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Graeme Simsion and Anne Buist talk The Glass House
60 Plays10 days ago
Join us for a fascinating interview with Anne Buist and Graeme Simsion, authors of the Menzies Mental Health series – i.e. The Glass House and The Oasis. We have a lot to talk about including the complexity of the Australian mental health care system, balancing technical accuracy and storytelling, and telling the lived experience of healthcare professionals while also prioritising the rights of people living with complex mental health conditions.
- Detailed show notes, and other links: linktree.com/novel_feelings
Content notes for this episode: inpatient hospital settings, burnout, involuntary treatment, burnout of medical professionals, stigma and discrimination facing people living with mental ill-health.
Our podcast was recorded on Wurundjeri Land, which is home to both of us in Naarm/Melbourne. Always was, always will be Aboriginal Land.
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Transcript
Introduction and Interview
00:00:03
Speaker
Hello and welcome to Noful Feelings, where two psychologists take a deep dive into your favourite books. I'm Priscilla. And I'm Elise. Today we have an interview with Anne Boist and Graham Simsian, authors of the Menzies Mental Health series, that is The Glass House and The Oasis, which came out earlier this year.
00:00:21
Speaker
We have a lot to talk about, including the complexity of the mental health care system, balancing technical accuracy with storytelling and telling the lived experience of health care professionals, while also prioritizing the rights of people living with complex mental health issues.
Authors' Backgrounds
00:00:35
Speaker
So Graeme Simstian is the internationally bestselling author of The Rosie Project, The Rosie Effect, The Rosie Result and The Best of Adam Sharp. Anne Buys is the author of the psychological thrillers Medea's Curse, Dangerous to Know, This I Would Kill For, and The Long Shadow.
00:00:53
Speaker
She's also the professor of women's mental health at the University of Melbourne. Anne and Graham have co-authored Two Steps Forward and Two Steps Onward and lived together in Melbourne, Australia.
00:01:05
Speaker
We have previously interviewed Graham about the legacy of the Rosie Project and Anne about her book Lock Ward. So please check out those episodes.
Book Overview: Dr. Hannah Wright's Story
00:01:14
Speaker
And a little bit about the books.
00:01:15
Speaker
So trainee psychiatrist Dr. Hannah Wright has only just got her head above water in the acute psychiatric ward at Menzies Hospital when she's thrown in the deep end of the outpatient clinic. Keen to develop her skills in talking therapies, she finds herself up against a boss who's focused on medication and a senior colleague with a score to settle.
00:01:34
Speaker
While Hannah comes under pressure to seek therapy herself to confront a traumatic past, the patient's health issues range from OCD to ice addiction, childhood abuse to the mental impact of aging, and from bad parenting to bad genes.
00:01:47
Speaker
They all come to the Oasis. and The Oasis is out now through Hachette Publishing. Please check out our show notes for disclaimers and content notes.
Series Reception
00:01:57
Speaker
Welcome to the pod again, Graham and Anne. Thank you so much for joining us today and congratulations on the publication of the latest novel and the Men's Seeds Mental Health series, The Oasis.
00:02:08
Speaker
What has the reception been like to the series so far? Well, we started off, of course, with the Glass House and we started off with a bit of a bang because we visited every bookshop in Australia or we certainly tried to get to all 400. We clocked up.
00:02:23
Speaker
So and we did about 110 or more events and then we've done some events with the Oasis as well. And so we've had a chance to talk to a lot of readers. And there's two very distinct groups.
00:02:35
Speaker
One are the health professionals who the psychiatrists in particular get PTSD, in inverted commas, and not literally, ah just by reliving their their training experiences and find it very authentic and It's amazing how many similar things have happened to so many different people and how many different professors are vying for the yeah supposed who Professor Ron Gordon was based on or inspired by.
00:03:01
Speaker
So that that's the the health professionals. um and And likewise, other health professionals, mental health nurses, OTs, physios, psychologists have been very positive about the depiction of their profession, which we don't get very often in a positive way. um if If you look at Nurse Ratched as being the the prototype mental health professional from the one flew over the cuckoo's nest.
00:03:23
Speaker
But the other group, which is much more kind of close to my heart, is the the families and in some cases the lived experience people, but the families of lived experience have given us an enormous amount of positive feedback um about how how it is sort of filled in a blank for them, that their family member was admitted to a mental health hospital.
00:03:44
Speaker
It was probably a fairly um difficult time for everyone. And whilst a lot might have been explained to them, I think it's a bit like, you know, when you have a cancer diagnosis, when you're told your son has schizophrenia for the first time, you don't really hear anything after that for a while.
00:04:00
Speaker
So this allowed them in the the fullness of a later time to really make sense of the experience they'd had. A number of them have said that it gave them understanding of what went on behind the scenes. So they'd had a particular perspective when you're in hospital um of what of what's going on. But this is, of course, the picture that's going on from the clinician point of
Book Promotion Tour
00:04:18
Speaker
view.
00:04:18
Speaker
Now, of course, there's not much point word. It's lovely to write a book that people like and that's authentic, um but not much help if people don't read it. um We've been very happy with the commercial aspect of it. The Glass House was Hachette's bestselling novel on their Australian list last year.
00:04:36
Speaker
um So that that really exceeded ours and theirs expectations. So and number one bestseller on the indie book list. So that, again, was was nice to have. Yeah, that's wonderful. Huge achievements.
00:04:47
Speaker
Yeah, well done. Yeah. Yeah, I think it's it's wonderful insight for me as well as a psychologist who only has worked in the private settings because I know a little bit about what happens in the hospital, but not to that extent.
00:05:00
Speaker
but i I have to ask what inspired the great Australian bookshop trip? but Well, there were two reasons. I think the first, Anne, as explained um implicitly, was to to get the message out to talk about mental health, particularly out in regional and rural areas.
00:05:17
Speaker
So to go on the road with a mental health message. Well, the Rosie Project was kind of part of the wave of changing in attitudes to um autistic community, neurodiversity.
00:05:29
Speaker
And i was kind of was watching this wave and how the autistic community adopted Don Tillman as just kind of such a great sort of avatar for them.
00:05:40
Speaker
And I thought, wouldn't it be great if a book, a fiction book about mental health could do that? Because both of us have written technical books. And whilst his data modelling book did okay, um I think probably 50 people read My Psychiatric Disorders Associated with Childbirth, A Guide to Management, which fiction can access a very different group and a much bigger group potentially. And I thought it would be great if it could just be part of a wave of decreasing stigma.
00:06:03
Speaker
And the other aspect of it was the Rosie project wasn't automatically originally a big success because it didn't fit nicely into any particular category. um And it really relied on being hand sold by bricks and mortar booksellers. So we were out to ask them to do that favor again for us with the glass house because we'd had a lot of pushback from publishers.
00:06:24
Speaker
um yeah mental health is grim people won't want to read about it i mean these are publishers who probably make most of their money selling crime books about murder but ah mental health mental health is too grim and also both books so the glass house and the oasis are episodic they're like a tv season so you have 13 episodes each one of which explores a particular patient um with ongoing clinical characters it's not a common structure for a novel it's a storytelling structure that we think most readers will be familiar with from television but again it was just a little bit unusual and we wanted to get out have those conversations with booksellers and hopefully have them on our side.
Clinical vs Lived Experience Perspectives
00:07:05
Speaker
And what were the logistics like of visiting so many bookstores but how were traveling around how did you organize yourselves were you literally on the road for hundreds of days straight?
00:07:16
Speaker
Well, Anne describes me as the admin guy, so logistics was but was ultimately my baby. um We spent five months on the road. We were out in a ah four-wheel drive with stuff emblazoned on the side about the Great Australian Bookshop Tour.
00:07:30
Speaker
um Yeah, and we we we planned it pretty meticulously. I think in the end, there were about five or six bookshops we didn't make and only... I don't think any of those were our fault. There you go. we They were all on our our tour list, but there was one that opened late one day and we just couldn't make it. There were a couple that didn't want to see us.
00:07:47
Speaker
um But, you know, at the end at the end of the day, um it was it was about five months on the road. um We used some trains and planes as well, but we did about 30,000 kilometres in the car. um Wow.
00:07:57
Speaker
Yeah, that's amazing. Very, very impressive. As someone who gets homesick after being away for maybe two weeks, um I cannot imagine the the feeling of doing that, but huge, huge achievements all around. So well done.
00:08:11
Speaker
um So bringing us back to the Oasis, so the most recent book in the series, in your acknowledgement section for that book, you say that these books have been inspired by the courage of patients and the dedication of mental health workers.
00:08:24
Speaker
There are those that argue that mental health stories should be told only from the perspective of lived experience rather than by clinicians like Hannah Wright, who's the protagonist of the books, of course. um We believe that if we are to improve our attitudes, approaches and systems, we need a better understanding of the needs and experiences of all parties.
00:08:41
Speaker
We hope the OASIS will contribute to that understanding. ah Can you share a little bit more about your thoughts on this topic? Well, we had one publisher who said they would not publish the book because for exactly what you said, mental health stories should be told from the point of view of lived experience, meaning lived experience of somebody who has a mental health issues. um I used to work in in business consulting, and there may well be some parallels here with psychology as well.
00:09:06
Speaker
If you want to move forward, if you want to get angry, you only need one perspective. You know only one person screaming and saying, I was i was cheated, I was ripped off, i was and whatever happened, I've been treated badly. If you want to move forward with the way that you do things and with changes to systems and behaviours, you need to get everybody's point of view on the table and understand where they're coming from, because nobody much gets up in the world, twirls their moustache and says, today I do evil.
00:09:31
Speaker
They get up doing what they think is the right thing. And if we're going to move forward, we're going to have to change their behaviours. And that means that we need to um we need to see them all. And certainly the feedback that that um Anne was talking about before suggests that people with lived experience appreciate seeing the the other side the other side of the story.
00:09:49
Speaker
And Hachette's were very enthusiastic and continue to be very enthusiastic about the series. And their attitude was it was being told from lived experience, but lived experience of a mental health worker.
00:10:01
Speaker
And we just try and balance that with patients' point of view as empathetically and accurately and authentically as possible. And there is a lot out there and there needs to be a lot out there written by lived experience, um people with mental health issues.
00:10:15
Speaker
And memoirs are fabulous, but they they really can't do that balance. Because if you're writing authentically from lived experience to someone who's been um involuntarily put into a psychiatric setting, then you're obviously going to see the nurses, the doctors as other, as the oppressors.
00:10:32
Speaker
and it's going to be very hard. And we've had that feedback from lived experience. Yeah. They were a bit kind of bit shaken by the fact that doctors and nurses are human beings in our book.
00:10:44
Speaker
They have flaws and foibles and they're not perfect. And they sometimes use Google to work out how to do things. And we we really wanted that balance. I there's an argument about power differentials.
00:10:56
Speaker
It would be hard to argue that the clinicians didn't have more power than the patients. But equally, the clinicians are frequently working in a situation where they lack the power that they would like to have because there are administrators and executives and and systems and politicians and so forth sitting above them and and tying their hands.
Storytelling Authenticity
00:11:14
Speaker
And I think that the answer is everybody's got a story here um as long as what we're doing is not stopping others' stories being told. And I think perhaps in the past there was a a tendency to tell stories all from a, particularly, well, not so much stories, but I think to tell um ah nonfiction, to report um particularly disorders, diseases, and mental health issues only from how they were observed from the outside rather than from the inside.
00:11:41
Speaker
but But I think fiction's a different matter.
00:11:44
Speaker
Yeah, absolutely. Some really good points in there. and And you have mentioned some feedback from people with lived experience um throughout the book. And it sounds like the overall reception has been positive, which is fabulous.
00:11:56
Speaker
um But I'm curious about the writing process. And were you able to work with or get consultation from people with different types of types of lived experiences as you went along? Yeah, look, look i think I think from different perspectives here. One is obviously that Anne has been working for 30 odd years with people with lived experience. So in that sense, she's in conversation with people like that all the time.
00:12:18
Speaker
And that was our primary source. But then we ran the manuscript past people with lived experience. I mean, ah particularly... A lovely example, I guess, of a ah beta reader for us was Yen Perkis, who lives with schizophrenia, is autistic and is is non-binary as well. So we have a non-binary character in the book. So it was helpful to get their perspective on a non-binary character and the representation there.
00:12:45
Speaker
um But... You know, Yen i was hugely positive about the book and ended up interviewing us in in Canberra. And we had look we had some so negative stuff on the manuscript. I mean, at one stage, we were looking at calling the book um the fish tank or the fishbowl for the same reason that it ended up being called the glass house because of the the acute psych ward being surrounded by glass.
00:13:06
Speaker
And from the point of view of the of the Medical people, they see themselves as being in a fishbowl or a glass house because the patients can all see in. It's not one-way glass. But equally, the patients can see themselves as being in a fishbowl.
00:13:18
Speaker
And the idea of calling it, even though it's called the vernacular, yeah know the fishbowl in a book, communicated perhaps the idea and that the patients were sort of exotic, strange things to be watched and looked at, observed.
00:13:33
Speaker
So some patients, some people with lived experience liked it. Some people didn't. So we canned it.
Series Development and Future
00:13:39
Speaker
Yeah, and this isn't your first time writing together as co-authors. Has anything changed since the last time you worked together or what's that process like?
00:13:49
Speaker
Well, Graham in particular is a planner and I think working together you have to have a plan. So in the screenwriting kind of fashion, we we have cards and we put them all out, 120, shuffle them around.
00:14:02
Speaker
so these are these are index cards that we write on to scene by scene that to lay out the plan for the book. But in our previous series, Two Steps Forward and Two Steps Onward, we were different characters. So we alternated chapters.
00:14:13
Speaker
He wrote the bitter divorcee man and I wrote the flaky widow. Even though there was a plan, we did write alternating chapters. The Glass House is totally in my sphere. This is my world. So um was once we're done with the plan, I wrote the entire book first draft with the one and a half chapter six.
00:14:33
Speaker
exceptions. And at the beginning of every chapter is a ah vignette in the patient's world. um And in fact, Graham wrote all of those. So obviously, after we discussed it, what but they were going to say.
00:14:45
Speaker
Then, of course, with The Glass House, we had 29 drafts. So there was a lot of editing and changing. um yeah And part of that was also shifting my voice, because I think the first draft was a bit much me of 35 years ago, um and that's not very millennial. So we needed to millennialise, Hannah.
00:15:03
Speaker
um I supervise current registrars, so it was already in the current training program in my head, but some of the attitudes and things that I had are very different to current generations. So we shifted that over the next 29 drafts.
00:15:19
Speaker
And by the time we did the OASIS, we had... We had it down or very close to having it down and it went much more smoothly. And we've just submitted um the third book to our publishers, the the first draft of it.
00:15:33
Speaker
And doing that again, we'd we'd profited from having that those two practice runs. That's amazing. How many books do you plan for in the series? Well, because it follows Hannah, who's a psych trainee, you shift every six months.
00:15:49
Speaker
So we figured there was actually eight in it if we really and wanted to extend that far, though. Some of the we weren't sure how in exciting some of those rotations would be. Psycho-geriatrics might not be as exciting, but forensics, for example, or child and adolescent.
00:16:03
Speaker
and Yeah. So we we doubt if we'll make eight um because it will really depend on the publisher and so how many people keep buying it. But the Oasis is doing quite nicely. and We were talking with our publisher about a a potential fourth and she's keen but needs to run it past the sales team.
00:16:20
Speaker
um so the food By the way, let let me say that's the ultimate answer. She needs to run it past the sales team if the books keep um we will keep writing. Yeah. Wonderful.
00:16:32
Speaker
And we could go beyond eight because, of course, once she graduates, she'll still be a psychiatrist and we could have her off doing things as well. Plenty more stories to be told. yeah Well, that's a message to the listeners then. Go out and buy a copy if you haven't yet.
00:16:46
Speaker
said Absolutely. Oh, and are you able to reveal any details about the third book? um Do you have, ah for example, a title reveal or anything you can share with us at this stage?
00:16:59
Speaker
I'll tell you what, because we were in public with our um with our publisher in the audience the other night up in the Gold Coast couple of nights ago, and we ran the title for the third one past the audience because our publisher's got some doubt. So it may change. So the working title is The Basement.
00:17:15
Speaker
So we've had the The Glass House, The Oasis. The next one's The Basement. Because it's about psychiatrists working in... general hospital or consultation liaison psychiatry. So and of course, their office is down in the basement, which really kind of pretty much represents where the medical profession feels psychiatry is. um the You know, the surgeons are up here, the cancer specialist, the cardiothoracic specialists, particularly the interventionist ones, ah all considered higher up the hierarchy and the poor old CL offices in the basement, which it was taken from real life CL
00:17:52
Speaker
ah where I worked once upon a time was in the basement. I like it. I'm intrigued. I like it too. I'm very intrigued. Interesting flag, and it's fun, um because we're just getting feedback from our beta readers now, and they're saying, oh, my God, this is so much more impactful and than than what I, you know, this is really tearing me to bits, this book, because it's set in a general hospital and we're dealing with physical illnesses.
00:18:20
Speaker
So the the patients are there for some physical reason, as well as whatever mental health issues might need some intervention. um So you've got people with cancer, you've got people who've had ma spinal injuries, you've got people with burns injuries and so forth.
00:18:33
Speaker
And in many ways, that's That reaction is the raison d'etre for our um writing these books, that that mental health isn't seen as being as serious in the
Mental vs Physical Health Perceptions
00:18:44
Speaker
reader's mind. yeah There's still that idea, maybe they could just snap out of it. it's yeah It's not as bad to have anorexia nervosa, which you might die of, major depression, which might also kill you. yeah um schizophrenia, which might um massively change your life in this, you know, to at least the extent that some of the spinal injury might have.
00:19:03
Speaker
But somehow people say, oh, no, it'd be so much worse to have a spinal injury or ah or burns or whatever. When you have, ah say, a spinal injury, you likely will also have depression. And the relationship between the two can make both worse, I suppose, yeah.
00:19:19
Speaker
Yeah, absolutely. Well, there's a moment in that in the third book um in progress at the moment where burns patient you know the psychiatrist is sort cleared out to make room for people who are doing the the physical stuff and she just comments you know the physical stuff always takes priority even though the reason for the burns because there was it's potentially a suicide attempt uh were likely psychological yeah and certainly in and dealing with them going forward the issue is very much likely to be more psychological and physical yeah interesting and what you're saying it certainly strikes me um
00:19:53
Speaker
and My PhD is all about stigma and stigma reduction relating to mental illness. And one of the common ways that people are trying to intervene um to reduce stigma is to try to try to emphasize to people that you know mental illness is an illness and should be seen akin to physical illness in terms of how we take it seriously, how we talk about it.
00:20:14
Speaker
the funding that should be going towards it, this's the space and the time that we're given towards mental ill health um should be equivalent to, but in some scenarios, perhaps preference um ahead of physical illness. So yeah, that's just reminding me of that kind of,
00:20:29
Speaker
those intervention strategies that are happening in the stigma reduction space quite broadly at the moment. yeah talk about We talk about these books being structured like a TV season. yeah And you could just keep naming medical TV dramas or comedies or whatever you like and that have run successfully for a long period of time that deal with physical illness.
00:20:49
Speaker
And there are almost none that deal with mental illness. Almost none. you really You really have to go out there yeah Our agent, when we were um shopping the the yeah the story around for adaptation, um were said couldn't find anything equivalent.
00:21:07
Speaker
I'm not surprised. We're not in the the mainstream media anyway. um Both books have offered a really detailed view into the inner workings of what it looks like on a psychiatric ward and what it looks like in an emergency um setting and all its imperfections.
00:21:23
Speaker
How do you balance the details and the intricacies of clinical practice with storytelling? um And were there any creative liberties that you had to take for the purpose of telling a good story?
00:21:35
Speaker
ah ge It was interesting. and We just had some feedback from a beta reader who said I've made, you know, who was an expert consultation liaison psychiatrist on the third book um with him saying, I'll leave it to you to balance tedious technical correctness, correctness against literary license.
00:21:53
Speaker
our our Our basic rule is we want it to be 100% authentic. And and Anne is actually responsible for that. At the end of the day, if you read something in that book and say that would could not happen or that is not the treatment that anyone would prescribe for this or that is an incorrect portrayal of CBT or whatever it might be, then the buck stops with Anne.
00:22:15
Speaker
um If you are bored reading it, then the buck stops with me. So you've got this this this this what might seem like a a trade-off between drama and drama Stephen Ward- and authenticity, but in fact it's more about going a little bit lighter on some of the technical details and saying that we're not gonna be wrong here, but we're going to skim over some of the things that might have happened um and let those and the technical really can say well that must have happened in the background or whatever.
Balancing Clinical Portrayal with Narrative
00:22:43
Speaker
um What happens in real life is typically dramatic enough that we don't need to enhance it. But that we had one case in the Oasis. It's a case of Valerie, who's our um chronic pain patient.
00:22:55
Speaker
Yeah, chronic pain. And when we ran it past our beta reader and and Valerie takes some action, Valerie basically becomes empowered and takes some action on her own behalf. And we ran it past our beta radio works in that area.
00:23:07
Speaker
And he said, unrealistic, I know these guys and these guys get caught up in the legal system and the court system. They're constantly trying to prove how sick they are. It's a vicious circle thing that makes them worse and so on and so forth.
00:23:19
Speaker
And Anne came back to me with that and said, you have to change the story. And I was a bit invested in the story. So I said, hold on, it can't be everybody. There's got to be exceptions. Well, there might be exceptions from time time. So, OK, let's make her an exception.
00:23:33
Speaker
And we'll have somebody in the book take the position of our beta reader and say, what normally happens is blah and blah and blah. And then Hannah says she's got to deal with an exception. And and the the thing with that is that yeah nobody's going to be misled in that. We get the the lecture about what normally happens and then we say, okay, here here's an outlier. So we serve we serve both masters.
00:23:52
Speaker
But as it turned out... I was reading ah a book by Craig Semple because we were on a panel with him and he's ah it's called The Cop Who Fell to Earth. And he has PTSD and he he talks about leading to that.
00:24:04
Speaker
And he talks about getting caught in the legal system and how he was seeing that he was going to end up dead, that this was just sucking him down. And he made a conscious decision to say, nope, I'm getting out of this. Just like Valerie. Just like Valerie. um And interestingly, of course, the light bulb went on in my head is that the people that I saw in medical panels and that my expert that read it saw are the ones that are stuck in the system. and That's why we're seeing them. And of course, the ones that don't get stuck in the system, we don't see.
00:24:37
Speaker
So that kind of made this feel much more authentic. Yeah, it's interesting when you're in the clinical space, the measuring stick is a bit different, I suppose, than what's actually perhaps happening and in the outside world. yeah Yeah, the the other one was the the very beginning of the Oasis is a vit the vignette about DJ getting out of the chronic locked ward.
00:25:01
Speaker
And when it was originally written that the way she was going to escape, I just said to Graeme, no way, no way is this, you know, someone who's been in hospital for a long period of time, overweight with antipsychotics, no way she's shimming up ropes and rope ladders and things.
00:25:19
Speaker
So we rewrote her um how she actually gets out, still leaving the fun part of it in, but she actually gets out in a way that I think, yep, that could happen. but Yeah.
00:25:29
Speaker
ah So that was, I thought, a good balance. Yeah, that was a great opening to the book. It's very dramatic. And a bit funny. I could certainly see that being the ah season opener of season two of the TV series as well. And you have you have to ask, you say, could this happen?
00:25:48
Speaker
And the answer is, it really actually comes down to our character, Frodo. Could you imagine someone doing that? And look, I think that's within the realms of imagination of what someone might do under those circumstances. So, yeah okay, away we go.
00:26:00
Speaker
And we're not in any way with what he does, misrepresenting a clinical situation or even the security situation that you might have in a um long-term secure environment.
00:26:10
Speaker
We'd love to talk about Hannah and her interests in psychological therapies, despite the fact that she's working in a system that is pretty much medical, ah biologically based, I suppose.
00:26:22
Speaker
Sometimes we found it hard um to read the sections where other characters doubt the validity of our work, especially as psychologists. Just a little bit confronting. that and Can you tell us about the character's training in psychotherapy and its limitations?
00:26:40
Speaker
Look, we're pretty positive about the psychologist. Our son is a psychologist and he's married to a psychologist. And in the glass house, Elena is the the the the golden child psychologist. um I got into so psychiatry because of my love of family therapy. And I think that shows in some of the family therapy scenes that I've put in there.
00:27:00
Speaker
um And my own personal experience, well, book one, the theme really was the battle for the soul of psychiatry. And there's a little bit of battle kind of between psychologists and psychiatrists with that is there's a whole group of psychiatrists who want to go off and just be real doctors and and the biological.
00:27:17
Speaker
And I guess part of the reasons some of the people, the patients we chose in the first book was to show you just can't do that as far as I'm concerned. So postpartum psychosis has fabulous treatments in the biological realm. ECT and antipsychotics and lithium work a treat.
00:27:34
Speaker
They get you better. You've got a really great prognosis. But Those medications or any other antidepressants are not going to treat the fact that you're not bonded to your baby, that your husband doesn't trust you and your mother-in-law hates you and the impact that that's going to have on you.
00:27:48
Speaker
Now, whether that's a psychologist or a psychiatrist, I think ultimately in the outpatient setting, it will be psychology that is dealing with that. But in the acute setting, you can't ignore that.
00:27:59
Speaker
And we certainly have psychologists on our ward that are part of our our team. But what we really wanted to show was the ignorance and both sides of you know what people think and feel.
00:28:11
Speaker
So we've got our Freudian psychiatrist who's very dismissive of the psychologists and it gets even worse in the third book because there's a battle going on between the psychologists as to who reports to who um in in the CL because they both have a very...
00:28:25
Speaker
um important role. Based on real life. Based on real life. And everything we've put in there is pretty authentic. We can go to some place in time where this has
Professional Dynamics in Mental Health
00:28:33
Speaker
happened. and But we also wanted to kind of have a ah place of actually explaining what is happening.
00:28:39
Speaker
In the glass house, um the we we got Elena in her private practice. sort of doing CBT essentially with a ah writer with writer's block.
00:28:49
Speaker
And Hannah's pretty dismissive of that initially because, of course, her world is the the the severe anorexia, the acute inpatient ward where people are being booted out after two weeks. um But we wanted to show that for her to kind of reflect on and think this is the early intervention stuff that we really need.
00:29:07
Speaker
And on our tour, we actually... um Well, one of our opening acts was it ah an author or or who was writing his daughter's manuscript.
00:29:18
Speaker
Marsha Moran. The the book Marsha Moran had written Pomegranate Soup, but she, in the words of her father, lost her life after a battle with writer's block um and he was trying to write the and finish the the manuscript that she struggled over.
00:29:33
Speaker
And so it was kind of really poignant to us to sort of show, you know, life imitating art, but how that early intervention is incredibly important. And we see a little bit more of that in the Oasis, ah except the problems with accessibility. So Taylor is a particularly good example um of the problems with our mental health system.
00:29:55
Speaker
I don't think anyone has- Borderline personality. Yes, it has good treatments for complex PTSD or borderline personality disorder, particularly for those ones that are really struggling, that don't turn up to appointments.
00:30:07
Speaker
And neither a private psychologist or a private psychiatrist is going to be able to hang in with someone, particularly in the early phase of treatment, someone who doesn't keep turning up. You're playing rent.
00:30:18
Speaker
You can't keep you know keeping that hour free for someone who doesn't pay. I have to say, as an outsider here, but someone who's got a systems and business background, um you look at it and you say that yeah there are the sort of battles and in in disputes you would expect to have, given the nature of the system, which will rebate psychologists from lesser number of sessions than it would rebate someone using psychodynamic psychotherapy, you using a Lacanian or Freudian approach, who would therefore be a psychiatrist or whatever.
00:30:46
Speaker
And and you know there's there's absolutely this... artificial divisions that happen here based on um ah the economics of um and the the funding ah of mental health, it seems to me.
00:30:59
Speaker
The other thing standing outside it was absolutely seeing this divide within psychiatry between the biological approaches and the more psychodynamic approaches. It was interesting.
00:31:10
Speaker
We've just come from the Australian Psychiatry Congress up in the Gold Coast, and there was a session on psychodynamic psychotherapies um aimed at young people who were looking at entering that side of things as psychiatrists.
00:31:23
Speaker
huge attendance, apparently very popular, very popular session. So it's not like it, it belongs to the past. um And then you've got the I hear psychiatrists talking about psychologists, I hear psychologists talking about psychiatrists, and there's not always a level of mutual respect that you would like to see. And there are definitely some, know, some some battle lines drawn around that.
00:31:45
Speaker
I've certainly witnessed that myself from yeah from my side as a psychologist in the way that people are talking about psychiatrists, but also, yeah, heard the inverse too. Absolutely. There's a lot of perspective ah shifting that happens between the two.
00:31:59
Speaker
professions, even though the end goal is very similar. And Elena comes in in the book at one point and really berates the psych profession, as it were, says, all you need is this amount of um experience in psychotherapy. You can go and hang hang out a shingle and see somebody for 50 sessions.
00:32:16
Speaker
And yeah she's she's pretty she's pretty coruscating about that. So we do feel that the psychologist's voice is on the page. And so certainly when it comes to training, i mean, and the psychologist has always been an absolutely essential part of my inpatient unit management. It's kind of they've always been there um and always will.
00:32:33
Speaker
But in training wise, psychologists get trained extremely well in CBT, mindfulness, all of the new sort of variations of it now. Psychiatrists, not so much so.
00:32:46
Speaker
They get a little bit in it and a they do one case um and then they do one case of psychotherapy, 40 sessions. That's it. There's a little bit of background theory they do, but really it's it's um you've got to go out and do it extra. I mean, I did extra family therapy training. Hang on, you've got to. You're saying... Sorry, if you're interested to, but you don't have to. No, you can go out um after you're qualified What most would do, though, would be have for some time in the public sector, but then that's still only preparing them for supportive psychotherapy, really, without extra training and supervision.
00:33:24
Speaker
you know Psychiatrists, and probably not psychologists either, are not really psychodynamic psychotherapists um that need extra. I think in the private space, there's not a lot of collaboration.
00:33:36
Speaker
From my experience, anyway, everyone is so busy, it's so hard to try and collaborate. um with the psychiatrist. And so I think that probably feeds into that divide as well.
00:33:46
Speaker
But also don't get me started on the Medicare rebate. ah i and and another topic I'm an educational developmental psychologist. There's that two-tier rebate happening.
00:33:57
Speaker
um So there's that divide as well. yeah And Hannah, is obviously, she's thrown in the the deep end with some of the client or patient work that she starts with as well.
00:34:08
Speaker
might intend to just be doing some light supportive therapy under the supervision of Elena. But before you know it, you know, a patient doesn't necessarily match your expectations a lot of the times too. And she's dealing with quite complicated ah cases despite her training too. So I can see why she, know, that naturally lends itself to some dramatic story beats in the Oasis. Yeah.
00:34:32
Speaker
And look, it's it it wouldn't happen today, but back when I trained, I had a Taylor as my, started in first year psychiatry with Taylor as my psychotherapy patient. And that continued probably a couple of years um with supervision, excellent supervision, learnt more from that patient than any other thing in psychiatry.
00:34:51
Speaker
And she still rings me a couple of times a year um just to let me know how she's going. and she she's She was amazing. That's great. And sometimes learning on the job is the best the best way to learn. I know that from my own experience, um everything, you can have a lot of theory in your university training, but it's only once you're actually doing the work that it's going to consolidate and you're going to understand the complexities and how to actually apply.
00:35:14
Speaker
these things. i might made in every In every book, we have to, in the first few pages, explain the difference between a psychologist and a psychiatrist. And there are readers who say, I don't care. They're all the same thing, virtually.
00:35:28
Speaker
and So so these yeah the these complexities of the interactions and the relative roles, i mean, even as a writer and someone who's been living with a psychiatrist for 40 odd years, it's not always clear to me um how that would land.
00:35:40
Speaker
It's not always pi clear to me and I work in the system. so I would say that patient that I saw as a psychotherapy patient and like I saw her for more than two years, but just not as a psychotherapy patient. was much more supportive.
00:35:52
Speaker
But you know recently when she rang me, she sort of thanked me and um basically put it in in her words, said what the research shows is ah She didn't tell me I had no skills, but I had no skills back then. And she so basically said the reason, you know, i got better with you is because you cared.
00:36:12
Speaker
um And that's what she needed. She had a dreadful background. And a nurse could do that? Well, yeah, well, a trained You know, you need some training and supervision um to be able to to hold it in the and someone holding you to do that. But, yeah, you don't need CBT skills or even you know a lot of experience in psychodynamic psychotherapy with great interpretations to be able to essentially give the component of what a lot of our core work is about actually just caring and and sitting with that patient over a long period of time.
00:36:44
Speaker
Yeah, I think that is that's that that was cited a lot during my course, ah psychology course. 85% of the work is therapeutic alliance. Yeah. Yeah. And on the other side of it, I suppose when you do invest a lot in your work and you work in the mental health space, it can lead to burnout.
00:37:02
Speaker
And mental health and burnout of healthcare care professionals is a recurring topic in the series so far. you think we place unrealistic expectations on healthcare professionals to be perfect?
00:37:14
Speaker
Yeah. Look, I think the the general public and some of the response to this book has been very much that, that they, um like our daughter, um read it and was appalled at how little Hannah knew and that she was Googling things.
00:37:28
Speaker
She then went into the public obstetric system and suffered because she thought registrars knew everything. um So she failed to take that lesson yeah into the next part of her experience. But, you know,
00:37:40
Speaker
I think there is ah this huge disparity in expectations and and reality. Our registrars, think they're actually more stressed now than they were.
00:37:50
Speaker
um The whole system is under an enormous amount of pressure. And the amount of... we We talk about this a bit in the third book. The amount that they have to do each rotation um officially get done and ticked off and cases done, it's it's ah an enormous pressure. And it's at a time when they're finding partners, having children... yeah We got interviewed at one stage but by an interviewer who said, look, i I'm just a
Ethical Dilemmas in Treatment
00:38:14
Speaker
bit shocked here. that Here's Hannah and yeah she's got this all this responsibility and so forth, but she's just broken up from a relationship. She's jumping into another relationship.
00:38:24
Speaker
We said, yeah, she's 27 years old. yeah This is what people do at 27 years old. She's a 27-year-old human being who's trying to do this particular job and yeah not not some sort of stereotype of ah of a perfect medical professional.
00:38:39
Speaker
And I think the other pressure that they have now, which I didn't have, is the length of stay. So I think our length of stay at the Austin was something like 16 days average in the acute ward. It's nine days down in the peninsula.
00:38:51
Speaker
So there's this enormous pressure. And then you have more discharge summaries. We had the option back in you know the bad old days of keeping you as long as you like, just moved wards, had people there for months.
00:39:02
Speaker
Of course, there's huge negatives with that, but it did take um away from some of that pressure that now that they're under. There's definitely pressure coming from multiple angles there too. And um yeah another prominent theme in the OASIS is the rights of people with complex mental health issues versus the responsibility of healthcare professionals.
00:39:21
Speaker
So, for example, through characters like DJ Voices who are dealing with community treatment orders. And this can be quite a controversial topic. What did you keep in mind while writing those subplots that were focusing on dignity of risk?
00:39:35
Speaker
Well, indeed, just that. And that was kind of very much in the head, my head, the dignity of risk. are we At our launch of The Glass House, Heidi Everett, um who ah wrote a book called My Friend Fox about her experience with schizophrenia, and spoke.
