Robert John Barrett: 1949-2007.
A Passionate Love: The Contributions of the Late Professor Robert John Barrett
Professor Robert John Barrett died suddenly, after a long and difficult illness, on January 12th, 2007. At the time of his death, at the age of 57, he was Head of the Discipline of Psychiatry at the Royal Adelaide Hospital, University of Adelaide. His passing was mourned by countless individuals in Australia and internationally. The celebration of his life, held in the University of Adelaide's Bonython Hall, from which generations of scholars have received their parchments upon graduation, was an emotive ritual of which Rob would have both approved and enjoyed immensely. The Hall was filled to capacity, with over 1,300 people listening to a collection of his favorite music and tributes delivered by eight of his friends and family members. Dignitaries in full academic regalia, including the Vice-Chancellor, the immediate past and current Deans of Medicine, and the Head of School oversaw proceedings from an elevated position in the Hall, the symbolic meaning of which would have caused Rob to smile wryly. A reflection of his life in pictures, at the conclusion of the ceremony, before the pall-bearers carried his coffin to the hearse, evoked yet more tears and grief at the tragic and untimely loss of this man: an outstanding intellectual, wise mentor, gifted teacher, caring doctor, and true and loyal friend.
A passionate love
In the application Rob prepared in 1998 for the position of Professor of Psychiatry at the University of Adelaide he wrote:
The most important personal quality that I offer is my enthusiasm--a passionate love for research, teaching and the stimulating collegial relationships that are part of academic life.
This paper is a tribute to that passion. It describes some of the many of his contributions to research, particularly research in ethics and in medical anthropology, to teaching, and to his clinical profession of psychiatry.
Precis of his curriculum vitae (based upon his own writings)
In 1973 Rob graduated from the University of Adelaide in medicine with distinction. After completing his internship he gained two year's experience in general practice, during which time he also pursued undergraduate studies in social anthropology. His post-graduate training in psychiatry under Professor Issy Pilowsky had a strong general hospital focus, his base being at the Royal Adelaide Hospital. Rob qualified in 1979 with the award of the Medallion of the Royal Australian and New Zealand College of Psychiatrists. At Hillcrest Hospital (a now defunct psychiatric hospital in the northern suburbs of Adelaide) he chiefly gained experience in the treatment of schizophrenia and the management of people with intellectual disabilities. His doctoral dissertation, an anthropological study of the culture of a psychiatric hospital and its relation to psychiatric practice, was undertaken through the Department of Anthropology at the University of Adelaide. This study was published as a book by Cambridge University Press (Barrett, 1996) and, later released in a French language edition (Barrett, 1998). Being fully trained as a psychiatrist and a social anthropologist (at both undergraduate and postgraduate levels), Rob was uniquely qualified within Australia. He was awarded a prestigious Neil Hamilton Fairley Fellowship by the NH&MRC (National Health and Medical Research Council) to pursue further studies in medical anthropology at Harvard Medical School, under Professor Arthur Kleinman and Professor Byron Good. There he was appointed a Visiting Fellow and a Member of Faculty.
He subsequently conducted a series of NH&MRC supported comparative studies of schizophrenia that combined anthropological and clinical research techniques, the research sites being located in Borneo and in Adelaide. In his position as an academic member of staff in Psychiatry at the University of Adelaide, Rob was deeply involved in undergraduate and postgraduate education, leading a number of initiatives in this area. He also enjoyed weighty clinical and administrative responsibilities at the Royal Adelaide Hospital.
At the time of his death Rob had been working on an ambitious project for which he had received NH&MRC funding with Associate Professor Bryan Mowry, from the University of Queensland. In this research he hoped to disentangle the genetic contributions to schizophrenia. This project consisted of rigorous ethnographic and clinical case examination, including collection of blood samples for DNA analysis, again from the Iban people of Sarawak. In addition to this work, at the time of his death he was also deeply involved in research into cultural and historical models of language and thought, in an attempt to better understand the origins and biases of clinical writings on thought disorders in schizophrenia.
While I have divided Rob's contributions under the subheadings of "research," "teaching," and "clinical practice," these are somewhat artificial partitions. Each area spills over into the others: Rob's ethos of holistic approaches to mental health care is mirrored in his body of work overall.
Rob produced a substantive body of work. It can be categorized as falling under the broad domains of anthropological studies of schizophrenia, the role of language in health care, cross-cultural explanatory models of mental illness, anthropological studies of ethical principles in research, and medical education. Rob's ethnographic contributions to the literature represent part of an international lineage that began in the late nineteenth century with W.H.R. Rivers, a psychiatrist and ethnographer, through to the Clyde Kluckhohn/Dorothea Leighton collaboration in the mid-twentieth century, and on to the great work conducted over the last thirty years by Arthur Kleinman, Byron Good, Mary-Jo Del Vecchio Good, Janis Jenkins, Ellen Corin and through to Rob Barrett himself (Parker, 2007).
Rob's concern for human rights is apparent throughout all of his writings. Rob had strong beliefs about the absolute necessity for respect and the humane treatment of everyone. This passion won him many admirers, and inevitably, some staunch enemies. Rob was never afraid to cross swords with those whom he felt were supporting injustice and discrimination.
In 2001 the South Australian Mental Health Service Reform led to mentally ill people being shackled in hospital emergency departments (Galletly et al., 2007). Rob went to the media, incredulous that mentally ill people should be treated in this way, with the shackling entailing both physical restraint using leather bands to tie all four limbs to the bedside and chemical restraint using pharmacological agents. Interviewed by the Australian Broadcasting Corporation (Barker, 2001), the empathy that Rob had for people with mental illness, which resonates throughout his research writings, is clear: "People are injured, and I think they're injured physically, and even more worrying perhaps, they're injured psychologically. If I were to tie you down for 24 to 48 hours I think you would be injured too, psychologically."
A member of Amnesty International, Rob was acutely concerned for people who become the victims of politics. He wrote about these issues (Barrett, 2000a) and also made practical attempts to bring about change. I recall his outrage over refugees being placed in detention, and I remember his road trip to Baxter to see conditions for himself.
Homeless people were another group for whom Rob felt empathy and concern. He wanted to know what conditions were like for the homeless, so he went out into the parklands at night with the Mobile Assistance Patrol, and spoke to individuals living on the streets (Allison, 2007). He supervised a doctoral dissertation, written by Andrew Morley, who conducted an ethnography of homelessness in Adelaide, to explore the association between mental health and homelessness, and possible avenues for helping these people.
Rob was very interested in language and the way we speak about mental health and illness and how we talk and write about the provision of services. Never one to accept intellectual knowledge at face value, Rob would assiduously and critically pursue basic concepts--including single words--to their historical origins (Good and Delvecchio-Good, 2007). This interest in linguistic matters is obvious in his early work on the ways in which health care professionals write in case notes (see for example Barrett, 1988), and continues throughout to his most recent publications. In 2006 he published two papers in collaboration with his colleague, Damon Parker, on the meaning of the term "community" (Barrett and Parker, 2006; Parker and Barrett, 2006). The primary purpose of these two papers was to determine what health professionals mean when they refer to a psychiatric service as a "community service," and how the use of the word "community" can both advantage and disadvantage patients and service providers.
In 2005 Rob co-authored a report on a preliminary ethnographic study of a research ethics committee (Parker, James and Barrett, 2005). Adopting an approach suggested by Bourdieu, the paper concludes that rather than being guided by the ethical principles of autonomy, beneficence and justice, the committee could be understood as functioning under an overriding principle of "agape," or brotherly love, which encompassed not only these three ethical principles, but also confidentiality, integrity, dignity and respect. Associate Professor Michael James has told me that working with Rob and Damon was one of the most enjoyable experiences he has ever had in research: he enjoyed not only the intellectual stimulation but also Rob's energy, good humor and sense of fun.
Rob's interest in ethics spanned a number of areas, but included the role of the pharmaceutical company in ethical decision-making at committee level (Parker, James and Barrett, 2005). Rob was also interested in the process of attaining informed consent. He considered and examined the meaning of "informed consent" across cultures as well as from the perspective of the individual giving consent, through to consent granted by a group of people (Barrett and Parker, 2003). He was interested, too, in the meaning of the term "risk" according to whether one is considering what risk might mean for the individual or for a group of people, such as the Iban for instance, when consenting to participate in medical research (Parker and Barrett, 2003).
One of the events that gave Rob an enormous amount of pleasure and sense of achievement was the 35th Royal Australian and New Zealand College of Psychiatrists Congress, held in Adelaide, in April 2000, which he convened. As with everything Rob did that he believed to be important, he devoted himself wholeheartedly into the organizing of the event, and worked extremely hard on its preparation. Rob and his Committee decided upon the theme of "Looking Outward: Culture, Creativity and Psychiatry." On the aims of the Congress, he wrote: "We sought to explore systematically the relationship between psychiatry and the society in which it is practiced--between our profession, our clinical work, and the cultural milieu of which it is a part." (Barrett, 2000b: 276). Rob's program combined presentations on culture, the arts and the humanities with scientific contributions. As an anthropologist Rob was keen to incorporate ritual into the Congress, and thus he included an opening ceremony by members of the Kaurna Nation, performances by the string orchestra that Rob formed especially for the Congress and composed entirely of psychiatrists and trainees, named Musicii Collegium Doctorum Animorum (Cum Amicis), along with a consumer band Finelines, to decrease the stigma and educate the psychiatric community "about the talents and positive contributions of people who have experienced mental illness" (Barrett, 2000b, p. 279). The Congress was a resounding success and seven years later is still discussed with admiration by those who attended, or wished they had.
Rob drew upon his research in the delivery of his teaching to medical students and to trainee psychiatrists, and anthropology and psychology students, whom he taught by invitation. His teaching was mesmerizing--students were enthralled and captivated, not only by his novel material, but also by his quirky sense of humor, his dynamic delivery, and his passion for his disciplines of medicine, psychiatry and anthropology. His students' world views were often permanently changed by his teaching (Frewin and Chur-Hansen, 2007). Should this sound an exaggeration, of the myriad examples I could cite, let me recount but one.
Last year I attended a workshop on the ethics of conducting research with refugees, and was approached by a young woman, Mel Baak, who had been in a class of Rob's in 2000, when she was a first-year medical student. In her words, Professor Barrett's lectures had been inspirational: after two years of studying medicine she made the decision to leave the course and Australia, to pursue work as a teacher for people of the Sudan, This major change of direction she attributes in no small part to Rob's influence. Since leaving medicine she has completed three years of a four-year degree in primary education (from which she graduated at the end of 2008), built a school in the Sudan, is Director of a charity to collect funds for the school and the community in which it is located, and made a movie about her experiences. In 2008 she presented her work to students in the University of Adelaide Medical School. In 2009 she is commencing her doctoral (Ph.D.) studies in Education, focusing on the role of primary education (in Sudan) in promoting well-being for Sudanese people. If Rob could know this, he would be so proud: he took much pleasure in nurturing the careers of his students and seeing them do well.
Rob's anthropological background, married with his medical and psychiatric training, gave him interdisciplinary perspectives on human behavior, and he was a great supporter of interdisciplinary approaches to teaching and learning. One of the fruits of his interdisciplinary bent was the introduction of two undergraduate courses for medical, psychology and health sciences students: "Person, Culture and Medicine" and "Emotion, Culture and Medicine." These courses were designed in collaboration with me (a psychologist) and Professor M. Henneberg (a biological anthropologist) (see Ruhli, Henneberg, Barrett and Chur-Hansen, 2002; Chur-Hansen, Parker, Henneberg and Barrett, 2006). The courses continue today, are popular with students, and have been cited as examples of exemplary teaching practice by the Carrick Institute of Australia. The Rob Barrett Memorial Prize is now awarded to the students with the most outstanding results in each of these courses.
Rob's postgraduate teaching was similarly influential. From the perspective of one of the trainee psychiatrists he has taught:
"Prof was a passionate teacher of psychiatry: both its theoretical basis and clinical application. His interviewing skills were something to behold. He inspired many medical students and junior doctors to pursue a career in psychiatry. The trainee psychiatrists of South Australia, both past and present, will be forever in his debt." (Shirripa, 2007).
The colleagues who taught in postgraduate programs with Rob were equally impressed by his contributions. Indeed, it has been noted that his keen interest in medical education and his participation in the Royal Australian and New Zealand College of Psychiatrists Examination Committee resulted in the production of a world-class assessment process that incorporates summative and formative feedback to candidates--an extraordinary achievement (Handrinos and Gill, 2007).
Rob's father, the late Professor Murray Barrett, was a biological anthropologist and the Dean of Dentistry at the University of Adelaide. Rob's research interests and his clinical practice were influenced to some extent by his father's work with Indigenous Australians. Rob accompanied his father on many field trips as a boy. At the time of Rob's death he was supervising an undergraduate research project on Indigenous students' transitions into university life. The Indigenous student undertaking the project, Paul Herbert, on first meeting Rob, excitedly told him that Rob was his Grandfather. That is, