19:19.610
So if it's socially determined,

292
00:19:19.970 --> 00:19:24.290
if we tag for example type two diabetes of which there's an epidemic in our

293
00:19:24.291 --> 00:19:28.070
society that's quite clearly socially determined.

294
00:19:28.071 --> 00:19:31.370
It's very much related to obesity,

295
00:19:31.580 --> 00:19:35.870
which in turn is very clearly related to poverty and deprivation and pour you

296
00:19:35.871 --> 00:19:39.870
out of the more likely you are to be a base. So, and,

297
00:19:39.871 --> 00:19:42.080
and those social things are,

298
00:19:42.280 --> 00:19:45.020
are those social factors are things that we should be doing something about,

299
00:19:45.021 --> 00:19:48.140
but that doesn't mean that we don't have to treat diabetes.

300
00:19:49.070 --> 00:19:51.920
When somebody presents with diabetes, we need to trade it.

301
00:19:51.921 --> 00:19:55.340
And you might argue that all of the things I've said about the social

302
00:19:55.341 --> 00:19:58.040
determinants of mental illness amount, to the same thing,

303
00:19:58.340 --> 00:20:01.220
that when somebody presents with some kind of mental illness,

304
00:20:01.250 --> 00:20:03.350
then that needs to be traded on its merits,

305
00:20:03.800 --> 00:20:08.180
independent of whether it's been caused by social factors or not.

306
00:20:09.440 --> 00:20:14.360
But there is a significant difference because diabetes

307
00:20:14.361 --> 00:20:18.650
explains what the person who has diabetes is suffering from

308
00:20:19.690 --> 00:20:21.980
it's, it's quite straightforward

309
00:20:23.900 --> 00:20:28.460
to give an explanation of how the person with diabetes comes to

310
00:20:28.461 --> 00:20:31.040
experience all of the range of symptoms that they have.

311
00:20:32.750 --> 00:20:37.370
Depression on the other hand at bet explains nothing.

312
00:20:37.850 --> 00:20:42.410
And at best it describes now depression as a

313
00:20:42.411 --> 00:20:45.560
description can be a relatively benign label.

314
00:20:45.561 --> 00:20:49.090
If somebody goes to the doctor and the doctor says,

315
00:20:49.120 --> 00:20:53.920
I think what you're experiencing could be described as depression.

316
00:20:53.921 --> 00:20:57.400
And this is a condition that's quite common in our society,

317
00:20:57.401 --> 00:21:00.430
and it tends to last weeks rather than months.

318
00:21:00.431 --> 00:21:02.050
And you've had it for several weeks now,

319
00:21:02.080 --> 00:21:05.650
so you can expect it to go away relatively soon,

320
00:21:05.651 --> 00:21:08.770
but why don't you come back in a couple of weeks and let me know how you're

321
00:21:08.771 --> 00:21:12.910
going with it. That's it might sound like nothing,

322
00:21:12.911 --> 00:21:16.330
but it's actually has a name it's called watchful waiting,

323
00:21:16.331 --> 00:21:20.560
and it's the recommended treatment for mild to moderate depression.

324
00:21:22.420 --> 00:21:27.100
And that's a very relatively benign process because what's

325
00:21:27.101 --> 00:21:31.450
being acknowledged there is that depression is a

326
00:21:31.451 --> 00:21:36.340
description of the person's experience in much the same way that

327
00:21:37.120 --> 00:21:41.710
attention deficit disorder is not a bad description of a pattern

328
00:21:41.740 --> 00:21:45.220
of inattentiveness and overactivity and impulsivity,

329
00:21:45.880 --> 00:21:49.600
but it's when these descriptions masquerade as explanations,

330
00:21:49.960 --> 00:21:53.530
that things become dangerous. And

331
00:21:55.180 --> 00:21:59.620
and the trouble with most of our mental health

332
00:22:00.220 --> 00:22:05.050
labels or categories, is it by an explanatory and

333
00:22:07.150 --> 00:22:09.220
I think that, that the risk of,

334
00:22:09.221 --> 00:22:13.900
of using a non word that they constitute an explanations

335
00:22:15.640 --> 00:22:16.473
and

336
00:22:18.040 --> 00:22:21.160
unexplained nation is different from an error.

337
00:22:21.220 --> 00:22:23.620
It's not that you've got the explanation wrong.

338
00:22:24.580 --> 00:22:27.250
It's also different from uncertainty,

339
00:22:27.251 --> 00:22:31.900
which is the theme of this festival because an

340
00:22:31.960 --> 00:22:34.240
unexplained nation actually to a certain extent,

341
00:22:34.241 --> 00:22:36.490
represents an intolerance of uncertainty,

342
00:22:36.850 --> 00:22:41.520
the need to come up with something, a liable for,

343
00:22:41.521 --> 00:22:45.040
for the experience. And it has,

344
00:22:45.220 --> 00:22:48.250
it has some cousins and explanation, I think,

345
00:22:48.580 --> 00:22:53.470
and perhaps the one of them is the philosopher

346
00:22:54.190 --> 00:22:56.920
Frankfurt wrote an essay some years ago called on.

347
00:22:58.150 --> 00:23:01.290
And and he it's,

348
00:23:01.291 --> 00:23:06.220
it's a really worthwhile little book to read and what he tries to capture

349
00:23:06.221 --> 00:23:10.540
with the notion of and distinguishing it from from

350
00:23:10.570 --> 00:23:14.770
lies is the idea that it's there is inherent in it,

351
00:23:15.100 --> 00:23:17.530
a reckless disregard for the truth.

352
00:23:18.760 --> 00:23:23.710
And I think that that the that the

353
00:23:23.711 --> 00:23:26.980
problem with our psychiatric labels,

354
00:23:27.010 --> 00:23:31.450
our unexplained Satori psychiatric labels is there in authenticity.

355
00:23:32.530 --> 00:23:36.610
And I want to say a little bit more about that, but in a little while,

356
00:23:36.611 --> 00:23:40.570
but to summarize where I'm up to at the moment,

357
00:23:40.571 --> 00:23:44.800
I think sickness is an unexplored nation or an,

358
00:23:45.260 --> 00:23:47.720
a tree for most young people's distress.

359
00:23:48.470 --> 00:23:52.820
So where do we go looking for something that might do better as an explanation?

360
00:23:58.610 --> 00:24:03.500
I have gone to a poem by Philip Larkin,

361
00:24:03.510 --> 00:24:07.340
which is well known and begins. They you up your mom and dad.

362
00:24:08.900 --> 00:24:09.733
And

363
00:24:11.630 --> 00:24:16.520
I prefer the notion of bang fact up to the notion of being

364
00:24:16.521 --> 00:24:21.110
sick as an attempt to explain young people's distress.

365
00:24:23.030 --> 00:24:25.220
I apologize for the use of the crude term,

366
00:24:25.221 --> 00:24:29.780
but it captures in a way that no other term I can find

367
00:24:30.650 --> 00:24:34.430
a difference between two sort of

368
00:24:35.540 --> 00:24:40.130
apparently mutually contradictory processes that are going on the first is the

369
00:24:40.131 --> 00:24:44.660
sense that, that Lakin's talking about. It's not just mum and dad obviously,

370
00:24:44.661 --> 00:24:47.930
but a whole series of life circumstances and, you know,

371
00:24:47.931 --> 00:24:51.590
intoxication and head injuries, and a whole range of things can,

372
00:24:51.620 --> 00:24:52.910
can have the effect.

373
00:24:53.360 --> 00:24:57.200
And this is what's been done to you or been done to the young person.

374
00:24:58.460 --> 00:25:03.050
But the other sense of it is of having fact up of having

375
00:25:04.340 --> 00:25:07.280
done those things, which we ought not to have done and left undone,

376
00:25:07.281 --> 00:25:10.670
those things, which we ought to have done and

377
00:25:13.400 --> 00:25:14.750
getting right.

378
00:25:15.350 --> 00:25:19.910
What's the contribution of those two different senses

379
00:25:20.210 --> 00:25:21.290
of that term,

380
00:25:21.291 --> 00:25:26.060
I think is a big part of the work that we do in making sense

381
00:25:26.061 --> 00:25:29.090
of our suffering and distress and unhappiness.

382
00:25:29.900 --> 00:25:34.760
And you might think that with young people the it's more,

383
00:25:34.790 --> 00:25:39.380
they're going to tend more towards focusing on what's been done to them and not

384
00:25:39.410 --> 00:25:42.680
taking responsibility for their contribution to it.

385
00:25:42.681 --> 00:25:47.300
But if I just re recall an experience that I had on

386
00:25:47.600 --> 00:25:48.141
yesterday,

387
00:25:48.141 --> 00:25:51.320
when I went into the hospital to see a young person who'd been admitted

388
00:25:51.321 --> 00:25:52.700
apparently with depression,

389
00:25:53.240 --> 00:25:57.290
I came from a very abusive background and whose

390
00:25:58.190 --> 00:26:02.960
onset of depression had been brought about by the fact that he'd been a

391
00:26:02.961 --> 00:26:06.110
heavy drug user and abruptly stopped using drugs,

392
00:26:06.111 --> 00:26:10.940
and now was confronted with all of the things that have been hidden by his use

393
00:26:10.941 --> 00:26:11.774
of drugs.

394
00:26:12.080 --> 00:26:16.850
And some of those things related to how much trouble his

395
00:26:16.851 --> 00:26:21.680
parents were in and how frightened and impotent he felt in the

396
00:26:21.681 --> 00:26:25.460
face of that. And, but his

397
00:26:27.050 --> 00:26:31.760
take on what he was going through was that he had filed

398
00:26:32.120 --> 00:26:37.040
that he was being aggressive at home which he was that he

399
00:26:37.041 --> 00:26:39.710
was behaving in a way that was unpleasant for his mother,

400
00:26:39.711 --> 00:26:44.340
which he was but a more sort of

401
00:26:44.341 --> 00:26:48.660
mature understanding of what was happening was to see him as having been screwed

402
00:26:48.661 --> 00:26:50.160
up by his circumstances,

403
00:26:50.161 --> 00:26:55.080
not as was being constantly told to him by police and all the

404
00:26:55.081 --> 00:26:56.340
other people who were involved,

405
00:26:56.610 --> 00:27:00.900
that he had screwed up and was responsible for the distress and unhappiness in

406
00:27:00.901 --> 00:27:01.734
his family.

407
00:27:06.650 --> 00:27:11.540
So one common way that young people screw up is by attacking overdoses.

408
00:27:12.410 --> 00:27:17.240
And and to try to w when I'm teaching about the

409
00:27:17.241 --> 00:27:22.190
importance of explanation in understanding and dealing with

410
00:27:22.220 --> 00:27:23.450
young people's distress,

411
00:27:23.451 --> 00:27:27.980
I use a kind of case example of

412
00:27:28.760 --> 00:27:33.560
a 16 year old go who lives with a mother and younger

413
00:27:33.561 --> 00:27:36.920
brother in what appears to be a happy and functional family.

414
00:27:38.180 --> 00:27:42.200
Who's taken an overdose that's moderate, moderately, severe,

415
00:27:42.470 --> 00:27:43.940
and has ended up in hospital.

416
00:27:44.240 --> 00:27:47.870
And when asked why she took the overdose, she says,

417
00:27:47.871 --> 00:27:50.300
I broke up with my boyfriend. And of course,

418
00:27:50.301 --> 00:27:54.050
that's not an explanation because hundreds of girls have broken up with their

419
00:27:54.051 --> 00:27:57.350
boyfriend every day. And most of them haven't taken a serious overdose.

420
00:27:57.800 --> 00:28:02.510
And so I get the trainees to ask me questions about what they think that,

421
00:28:02.511 --> 00:28:07.340
that might aluminate provide an explanation of why the is

422
00:28:07.820 --> 00:28:08.653
behind in this way.

423
00:28:09.470 --> 00:28:14.270
And the first set of questions that they tend to ask are about

424
00:28:14.271 --> 00:28:16.940
her mood and her depression, and pretty quickly,

425
00:28:16.941 --> 00:28:21.380
it's established that she's matched the criteria for a moderately severe

426
00:28:21.381 --> 00:28:22.214
depression.

427
00:28:23.480 --> 00:28:27.980
And I asked him whether that's an explanation and some of them think that it is,

428
00:28:28.010 --> 00:28:28.843
but most of them,

429
00:28:29.000 --> 00:28:31.880
but that's not really because they know that I'm not going to like it.

430
00:28:31.881 --> 00:28:32.780
If they say I got it is.

431
00:28:35.870 --> 00:28:37.220
And so the next set of questions,

432
00:28:37.221 --> 00:28:39.620
I tend to ask her about the nature of the breakup.

433
00:28:39.621 --> 00:28:42.980
And I make it that the breakups been relatively benign,

434
00:28:42.981 --> 00:28:46.610
that the they've been together for six months. It's been a nice relationship.

435
00:28:46.790 --> 00:28:51.350
He's been kind to her but he doesn't want to be in a serious relationship.

436
00:28:51.650 --> 00:28:53.930
You know, it's all about me. It's not about you kind of thing.

437
00:28:55.040 --> 00:28:59.690
So there's not been anything particularly toxic about that Brian cup,

438
00:28:59.720 --> 00:29:03.890
and that doesn't explain why she's become suicidal. And we,

439
00:29:03.980 --> 00:29:08.780
we plug away for a while and eventually it comes out that

440
00:29:09.380 --> 00:29:12.920
or somebody gets expresses an interest in where dad might be in the process.

441
00:29:13.550 --> 00:29:16.340
And it turns out that the parents divorced when she,

442
00:29:16.370 --> 00:29:17.840
when the goal was two years old,

443
00:29:18.140 --> 00:29:22.310
dad disappeared from the scene and had no contact with her until she was 11 or

444
00:29:22.311 --> 00:29:24.950
12. At which time she, he,

445
00:29:25.040 --> 00:29:28.670
he made tentative attempts to come back into a life and my gradually built a

446
00:29:28.671 --> 00:29:33.350
relationship. And then about the time that she started up with the boyfriend,

447
00:29:33.351 --> 00:29:37.220
he got a transfer into state, again, interrupting their relationship.

448
00:29:38.030 --> 00:29:40.280
And so now we have an explanation don't we,

449
00:29:40.281 --> 00:29:45.280
because we can see that the breakup with the boyfriend, which is troubling,

450
00:29:45.281 --> 00:29:48.460
but a relatively benign process in a young person's life,

451
00:29:48.760 --> 00:29:52.150
resonates with the abandoned and experience that she's had from a father.

452
00:29:52.810 --> 00:29:57.610
And so, whereas on the one hand, if we went down the mental luminous line,

453
00:29:57.611 --> 00:29:59.950
we'd be able to say, well, she's depressed.

454
00:29:59.951 --> 00:30:02.620
And people who are depressed often make suicide attempts,

455
00:30:02.950 --> 00:30:05.050
and we can give her some treatment for her depression,

456
00:30:05.051 --> 00:30:07.870
whether that's drugs or cognitive behavioral therapy or something.

457
00:30:08.110 --> 00:30:11.140
And she might've got better. She might've done really well with that process.

458
00:30:11.860 --> 00:30:13.870
But I think the alternative process,

459
00:30:13.871 --> 00:30:18.100
which is to come up with an explanation for her suicide attempt and for her to

460
00:30:18.101 --> 00:30:21.340
stress that doesn't amount to a medical label,

461
00:30:21.341 --> 00:30:25.210
but amounts to a story about the relationship that she had with a father and

462
00:30:25.211 --> 00:30:28.900
what went wrong with that and how that was recapitulated in a relationship with

463
00:30:28.901 --> 00:30:33.700
a boyfriend has, has potentially has a different set of outcomes.

464
00:30:35.620 --> 00:30:37.540
And you know, the,

465
00:30:37.570 --> 00:30:42.190
the outcome that it had had in this case was that the mother said

466
00:30:42.191 --> 00:30:46.690
something like well, she burst into tears actually and said, I,

467
00:30:46.691 --> 00:30:50.080
now I kind of see it. I always thought, you know, your father was a did.

468
00:30:50.290 --> 00:30:51.940
And it was a good thing that he was out of your life,

469
00:30:51.970 --> 00:30:54.040
but now I can see how difficult that was for you.

470
00:30:54.400 --> 00:30:57.760
And perhaps I shouldn't have said all of those awful things about him and,

471
00:30:58.030 --> 00:30:59.040
you know, the,

472
00:30:59.041 --> 00:31:03.520
the fact that the mother's response to the child's overdoses,

473
00:31:03.580 --> 00:31:08.530
warm and supportive in that way then means that the family had

474
00:31:08.531 --> 00:31:12.460
discharged. You know, maybe there's some psychiatric follow-up organized,

475
00:31:12.461 --> 00:31:17.080
but I'm feeling kind of confident that this

476
00:31:17.081 --> 00:31:21.610
experience has set the young person up for

477
00:31:21.611 --> 00:31:24.790
growth rather than, and you know, that,

478
00:31:24.820 --> 00:31:27.880
that we know that people can grow and develop out of crises.

479
00:31:29.770 --> 00:31:33.700
Now the fact that I use that case for a teaching example

480
00:31:34.660 --> 00:31:35.493
gives it away. It,

481
00:31:35.700 --> 00:31:39.370
doesn't not really because it's not usually as straightforward and as dramatic

482
00:31:39.371 --> 00:31:40.204
as that.

483
00:31:40.990 --> 00:31:45.850
But it is the case that people come to us with a fairly limited repertoire

484
00:31:45.880 --> 00:31:48.250
of themes. Everybody's got a different story,

485
00:31:48.251 --> 00:31:51.400
but the themes are relatively limited and

486
00:31:53.320 --> 00:31:58.030
prominent Adelaide real estate agent once explained to me that the only two

487
00:31:58.031 --> 00:32:00.790
forces that control the world, I fear and grade.

488
00:32:02.230 --> 00:32:05.470
And I think Melanie Klein actually said something quite similar to that.

489
00:32:06.190 --> 00:32:09.490
But if you, if you substitute hunger for, for grade,

490
00:32:09.760 --> 00:32:13.750
I think most of the people who come to see me are generally frightened

491
00:32:13.990 --> 00:32:16.390
frightened of something or hungry for something,

492
00:32:16.391 --> 00:32:19.870
usually relationships of some sort, and they're in pine.

493
00:32:20.200 --> 00:32:23.890
And I have as a product of that, or going along with that,

494
00:32:24.070 --> 00:32:25.630
some level of disarray arousal,

495
00:32:25.660 --> 00:32:30.400
they don't feel emotionally and physically and physiologically as they would

496
00:32:30.401 --> 00:32:32.350
want to. And

497
00:32:34.360 --> 00:32:39.350
so that, that's the kind of,

498
00:32:39.560 --> 00:32:42.550
th those are the kinds of themes that I've got to work with.

499
00:32:42.550 --> 00:32:43.960
I don't have to start from scratch.

500
00:32:43.961 --> 00:32:48.070
I know the kind of territory that I'm likely to encounter,

501
00:32:49.600 --> 00:32:54.310
but if I respond as a lot of conventional psychiatric and

502
00:32:54.311 --> 00:32:58.870
psychological practice does just to the pain and the disc

503
00:32:58.871 --> 00:33:03.130
arousal which is a very understandable response,

504
00:33:03.280 --> 00:33:06.220
cause nobody likes to see somebody in pain and we want to waste suffering.

505
00:33:06.880 --> 00:33:08.350
But if I respond just to that

506
00:33:10.060 --> 00:33:14.980
then I might be offering analgesia at the expense of

507
00:33:15.130 --> 00:33:19.530
understanding. And whereas the,

508
00:33:19.690 --> 00:33:23.380
the project that I'm advocating might in many cases,

509
00:33:23.410 --> 00:33:26.950
prolong the pine that people are experiencing.

510
00:33:27.880 --> 00:33:32.770
But it might be with the added benefit,

511
00:33:33.280 --> 00:33:37.600
oh, of immunizing people against further difficulties and distress

512
00:33:39.010 --> 00:33:39.843
later in life.

513
00:33:40.540 --> 00:33:45.070
And actually now there's increasing concern about the

514
00:33:45.071 --> 00:33:49.120
role of psychiatric drugs in injustice,

515
00:33:49.630 --> 00:33:53.950
why there's very little doubt that many psychiatric drugs whether they're

516
00:33:53.960 --> 00:33:57.250
prescribed ones or ones that you buy in the pub we're on the street

517
00:33:59.420 --> 00:34:02.050
microwave pine in the short term, and do a good job of that.

518
00:34:02.200 --> 00:34:05.980
And I enhanced functioning in the short term and they do a good job of that.

519
00:34:06.220 --> 00:34:10.450
And many of them have few side effects for many of us who take them,

520
00:34:11.380 --> 00:34:14.920
but there is increasing concern that that might not be the outcome in the longer

521
00:34:14.921 --> 00:34:19.750
term that one of the reasons why there's

522
00:34:19.751 --> 00:34:23.980
more depression around and more recurrence of depression might be that we're

523
00:34:23.981 --> 00:34:27.040
treating it earlier and more frequently with antidepressants,

524
00:34:27.041 --> 00:34:31.450
which while I may reduce and shorten that episode of depression may

525
00:34:31.451 --> 00:34:35.110
predispose us to further episodes of depression.

526
00:34:36.430 --> 00:34:40.810
Now that's by no means proven it's something to worry about rather than

527
00:34:41.590 --> 00:34:46.240
something to necessarily act on, but it does anyway fit,

528
00:34:46.241 --> 00:34:49.350
even if it's not a a physiological effect,

529
00:34:49.420 --> 00:34:54.100
it does fit with the idea that avoiding pine

530
00:34:54.940 --> 00:34:57.370
might not be the best long-term strategy.

531
00:34:57.371 --> 00:35:01.180
It might be a better short-term than long-term strategy.

532
00:35:05.050 --> 00:35:05.883
So

533
00:35:08.980 --> 00:35:10.930
this might make some people puke, but

534
00:35:13.460 --> 00:35:16.280
what I think the psychiatric enterprise is about,

535
00:35:16.730 --> 00:35:21.080
and the psychological enterprise is about providing a

536
00:35:21.081 --> 00:35:21.800
safe,

537
00:35:21.800 --> 00:35:26.510
validating environment in which our patients

538
00:35:26.540 --> 00:35:31.190
can with our help come to some kind of authentic account

539
00:35:31.580 --> 00:35:33.530
of where they are and how they got there.

540
00:35:35.540 --> 00:35:40.470
Now it's not the, that just any story we'll do when I,

541
00:35:40.530 --> 00:35:45.360
when we set out to develop a narrative with our patients about who

542
00:35:45.361 --> 00:35:47.130
they are and how they got there.

543
00:35:49.980 --> 00:35:52.370
It's, it's it's got, we,

544
00:35:52.371 --> 00:35:55.290
we have to strive towards an authentic story.

545
00:35:57.270 --> 00:35:59.460
And what is an authentic story? Well,

546
00:35:59.461 --> 00:36:01.920
that's something that perhaps our novelist,

547
00:36:02.000 --> 00:36:05.490
a better place to judge then than a therapist,

548
00:36:05.520 --> 00:36:07.560
but it's,

549
00:36:07.561 --> 00:36:12.480
it's not very different from the scientific process where we develop a

550
00:36:12.481 --> 00:36:16.710
hypothesis and we test it and we improve it and we enhance it,

551
00:36:16.770 --> 00:36:21.450
and we're always trying to make better sense of the circumstances.

552
00:36:21.450 --> 00:36:23.670
And the,

553
00:36:23.790 --> 00:36:28.170
the narrative task is to bring that all together into a coherent,

554
00:36:28.171 --> 00:36:30.570
cohesive and meaningful story.

555
00:36:32.550 --> 00:36:36.000
And that I think

556
00:36:37.500 --> 00:36:42.450
is something that we must always be treating with the same kind of skepticism

557
00:36:42.900 --> 00:36:45.780
that I advocated at the beginning of my talk,

558
00:36:45.781 --> 00:36:49.680
we should direct towards drug treatments and conventional psychiatric

559
00:36:49.681 --> 00:36:50.371
assessments.

560
00:36:50.371 --> 00:36:55.260
That the story that I come up with with my patient needs to

561
00:36:55.261 --> 00:37:00.060
be always interrogated and re-examined to see whether it's not just

562
00:37:00.061 --> 00:37:03.120
something that suits me and them to avoid some kind of conflict,

563
00:37:03.121 --> 00:37:06.930
but it actually the best and most authentic story that can be

564
00:37:07.560 --> 00:37:09.750
developed for that person at that time.

565
00:37:11.550 --> 00:37:16.200
So my conclusion is that what helps

566
00:37:16.201 --> 00:37:21.180
us survive in an uncertain environment when things

567
00:37:21.181 --> 00:37:26.160
don't go well for us is not so much good drugs good

568
00:37:26.970 --> 00:37:29.280
diagnosis, but good stories. Thank you.

569
00:37:42.760 --> 00:37:43.120
<v 1>[Inaudible].</v>

570
00:37:43.120 --> 00:37:46.930
<v 2>Fantastic presentation. Aren't the kids who get John as a psychiatrist,</v>

571
00:37:46.931 --> 00:37:49.960
lucky beings. I think that you take that care

572
00:37:53.290 --> 00:37:53.770
[inaudible],

573
00:37:53.770 --> 00:37:57.250
But you take that care and time to unravel the complexities of a story.

574
00:37:57.700 --> 00:37:58.900
We have microphones.

575
00:37:58.901 --> 00:38:03.880
I really want to optimize the time to get as many of you who would like to add

576
00:38:03.881 --> 00:38:07.810
comment or ask a question involved here. We have microphone there.

577
00:38:07.811 --> 00:38:10.120
And I think we have one up the top. Is that right?

578
00:38:10.330 --> 00:38:14.320
Can someone just let me know that? I think that's right. So feel free to,

579
00:38:14.500 --> 00:38:17.110
I'm just going to cut straight to questions. I think why don't we do that?

580
00:38:17.170 --> 00:38:19.990
I mean, I've got zillions, but you'll have just as many zillions,

581
00:38:20.470 --> 00:38:24.040
if you could keep them fairly brief and concise and put a question mark on the

582
00:38:24.041 --> 00:38:28.060
end, that'd be great. And if a few of you queue up,

583
00:38:28.870 --> 00:38:30.730
what I might do is do them in batches of two,

584
00:38:30.731 --> 00:38:34.930
so we can get as many comments and input as possible. So please, thank you.

585
00:38:35.350 --> 00:38:39.370
Hello. I do have a question. It as I was listening to your talk, John,

586
00:38:39.371 --> 00:38:43.180
I was thinking a lot about learned optimism and optimistic kids,

587
00:38:43.181 --> 00:38:47.680
which of course is the work of our incoming thinker in residence in Adelaide.

588
00:38:48.160 --> 00:38:52.270
And my question is I think I heard you mentioned the term

589
00:38:52.330 --> 00:38:56.980
immunization, immunizing kids against depression, and thinking about,

590
00:38:57.370 --> 00:38:57.611
you know,

591
00:38:57.611 --> 00:39:01.690
it's not just the stories that these kids have that they bring with them,

592
00:39:01.691 --> 00:39:03.400
but also the skills that they have,

593
00:39:04.000 --> 00:39:08.500
which shapes and determines their responses to these

594
00:39:08.501 --> 00:39:12.370
stories. And so my question is, you know, is there a lot of

595
00:39:14.260 --> 00:39:18.070
complimentary nature of what you've discussed this morning and also concepts

596
00:39:18.071 --> 00:39:22.930
such as learned optimism? Thank you. Go for it.

597
00:39:28.510 --> 00:39:30.820
<v Jon Jureidini>I'm sure there's some, I mean, I'm sure that,</v>

598
00:39:31.030 --> 00:39:34.690
to some extent it's talking about the same thing in different ways,

599
00:39:34.720 --> 00:39:37.120
but I think that there's an important difference.

600
00:39:39.760 --> 00:39:42.910
Because I think that that learned optimism as an, again,

601
00:39:42.911 --> 00:39:45.130
as an end in itself is missing the point.

602
00:39:46.630 --> 00:39:51.160
What I think we need to teach kids is

603
00:39:53.830 --> 00:39:58.210
all of the cognitive and moral skills that they need in order to be able to

604
00:39:58.211 --> 00:40:01.540
manage in an uncertain environment.

605
00:40:02.830 --> 00:40:07.570
And the more skills they have and the

606
00:40:07.571 --> 00:40:11.470
more positive qualities they have in the more positive experiences they have,

607
00:40:11.860 --> 00:40:14.710
if that happens to be matched by a sympathetic environment,

608
00:40:14.740 --> 00:40:16.210
the more optimistic they'll be.

609
00:40:17.320 --> 00:40:21.700
But to think that somebody who has been abused and neglected

610
00:40:21.760 --> 00:40:26.290
and and has a bad school experience and then

611
00:40:26.620 --> 00:40:30.400
encounters adversity can overcome that through some

612
00:40:31.660 --> 00:40:33.460
through being taught, to be optimistic.

613
00:40:34.270 --> 00:40:39.250
I think misses the point and type has over some very important

614
00:40:39.251 --> 00:40:40.084
cracks.

615
00:40:41.550 --> 00:40:43.470
<v 2>Hm. Thank you.</v>

616
00:40:44.520 --> 00:40:46.830
Could you just clarify my understanding of it?

617
00:40:48.480 --> 00:40:49.660
I interpreted your,

618
00:40:49.661 --> 00:40:53.490
your criticism of traditional psychotherapies is that they're more descriptive

619
00:40:53.520 --> 00:40:55.410
than explanatory, but then,

620
00:40:55.800 --> 00:40:59.880
and the problem is that is that they're using a descriptive technique and then

621
00:41:00.150 --> 00:41:01.650
forming treatments from that.

622
00:41:02.100 --> 00:41:04.710
Whereas your solution seems to be more explanatory,

623
00:41:04.711 --> 00:41:08.250
but you didn't really elaborate on the treatments that you would be able to

624
00:41:08.880 --> 00:41:09.960
implement with.

625
00:41:09.961 --> 00:41:14.040
So you have an explanation that is actually quite psychodynamic dynamic,

626
00:41:14.041 --> 00:41:18.390
I would think coming from childhood and he didn't really elaborate on how you

627
00:41:18.391 --> 00:41:23.310
would use that information to then adequately treat a client.

628
00:41:24.150 --> 00:41:24.983
Good question.

629
00:41:27.960 --> 00:41:32.880
<v Jon Jureidini>Well, any treatment is part of a treatment package and the most</v>

630
00:41:33.650 --> 00:41:38.360
part of that package is all of the non-specific stuff. It's you know,

631
00:41:38.361 --> 00:41:40.400
that shared by good therapists,

632
00:41:40.401 --> 00:41:42.320
whether they are doing cognitive behavioral therapy,

633
00:41:42.321 --> 00:41:45.200
giving drugs or doing psychoanalysis

634
00:41:46.700 --> 00:41:51.650
and that's something to celebrate because we can all bring that into our

635
00:41:51.651 --> 00:41:56.180
work before we get started on what we think is the important bit,

636
00:41:56.210 --> 00:42:00.800
but which evidence shows probably isn't the most important part. For me,

637
00:42:00.801 --> 00:42:04.940
the bit that I try to add to that nonspecific part of it

638
00:42:05.540 --> 00:42:10.160
is I guess, psychodynamically oriented some of the time,

639
00:42:10.161 --> 00:42:12.760
but it might also be. So.

640
00:42:12.760 --> 00:42:16.360
<v 2>For the benefit of the collection collective here,</v>

641
00:42:17.260 --> 00:42:18.640
remind us what psychodynamic is.

642
00:42:19.780 --> 00:42:23.350
<v Jon Jureidini>Well, I guess psychodynamic is about trying to make sense of your current</v>

643
00:42:23.351 --> 00:42:25.060
circumstances by

644
00:42:26.680 --> 00:42:31.150
understanding the forces that have shaped those

645
00:42:31.151 --> 00:42:35.650
circumstances. But, but the,

646
00:42:36.430 --> 00:42:41.080
the actual therapy that I do might be quite behavioral,

647
00:42:41.170 --> 00:42:43.600
it might be setting somebody tasks today.

648
00:42:46.270 --> 00:42:50.920
Fat, I think that two things might happen as a result of me setting somebody a

649
00:42:50.921 --> 00:42:51.754
task.

650
00:42:51.880 --> 00:42:55.240
The first thing is that they might do that task and it might benefit them and

651
00:42:55.241 --> 00:43:00.070
they might feel better and stronger and more a sense of mastery,

652
00:43:00.071 --> 00:43:04.930
and that will enable them to get on with their life in a more effective

653
00:43:04.931 --> 00:43:06.160
and satisfying why.

654
00:43:07.300 --> 00:43:10.870
The second thing second possibility is that might not go as well as that,

655
00:43:10.900 --> 00:43:12.820
in which case I'll come back and tell me about it,

656
00:43:13.240 --> 00:43:17.920
and I will understand better what's causing their difficulties and

657
00:43:17.921 --> 00:43:20.530
together we'll enhance our understanding of that.

658
00:43:20.830 --> 00:43:24.370
And that will generate the next level of intervention,

659
00:43:24.371 --> 00:43:28.630
whether that is mutual sort of development of a story,

660
00:43:28.631 --> 00:43:32.950
or whether it's setting about some behavioral task or whether it's medicating or

661
00:43:32.951 --> 00:43:37.360
doing family therapy or whatever it is that the modality sames,

662
00:43:38.230 --> 00:43:42.010
the best match between what I can do and what might be helpful for the person.

663
00:43:42.880 --> 00:43:44.950
<v 2>So, John, where does your medical heritage, oh,</v>

664
00:43:45.010 --> 00:43:47.230
psychiatrists have a medical degree, your doctors,

665
00:43:47.231 --> 00:43:51.940
and then you tack on the psychiatry bit where does the medical degree fit into

666
00:43:51.941 --> 00:43:52.774
all of this?

667
00:43:53.530 --> 00:43:54.221
<v Jon Jureidini>Well, in the setting,</v>

668
00:43:54.221 --> 00:43:59.080
in which I work with people who are sick and sometimes dying

669
00:43:59.110 --> 00:44:03.580
than being a doctor, I think is an enormous asset in that situation to be

670
00:44:04.930 --> 00:44:09.490
able to sort of respond with equanimity in the face of

671
00:44:09.700 --> 00:44:12.670
horrible situations and that generalizes out of,

672
00:44:13.030 --> 00:44:17.980
I think the direct medical setting into the horrible suffering that some of

673
00:44:17.981 --> 00:44:19.360
the people that I see experience.

674
00:44:19.361 --> 00:44:24.280
So I think having been trained as a doctor has been enormously beneficial to me

675
00:44:24.281 --> 00:44:25.150
in my work.

676
00:44:26.530 --> 00:44:31.350
But in terms of the individual interventions that I use I'm not

677
00:44:31.351 --> 00:44:34.860
sure that apart from the very occasional bit of prescribing,

678
00:44:34.861 --> 00:44:39.480
I'm not sure that any of those things pertain directly to being a doctor.

679
00:44:40.710 --> 00:44:45.540
Except I suppose in the things that I don't do. And I mean,

680
00:44:45.600 --> 00:44:47.160
I'm well placed, I think,

681
00:44:47.550 --> 00:44:51.690
to spot the in

682
00:44:51.840 --> 00:44:56.100
psychiatry because of my conventional medical psychiatric training.

683
00:44:56.101 --> 00:44:57.510
So I think that's an important asset.

684
00:45:00.740 --> 00:45:03.950
<v 2>And he's a psychiatrist in the room. I mean,</v>

685
00:45:05.810 --> 00:45:07.010
it, it flies in the face,

686
00:45:07.050 --> 00:45:11.870
your whole argument flies in the face of the predominant argument and public

687
00:45:11.871 --> 00:45:16.820
health message. Now that that mental illness is a disease.

688
00:45:18.410 --> 00:45:23.060
It does. And we'll come to that, please.

689
00:45:23.061 --> 00:45:24.710
Thank you, Dr. Giardini.

690
00:45:24.711 --> 00:45:28.310
Thank you so much for your inspiring lecture and for exposing the

691
00:45:29.810 --> 00:45:34.700
as a mother of an almost 14 year old girl who has recently written

692
00:45:34.701 --> 00:45:39.080
about the four different ways that she's attempting or thinking about killing

693
00:45:39.081 --> 00:45:39.914
herself.

694
00:45:40.730 --> 00:45:45.650
And who's been diagnosed by a private psychiatrist as

695
00:45:45.651 --> 00:45:48.530
suffering, depression and anxiety,

696
00:45:49.130 --> 00:45:50.930
severe depression and anxiety,

697
00:45:51.740 --> 00:45:55.400
and has also presented at the women's and children's hospital emergency

698
00:45:55.401 --> 00:45:56.030
department.

699
00:45:56.030 --> 00:46:00.650
And seeing the psychiatrist there having waited eight and a half hours to be

700
00:46:00.651 --> 00:46:05.180
admitted and being kept for six hours and told she didn't belong there.

701
00:46:05.450 --> 00:46:09.560
Please tell me, I want to know, I need to know cut the.

702
00:46:10.730 --> 00:46:14.270
I want to know who's going to listen to my child's story.

703
00:46:14.510 --> 00:46:16.640
Who's going to help her work out her story.

704
00:46:17.060 --> 00:46:21.140
I'm a resourceful parent as is my husband. We have financial resources.

705
00:46:21.141 --> 00:46:24.440
We've tried the private and the public system helped me cut the.

706
00:46:24.890 --> 00:46:27.920
I need to know where to go next. Thank you.

707
00:46:31.490 --> 00:46:34.220
Thank you for that question, John.

708
00:46:36.590 --> 00:46:38.780
And it's you know, there's a sensitivity here,

709
00:46:38.781 --> 00:46:42.980
isn't there because you haven't met the daughter, your daughter.

710
00:46:43.640 --> 00:46:45.440
<v Jon Jureidini>And I work at the women's and children's hospital.</v>

711
00:46:48.830 --> 00:46:49.041
Look,

712
00:46:49.041 --> 00:46:53.960
I think you've just got to keep trying until you find the person

713
00:46:53.961 --> 00:46:57.770
who can well,

714
00:46:58.970 --> 00:47:03.260
I, I don't think it's appropriate for me to list places for

715
00:47:03.890 --> 00:47:06.690
consultation. I think it's sorry.

716
00:47:07.550 --> 00:47:10.730
<v 2>Just to generalize this, this is,</v>

717
00:47:11.060 --> 00:47:14.810
this is a story that we hear over and over again from parents who feel

718
00:47:15.080 --> 00:47:19.940
despairing about their children's expression of extreme distress

719
00:47:20.330 --> 00:47:21.020
and, and some,

720
00:47:21.020 --> 00:47:25.130
and there's an incredible amount of fear around suicide and the prospect of

721
00:47:25.131 --> 00:47:29.350
suicide. There's a lot of fear and concern and, and in many families cases,

722
00:47:29.351 --> 00:47:33.310
grief about losing a young one. And so there's a sense of urgency about,

723
00:47:34.270 --> 00:47:38.320
about many of the public health campaigns that we we see about

724
00:47:38.860 --> 00:47:42.610
helping people help their children get help.

725
00:47:43.510 --> 00:47:48.370
So you can understand the desperation that people feel when they found habit

726
00:47:48.460 --> 00:47:53.020
at emergency way meant to put you on the star.

727
00:47:53.050 --> 00:47:56.890
Not at all. I have a great deal of respect for you and your lovely family.

728
00:47:56.891 --> 00:47:59.170
I taught your children primary school,

729
00:48:00.520 --> 00:48:02.800
but indeed when the public system,

730
00:48:02.801 --> 00:48:07.270
the public hospital tunes my child away and refuses to read what she has written

731
00:48:07.271 --> 00:48:10.570
about the dark place that she lives in and the four different ways that she's

732
00:48:10.571 --> 00:48:15.160
going to kill herself, then I feel very disparate. Thank you.

733
00:48:15.730 --> 00:48:17.590
But trying to generalize this,

734
00:48:17.591 --> 00:48:20.290
and I understand thank you for your follow up comment.

735
00:48:22.330 --> 00:48:23.620
There is a sense of urgency,

736
00:48:23.621 --> 00:48:28.270
and I wonder if that's why we've become much more focused on the

737
00:48:28.271 --> 00:48:33.160
medical treatments available and the medical explanations for young

738
00:48:33.161 --> 00:48:37.420
people's suffering, because it seems like a much more

739
00:48:38.680 --> 00:48:43.330
straightforward, less complex path trajectory to give them support.

740
00:48:44.520 --> 00:48:48.030
<v Jon Jureidini>I think that's right. I mean, I think where we are</v>

741
00:48:49.740 --> 00:48:53.550
somewhere between appropriately respectful and inappropriately intimidated by

742
00:48:53.551 --> 00:48:54.384
suicide,

743
00:48:55.770 --> 00:49:00.420
know the number of young people of high school age under 18,

744
00:49:00.780 --> 00:49:05.040
who killed themselves in south Australia each year is less than four.

745
00:49:06.060 --> 00:49:09.810
And while every one of those deaths is a tragedy that

746
00:49:10.950 --> 00:49:15.150
obviously is extremely damaging and distressing for the families involved.

747
00:49:15.510 --> 00:49:16.860
It's not the case that there,

748
00:49:16.861 --> 00:49:19.590
there are young people killing themselves all over the place,

749
00:49:19.620 --> 00:49:24.330
but we often respond to young people's distress as though the

750
00:49:24.331 --> 00:49:28.890
only line of intervention. Well,

751
00:49:29.650 --> 00:49:34.290
our, our approach to intervention needs to be dictated by what's the

752
00:49:34.291 --> 00:49:36.840
safest thing to do from the point of view of suicide.

753
00:49:37.560 --> 00:49:41.520
And in trying to ensure safety from suicide.

754
00:49:41.940 --> 00:49:46.260
I see young people whose freedom is taken away whose family's

755
00:49:46.830 --> 00:49:51.420
capacity is undermined, whose own autonomy is,

756
00:49:51.750 --> 00:49:55.590
is destroyed, freedom being taken away. Well,

757
00:49:55.591 --> 00:49:57.840
if detained to hospital,

758
00:49:57.841 --> 00:50:01.800
because people think that if in a psychiatric ward,

759
00:50:01.830 --> 00:50:03.180
then they're not going to kill themselves,

760
00:50:03.181 --> 00:50:06.120
which is psychiatric wards answer is Onpro,

761
00:50:06.300 --> 00:50:09.780
but probably it's not unreasonable to expect that while you're in the

762
00:50:09.781 --> 00:50:13.110
psychiatric ward, you are a bit safer from suicidal behavior,

763
00:50:13.500 --> 00:50:16.290
but you've got to look beyond that 24, 48,

764
00:50:16.290 --> 00:50:19.680
72 hours of the person's going to be in there and think about what's the overall

765
00:50:19.681 --> 00:50:21.750
impact on that young person's life.

766
00:50:22.140 --> 00:50:27.060
And there are times when my job in the emergency department is

767
00:50:27.200 --> 00:50:30.860
back up the staff to say, this person is suicidal,

768
00:50:30.861 --> 00:50:34.880
but the best thing to do to do for them overall is to send them home with their

769
00:50:34.881 --> 00:50:38.540
family and to accept that there is some risk associated with that,

770
00:50:38.810 --> 00:50:41.060
but that the risks associated with that,

771
00:50:41.061 --> 00:50:45.050
or outweighed by the risks associated with hospitalizing,

772
00:50:45.051 --> 00:50:48.940
the person or whatever, intentionally terrifying for a family though.

773
00:50:49.480 --> 00:50:51.070
And so families aren't who are.

774
00:50:51.070 --> 00:50:53.680
<v 2>Dealing with a very volatile situation.</v>

775
00:50:54.190 --> 00:50:57.130
<v Jon Jureidini>And families should never be made to manage that on their own.</v>

776
00:50:57.131 --> 00:50:59.770
We should always be offering support and,

777
00:51:00.820 --> 00:51:05.500
and services and intensive follow-up, but we mustn't be.

778
00:51:06.040 --> 00:51:08.860
That's why I say we have to be respectful of the risk of suicide,

779
00:51:08.861 --> 00:51:13.360
but we mustn't be intimidated by it because I think we sometimes make bad

780
00:51:13.361 --> 00:51:17.740
decisions because we're scared and we're not prepared to

781
00:51:17.741 --> 00:51:22.390
tolerate the fear and uncertainty that's associated with that. And,

782
00:51:23.260 --> 00:51:25.990
you know, a good psychiatrist,

783
00:51:25.991 --> 00:51:28.810
clinician is somebody who can take the right risks.

784
00:51:29.320 --> 00:51:33.460
And if we're risk averse, I think we do more, more harm than good,

785
00:51:33.610 --> 00:51:37.600
which is not related at all to the case. That was just right. But what you've.

786
00:51:37.600 --> 00:51:40.930
<v 2>Said is that we need to back up and we need to provide support services.</v>

787
00:51:40.931 --> 00:51:43.900
And the concern for many parents is that there just aren't enough support

788
00:51:43.901 --> 00:51:48.070
services. So they, they revert to emergency at times of.

789
00:51:48.070 --> 00:51:49.360
<v Jon Jureidini>Emergency, maybe,</v>

790
00:51:49.361 --> 00:51:53.830
maybe for some people was those resources and those services don't reside best

791
00:51:53.831 --> 00:51:54.970
within the medical system.

792
00:51:55.450 --> 00:52:00.220
Maybe there are other places where that support and resources can, can be found.

793
00:52:00.760 --> 00:52:05.180
And, you know, we know that all of those, I mean,

794
00:52:05.740 --> 00:52:08.710
it's difficult to think about this when you're in the midst of an acute

795
00:52:09.160 --> 00:52:13.990
emergency and it's difficult for anybody to make good decisions in

796
00:52:13.991 --> 00:52:15.310
those circumstances.

797
00:52:15.640 --> 00:52:19.330
But the majority of times when our young people come to us in distress,

798
00:52:19.510 --> 00:52:20.950
it's not actually an emergency.

799
00:52:20.951 --> 00:52:24.130
It's something that needs to be taken seriously and dealt with,

800
00:52:24.160 --> 00:52:25.630
but it's not an emergency.

801
00:52:25.631 --> 00:52:29.110
And there is time to do things in a different way and doing things in a

802
00:52:29.111 --> 00:52:32.800
different way, might range from one end of saying,

803
00:52:32.801 --> 00:52:34.330
I'm just going to sit with this.

804
00:52:34.540 --> 00:52:37.510
I'm going to tolerate the fact that everybody feels really bad and it's

805
00:52:37.511 --> 00:52:38.344
frightening.

806
00:52:38.470 --> 00:52:43.330
And I'm probably not going to get any sleep tonight through to there's somebody

807
00:52:43.331 --> 00:52:47.020
I know in my family or in my community who I think it would be really good for

808
00:52:47.021 --> 00:52:51.850
my son to talk to through to this is something that

809
00:52:52.240 --> 00:52:56.290
exceeds the capacity of my extended family, friends, and resources,

810
00:52:56.291 --> 00:52:57.940
and I need to go for professional help,

811
00:52:58.300 --> 00:53:02.050
but I just think we jumped to there too quickly.

812
00:53:02.230 --> 00:53:05.800
And I absolutely agree that we professional psychologists,

813
00:53:05.801 --> 00:53:09.190
whatever have to do a much better job in this territory. I'm not shy.

814
00:53:09.220 --> 00:53:13.270
I'm not for one minute suggesting we abolish psychiatry.

815
00:53:13.720 --> 00:53:14.830
There are,

816
00:53:15.550 --> 00:53:18.760
the problem is that we can flight to populations.

817
00:53:19.270 --> 00:53:23.890
When people talk about in that quote about people desperately needing a mental

818
00:53:23.891 --> 00:53:25.440
health care that they're locked out of,

819
00:53:25.620 --> 00:53:28.860
there are people who desperately need mental health care that they're locked out

820
00:53:28.861 --> 00:53:29.460
of,

821
00:53:29.460 --> 00:53:34.110
but that's from the one or 2% of the population who have major mental

822
00:53:34.111 --> 00:53:34.944
illnesses.

823
00:53:35.220 --> 00:53:39.660
And I think on average that we psychiatrist and the mental health system do

824
00:53:39.661 --> 00:53:42.210
more good than harm for those people.

825
00:53:42.990 --> 00:53:47.250
But then there's another 20% who were identified in community surveys as having

826
00:53:47.970 --> 00:53:50.610
psychiatric problems or disorders or diagnosis.

827
00:53:50.880 --> 00:53:54.090
And there's not a blind bit of evidence to show that I'm any better at dealing

828
00:53:54.091 --> 00:53:58.710
with those people than a GP or a counselor or somebody else's mature

829
00:53:59.040 --> 00:54:00.960
and thoughtful and helpful.

830
00:54:01.620 --> 00:54:04.710
And so we do need to strengthen mental health services,

831
00:54:04.740 --> 00:54:07.770
but we need to strengthen mental health services for the people who absolutely

832
00:54:07.771 --> 00:54:10.920
need them. Not for the people who think that might help.

833
00:54:12.020 --> 00:54:15.140
<v 2>Lots to talk about there. And we're going to come to you now. Thank you.</v>

834
00:54:16.670 --> 00:54:20.360
Thank you, John. My name's Leslie, and I'm actually a rural GP.

835
00:54:20.361 --> 00:54:22.580
So I've jumped in just at the right moment here.

836
00:54:23.330 --> 00:54:26.930
There's a few things I'd like to see is that, that out of the city,

837
00:54:26.960 --> 00:54:31.580
the resources that the mental health resources often are not available so often

838
00:54:31.640 --> 00:54:34.970
I'm dealing with it on my own, and it may be a suicide. You know,

839
00:54:34.980 --> 00:54:38.330
people threatening suicide. There's a few things that you said,

840
00:54:38.390 --> 00:54:40.640
you talked about watchful waiting,

841
00:54:40.880 --> 00:54:43.460
but I must say I've got to do active watchful waiting.

842
00:54:43.670 --> 00:54:46.190
Cause I have a short time to, sorry it was happening.

843
00:54:46.820 --> 00:54:49.300
There's a few resources that we have available to us.

844
00:54:49.550 --> 00:54:52.820
I have a single sheet that young people can put themselves in the middle of the

845
00:54:52.821 --> 00:54:57.410
universe and they can actually identify any stresses, roundabout them.

846
00:54:57.740 --> 00:55:00.650
And it's on one page and it's very quick and you don't need to ask any

847
00:55:00.651 --> 00:55:03.800
questions. They actually write it out and show you exactly why they are,

848
00:55:03.830 --> 00:55:04.663
where they are.

849
00:55:05.090 --> 00:55:09.830
The other thing that seems to be occurring is boredom and sleep deprivation

850
00:55:10.160 --> 00:55:13.790
are increasingly, sorry, not sleep deprivation,

851
00:55:14.060 --> 00:55:18.950
slip sleep disorders seem to be becoming increasingly identified as

852
00:55:19.190 --> 00:55:20.420
other stressors.

853
00:55:20.780 --> 00:55:23.840
And I wonder if you could comment a little bit on that the hyperstimulation of

854
00:55:23.841 --> 00:55:24.860
our young people today.

855
00:55:26.660 --> 00:55:27.493
<v Jon Jureidini>Yes. I mean, I think the,</v>

856
00:55:27.620 --> 00:55:30.620
the first point you made really illustrates what I was saying before.

857
00:55:30.621 --> 00:55:32.300
You're one of those people that,

858
00:55:32.390 --> 00:55:35.960
that people can come to with their distress and you can help them.

859
00:55:35.961 --> 00:55:38.810
And it's not just the piece of paper that you give them,

860
00:55:38.811 --> 00:55:40.760
it's you providing the safe,

861
00:55:40.761 --> 00:55:45.320
containing environment in which they take the piece of paper and then go away

862
00:55:45.321 --> 00:55:47.030
and do whatever it is that they do with it.

863
00:55:47.390 --> 00:55:51.050
And that can be replicated throughout the system by mature

864
00:55:51.980 --> 00:55:56.930
well-trained professional people who don't need to be psychiatrist and don't

865
00:55:56.931 --> 00:56:01.280
need to be dispensing medication or cognitive behavior therapy or any other

866
00:56:01.281 --> 00:56:06.170
packaged intervention. Your comment about boredom, I think

867
00:56:09.530 --> 00:56:11.360
is, is a really interesting one.

868
00:56:13.010 --> 00:56:17.330
Because I don't think our young people have enough opportunity to be bored.

869
00:56:18.440 --> 00:56:22.820
I think that this is part of the same package as the intolerance of

870
00:56:22.900 --> 00:56:26.830
unpleasant feelings. There's always something available to distract you.

871
00:56:27.280 --> 00:56:32.050
You can always get out your iPhone or play a

872
00:56:32.051 --> 00:56:36.430
computer game or watch television or, and, and the,

873
00:56:36.820 --> 00:56:41.530
the value of being pushed to reflect

874
00:56:43.060 --> 00:56:47.470
that people of my generation grew up with

875
00:56:48.940 --> 00:56:51.100
is no longer so readily available.

876
00:56:51.460 --> 00:56:55.630
And of course there are lots of advantages to that, but I think there are,

877
00:56:55.690 --> 00:56:59.800
there are dangers and disadvantages as well in terms of sleep.

878
00:57:00.070 --> 00:57:04.510
I agree with you, absolutely. That sleep is, is a really important issue.

879
00:57:04.930 --> 00:57:09.670
And often sleep is presented as a symptom of psychiatric disorder,

880
00:57:09.910 --> 00:57:12.900
but it's a very potent, you know,

881
00:57:12.901 --> 00:57:16.480
it's one of those things that disarray sleep disturbance is one of those things

882
00:57:16.750 --> 00:57:21.670
that disc arounds us and gives us a different perception of our bodily

883
00:57:21.700 --> 00:57:26.290
experiences in the way that invites us to present it as an

884
00:57:26.320 --> 00:57:30.640
illness. And you just have to look at sleep deprived, new mothers,

885
00:57:30.641 --> 00:57:34.600
and the ease with which they can attract diagnosis of postnatal, depression,

886
00:57:34.601 --> 00:57:36.550
or postnatal anxiety,

887
00:57:37.090 --> 00:57:42.040
and how that medical condition can be Morag miraculously cured by a few good

888
00:57:42.041 --> 00:57:42.874
nights late.

889
00:57:44.220 --> 00:57:46.590
<v 2>So sleep disordered, rural doctors as well.</v>

890
00:57:46.770 --> 00:57:50.160
Cause we have to go up in the middle of the night too. So we've got,

891
00:57:50.161 --> 00:57:54.810
we've got about two and a half minutes and I'm under strict guidance to finish

892
00:57:54.811 --> 00:57:55.531
this on time.

893
00:57:55.531 --> 00:57:59.580
So what I'm going to do is just get the two of you to ask your questions and

894
00:57:59.581 --> 00:58:03.960
then we'll come to John for final wrap, if that's okay. Thank you. Thanks John.

895
00:58:04.380 --> 00:58:07.890
Half of the population of females, most of whom will need to, well,

896
00:58:08.160 --> 00:58:13.050
we'll have already faced the issue of contraception, huge, massive chemicals,

897
00:58:13.051 --> 00:58:15.840
coursing through their bodies, the easiest option,

898
00:58:15.841 --> 00:58:19.020
or one of the easiest options is the three-year implant like Implanon.

899
00:58:19.530 --> 00:58:22.830
My daughter chose that option. And sometimes, sometime afterwards,

900
00:58:22.831 --> 00:58:26.100
she changed from a bright, bubbly, incredibly competent person,

901
00:58:26.190 --> 00:58:30.630
never anxious bone in her body to sudden onset anxiety,

902
00:58:30.631 --> 00:58:32.490
fear and loss of self-belief.

903
00:58:33.000 --> 00:58:36.780
This decline resulted in her admission to a psychiatric ward where there was no

904
00:58:36.781 --> 00:58:40.380
separation whatsoever between short and long term patients.

905
00:58:40.800 --> 00:58:45.630
She said it cured me and it broke me sometime later.

906
00:58:45.660 --> 00:58:49.980
She tragically suicided. When I asked her doctor,

907
00:58:49.981 --> 00:58:53.370
if there was any history of any connection between psychosis and high

908
00:58:53.371 --> 00:58:56.310
progesterone levels, she said, yes, of course,

909
00:58:56.340 --> 00:58:59.010
that's why Depo-Provera was taken off the market.

910
00:59:00.330 --> 00:59:05.190
What would you advise to your daughter to all the women facing

911
00:59:05.400 --> 00:59:10.230
decades of contraception issues where seemingly the

912
00:59:10.231 --> 00:59:15.060
simplest option is highly chemical, highly potential,

913
00:59:15.240 --> 00:59:19.320
and four other mothers have approached me with similar consequences in

914
00:59:19.321 --> 00:59:22.340
situations. All right. So thank you for, for that.

915
00:59:22.341 --> 00:59:24.620
And I'm sorry about to hear about your daughter.

916
00:59:24.650 --> 00:59:28.700
What we might do is just pause if you don't mind. And we'll just consider that,

917
00:59:29.900 --> 00:59:31.100
that question. Thank you.

918
00:59:33.160 --> 00:59:34.630
<v Jon Jureidini>I mean, I think, I think what you,</v>

919
00:59:34.690 --> 00:59:37.060
apart from the moving nature of your question,

920
00:59:37.061 --> 00:59:41.500
what it illustrates is how bad we doctors are at collecting information about

921
00:59:41.501 --> 00:59:45.850
adverse drug reactions and how bad we are as a community at doing that.

922
00:59:46.780 --> 00:59:51.190
And how important it is that every individual who

923
00:59:51.200 --> 00:59:55.480
has a story like this one is

924
00:59:55.481 --> 01:00:00.460
somehow heard by the system and that information is collected together

925
01:00:00.670 --> 01:00:03.490
because one individual case tows is very little,

926
01:00:03.491 --> 01:00:06.880
but when we collect together these cases we can learn.

927
01:00:06.910 --> 01:00:11.530
And and then we can prevent further disasters from

928
01:00:11.531 --> 01:00:12.820
happening, which.

929
01:00:12.820 --> 01:00:16.480
<v 2>Is the case that often parents are the ones that do that data collection.</v>

930
01:00:16.481 --> 01:00:19.600
If only there was a way to sort of filter that experience.

931
01:00:19.990 --> 01:00:24.460
And in some ways the internet has become a repository for that experience,

932
01:00:24.490 --> 01:00:29.110
but it's not always extracted and collided in a way that science can interpret.

933
01:00:29.111 --> 01:00:32.230
So thank you for that. And a final question. Thank you.

934
01:00:33.880 --> 01:00:37.480
<v 4>Thanks Dr. Jon I'm instructor of medicine</v>

935
01:00:40.450 --> 01:00:41.410
my, this,

936
01:00:41.411 --> 01:00:46.390
my problem will drive for a long drive and sometimes

937
01:00:46.960 --> 01:00:51.340
I've I was thinking about an event that happened

938
01:00:52.030 --> 01:00:54.160
Peter twenties, years back,

939
01:00:54.550 --> 01:00:59.440
and sometimes what I studying my

940
01:00:59.441 --> 01:01:02.140
goal, my mind goes other places

941
01:01:04.270 --> 01:01:05.590
basically thinking of my studies.

942
01:01:05.950 --> 01:01:10.300
So I'm not giving artists proper concentration that I could

943
01:01:11.530 --> 01:01:14.710
10 years, years back. How can you overcome this problem?

944
01:01:15.880 --> 01:01:18.700
<v 2>Did you were having trouble hearing</v>

945
01:01:20.500 --> 01:01:24.550
what we might do because I have to wrap the event? It's just,

946
01:01:24.551 --> 01:01:26.230
it's a quite resonant space as well.

947
01:01:26.231 --> 01:01:29.170
We might just get your questions separately at the end, if that's all right.

948
01:01:29.171 --> 01:01:31.810
Is that okay? Thank you. Sorry about that.

949
01:01:31.811 --> 01:01:36.550
Unless someone did hear and can interpret for me. No, sorry. Hold that thought.

950
01:01:37.540 --> 01:01:40.210
Look, thank you for attending Jon Jureidini.

951
01:01:40.240 --> 01:01:43.360
Thank you for being a guest speaker at this year's festival. Hmm.