00:39:51
Speaker
And she spoke very powerfully about the dignity of risk. And it sort of took my breath away. i don't sign those forms very often in perinatal psychiatry. But over my lifespan, I have many times um because I've worked in other areas and on call, et cetera.
00:40:06
Speaker
And I don't think I will ever sign one of those without thinking that. um in my, and really thinking it through. And it's this really difficult balance about the risk to community or the risk to the patient through non-compliance, et cetera, that do we allow them, you know and should we even be able to say that, allow them to.
00:40:24
Speaker
But ultimately when you're sitting there about to sign that form, this is the sort of question that, you know which is the bigger risk? And i mean, in the best of all possible worlds, there'll be a plan there that they've done when they're well, obviously not for their first episode, but subsequently that you can follow what they want.
00:40:42
Speaker
um But that's not always possible, not always sitting there. And we really wanted that um in DJ's or Heidi's voice or someone like Heidi's voice um coming through DJ.
00:40:54
Speaker
And as you know, the um the outcome in the book for DJ is not 100% happily ever after. And we we don't want to put these things on the page as advocates and gloss over and say, let's give you the happy ending version. Let's see the people who oppose that view are all baddies wearing black hats and you know twirling their moustaches.
00:41:14
Speaker
But rather, let's see the different points of view which are sincerely held and see the sometimes ambiguous views outcomes that come come from it and make your own make your own calls. We want to see the the various possibilities laid out so people can say, do do we have this community treatment order or should we not?
00:41:31
Speaker
um How do we balance it?
Recommended Reads and Farewell
00:41:34
Speaker
And more than anything else, psychiatry and psychology, it's not black and white, um but there is a lot of grey and complexity in in the cases we see.
00:41:44
Speaker
And I'm sure a lot of readers will be, as you flagged, are starting to get more of a window into what that looks like and the difficult decisions that characters like Hannah and her colleagues have to make dayto- day to day and in real life, of course, as well.
00:41:57
Speaker
Yeah. And we only have one more question to go. Do you have any book or author recommendations to share with our listeners? Okay. Well, but but I think if someone's listening, i do these things every every year for the age and that sort of thing. And I think, look, I've i' got books that I like reading and so forth, but why would anybody care what I liked?
00:42:16
Speaker
I think that people are interested in what I might like because they've read the Rosie Project or whatever. And therefore, I frequently recommend books in the autism space and say, well, okay, I'm now familiar with that space.
00:42:26
Speaker
So I guess in the broader mental health space, which is, of course, what we're writing about in in The Glass House The Oasis, I think it's really good to read the lived experience books and compare and contrast them with the fictional representations. I mean, you say, well, this is reality.
00:42:42
Speaker
Did Anne and Graham do it fairly in the fictional treatment? What else could I learn about this? the way, in the autism space, I think John Elder Robeson's book, Look In The Eye, is still a fine book from a female perspective because think the presentations can be quite different, Bob.
00:42:58
Speaker
presentation be quite different across people. Clem Bastow and Australian Late Bloomer. In the space that we've been writing about, Anne talked about Craig Semple's book, The Cop Who Fell to Earth. It's a very fine memoir that will actually make, you really know at the end of it what PTSD and major depression looks like. And it's, you in that, in a very visceral sort of sense, because here's the big cop, here's the story and whoomp, this is where they've ended up.
00:43:25
Speaker
um I'd have to add in Because I'm Not Myself, You See um by Ariane Beetson. She and I were reading our manuscripts at the same time um and puffed each other. But hers is a very fine, beautifully written um memoir about postpartum psychosis.
00:43:41
Speaker
um And she works in the field. She works for COPE. She's actually a psychologist. um So she does ah does a ah fine job of it kind of conveying how terrifying it is, really.
00:43:53
Speaker
And we mentioned Heidi Everett. um So her book, My Friend Fox, Schizophrenia Memoir, very finely written as well. Strongly recommended. Wonderful. We had Ariane on the show last year. So listeners, if you're keen to hear more about Ariane's story, I'm Not Myself, you see, please go and check out that episode as well.
00:44:10
Speaker
I think that wraps us up for today. Yeah. Thank you so much again, Anne and Graeme, for joining us today. It's been such a pleasure. Thank you so much. Thanks, guys. Thank you. Thank you.
00:44:21
Speaker
A huge thank you to Anne and Graham for coming on the pod once again. It's always such a fun conversation. Absolutely. As usual, our detailed show notes are available on novelfeelings.com, including the author's social media handles and their book recommendations.
00:44:36
Speaker
And both The Glass House and The Oasis are out now through Hachette Publishing. So go and check them out. That wraps us up for today. If you like us, please leave us a review on Apple Podcasts, Spotify, or wherever you get your podcasts.
00:44:48
Speaker
Find us online on Instagram and YouTube through Novel underscore Feelings or search Novel Feelings Community on Facebook. If we've entertained you or taught you something, please consider buying us a coffee to show your thanks.
00:45:00
Speaker
All proceeds go towards making the show stronger and more sustainable. All links are in our show notes. Thank you so much for listening and thanks to Graham and Anne for coming on the pod.
00:45:11
Speaker
Bye. Our podcast was recorded on Wurundjeri land, which is home to both of us in Naam, Melbourne. We also acknowledge the role of storytelling in First Nations communities.
00:45:23
Speaker
Always was. Always will be. Aboriginal land.