“In that cultural context there was a lot of pressure.”
The pressure he and his brother felt while growing up in Malaysia must have been NOTHING compared to what he feels through his work today. Yes, he did medicine- as was expected. Yes- he brought honour to the family name. Yes, there is SO much more to him! Here is Julian’s story.
I met up with Dr.Julian Toh on a hot Saturday afternoon, where I learnt SO much about this quietly spoken metal head (I know right?!) who is a psychiatrist and psycotherapist at Psynapse in North Adelaide,
Julian works in the Community Mental Health Service as well as his private practice. He is a dad of two gorgeous girls, a husband, a kick arse martial artist, loves heavy metal and long walks in the bush. He’s a mixture of spider loving conservationist who loathes collars and sage empath who could diffuse the most traumatic of altercations.
He exudes ‘calm’ and his expanse of knowledge within his field is nothing short of incredibly admirable.
Julian candidly explained his upbringing in Malaysia- where it was culturally expected that he would study medicine. He would bring honour to the family name and there would be no dispute.
Truth be known, he really wanted to be a marine biologist!
However, after work experience in Ophthalmology here in Australia at the Royal Adelaide Hospital, the human side of biology and physiology peaked his interest. The combination of family pressure, work experience and a fantastic biology teacher called Mr.Brown lead Julian to become a psychiatrist.
Being taught at Prince Alfred College by Mr.Brown was a ‘real turning point’ for Julian. This biology teacher was passionate and motivational for three years of teaching him and introduced the thought of medicine being a good avenue for Julian to follow.
He studied medicine at Adelaide University ‘in the days back before I-technology, so we were required to actually attend lectures.’
The first three years of the course was all academic.
“We didn’t see our first real patient until fourth year.”
And boy did he see it!
Julian’s student placement in his fifth year of study took him to Johns Hopkins University’s neurosurgery department, in the ‘ghetto’ -ness of Baltimore. Gang violence, high HIV rates and massive exposure to head trauma and bullet wounds added to the shift from neurosurgery to psychiatry for Julian’s future study path.
Again, a teacher (this time a psychiatrist) influenced Julian and led him to do some time on a ‘psych’ ward.
Neuroscience, psychology and anthropology were the combined ingredients that created the passion Julian works with today.
How do all these sciences teach us how we relate to each other?
Julian said “that’s how my interests shifted from neurosurgery to psychiatry.”
Upon returning to Adelaide, Julian’s first internship began at the Queen Elizabeth Hospital in psychiatry.
He said “back then before the pressure of high bed turnover and short duration of stays, people actually stayed in hospital and made quite solid recoveries.”
It gave doctors time to study their phenomenology, their symptoms and their life experiences. It gave Julian time to become interested in personality disorders, through exposure to psychosis- particularly upon seeing many cases of schizophrenia.
As with any industry, evolution leads to a need for those at the forefront to ‘keep up’. Psychiatry is not excluded here and Julian has noticed some changes over the last two decades.
In the late 90s, early 00s, there was so much stigma around certain conditions. For example, attention deficit disorder, depression and anxiety, personality disorders, are all now more recognised and medications can lead to rapid improvement.
Another improvement within the psychiatry field is the developing alignment of public health services with public need. Julian said this is a great, positive sign for the future.
“We still have a long, long way to go but it’s a good start.”
When he first began practising, Julian explained that having a personality disorder EXCLUDED a patient from receiving help through the public health system. He was ‘angered in a social justice kind of way’ and it was one of the first stepping stones leading to where he is now.
In 2013 Julian was the lead clinician of the Salisbury Mental Health Services where he created a brief intervention clinic for patients with personality disorder thereby bridging the gap between need and service availability (ie.none!)
The service therapy model he promoted then is now going to be rolled out across South Australia in all Public Mental Health Services.
(About here is where MY perceived accomplishments, intellect and esteem seemed to internally vaporise …..I kept sipping my iced coffee as if everything was cool though….)
My brain started to hurt just a little from the concentration and big, big words so I changed the course of the conversation to ‘self care’.
With such an intense and demanding job, I wondered if Julian takes enough time to look after his OWN wellbeing and mental state.
He said in his early days of being a consultant (which creates more responsibility than being a registrar), he did struggle a little with ‘decompressing’ after a tough day.
His skills have improved since because “all aspects of human experience are adaptive”. He explained that rigidity and intensity of these experiences lead to dysfunctional adaption and he has various ways to overcome this.
Detaching from work is a learned practice. When Julian gets home from work and feels the exhaustion and work-related thoughts creeping in (because he is empathetic- probably a heaps good thing in his line of work), he reads a lot. Not only to ‘switch off’ as it were, but to try and understand the framework and phenomena of every day life and occurrences he’d seen at work.
(ME? oh, I like Lee Child, Dan Brown…..a sappy romance if I’m REALLY drained…..)
Another outlet for Julian is martial arts. ( I DID mention ‘loving conservationist’ before right? Well here is the yin of the yang). Julian has trained in martial arts since forever and uses it to ‘express some of those energies’ he brings home from a traumatic work day.
Meditation, hiking and staying in touch with the great outdoors also keep Julian grounded. He believes (as does the literature) that to isolate oneself encourages creative thinking capacities. Quiet time is very important. Julian recommended Susan Cain’s book(s).https://g.co/kgs/abB2x3
He also appreciates the love and support of his family, a home cooked meal and even the demands of his children as “it means they feel open enough to talk to me.”
(ME? Ummm……no…..my children’s demands are NOT seen that way. )
Another important aid for Julian to use for his wellbeing is ‘peer support groups’
I touched on this in my recent blog about Chrissy,
Twice a month Julian meets with a group to discuss journal articles, patients they’ve seen AND their own needs as health care experts. The group provides a safe forum to discuss feelings and direct experiences within the work setting- something they all have in common.
Whether you’re a leading psychiatrist or a mum of children or a deep diving marine biologist (couldn’t help this Jules….had to), we all need a ‘collective’ (I’m hearing ‘tribe’ too much at the mo’).
We all need love, assistance and backing from those with common interests.
I really believe (this is me not Julian) that this is something severely lacking in today’s high-tech, poke-neck society.
We seem to be too busy comparing perfect, non-realistic lives, trying to grasp the end of the dreamscaped rainbow that will just never be something tangible, memorable or authentic.
Call it a ‘tribe’ or a ‘collective’ or even a ‘collective tribe’- whatever, but let’s just learn to build each other up!
Sorry….I followed the shiny tangent….
Back to Julian.
We’ve all watched a lot of movies with psychiatric wards. Cuckoo’s Nest, straight jackets, riots and all the rest.
So I’ve asked on behalf of the audience.
“Have you ever felt in real, physical, threatening danger?”
Julian asked for a five hour window. We joked around…..not really. (a.little.)
Protocol for home visits includes initial risk assessment, with all information available (which is sometimes not adequate enough), being accompanied by another staff member and a direct link to police assistance and ‘home base’. If a situation is deemed too dangerous, the police are required to assist for the initial consultation.
Yes- his job is demanding. Yes- it’s testing and trying and yes- it can play with his mind, give him nightmares and upset him. But one thing Julian does to combat this is a ‘Gratitude Journal’.
What a fantastic idea! Something we should ALL do?
Julian has kept a ‘gratitude folder’ for ten years now, and encourages his trainees to follow suit.
It’s a great reminder with photos of gifts, thank you cards, emailed thanks, from students, patients and colleagues. He said that especially after a bad day, he can look here and be reminded that he IS making a difference and he IS doing great things in the lives of many.
A bad day for me might be that I’ve burnt the spare ribs I cooked for dinner (I’d never bloody cooked them before OK?) where a bad day for Julian might be that he loses a patient to suicide. Something he has sadly had to deal with a number of times. Having the gratitude folder alleviates a part of these tragic situations.
I asked Julian if he looks up to someone in his industry.
He said “OOH YEAH” (just like that).
Two very important role models came to mind.
Dr. Les Koopowitz https://www.linkedin.com/in/leslie-koopowitz-869992109/?originalSubdomain=au is a Clinical Associate Professor at the University of Adelaide taught Julian knowledge in neuroscience and how it integrates with a clinical situation. More than this, Dr. Koopowitz displayed an empathetic ,calm and content manner with patients- exactly how Julian is today.
The other leader Julian wanted to recognise is Dr. Maura Kenny https://www.mtia.org.au/our-people-1/dr-maura-kenny-1 a psychiatrist who specialised in cognitive behaviour therapy and moved on to specialise in mindfulness based cognitive behaviour therapy.
He said she ’emulates warmth and compassion’ and this translates to teaching students, junior doctors and patients to do the same.
Julian said “I really treasure her ongoing guidance”.
For those considering studying medicine, I asked Julian for three pearls of wisdom to ensure a safe and worthwhile journey. “We all go into this field with an ambitious project. To heal the psychic and spiritual wounds of others resulting from bad things done to them, sadly by other human beings It’s a huge project. So the first piece of advice would be ‘don’t forget your own needs and self care.’
Julian extends this to healers/ doctors/ therapists/ even teachers.
He said “the wounded healer is often the most affected healer”.
The second gem of wisdom was ” that ambitious project you go into in this field? NEVER forget it.” The other danger we may face is to lose sight of those original motives we had and become detached. We can then find ourselves distanced from our patients. Don’t forget why you started.
The third pearler was this. My favourite. (just saying).
“Life is fairly short. To live a good life is to lead a meaningful life.”
If you can cultivate a sense of purpose and meaning into your work- that helps a lot. We spend so much of our time there, so make it count.
I asked Julian ‘where to from now?’.
He was going home to take a nap…..we laughed. I went quiet.
Then he came up with this instead.
Not one to make specific (new year) resolutions and such, Julian is more guided by values.
As he works in both public and private mental health services , he realises there is still much work to do within the public system.
Goals such as reducing stigma, increasing mental health literacy, increasing mental health services and ensuring equity of care, particularly within the indigenous population.
He will be actively involved in all these aspects.
He will also continue to nurture the upcoming med students, who seem to be showing a genuine passion to excel within his field. This fills him with a refreshing hope for the next generation.
He will continue to try and be a great dad and husband. He will also continue to be a ‘pseudo-marine biologist-who-hunts-and-gathers-and-takes-crabs-home-to-the-family’.
I think there may be a shield maiden binge and a Tolkien novel in there somewhere too……
For your time Julian- I thank you! I wish you many valuable, life-saving work days ahead because you ARE valued. You are loved and you are a precious empath amongst the spoils of sadness and sorry situations.
I appreciate the raw outpouring of your life to date and the amazing work you do within the mental health sector. You are quite amazing.
We celebrate you!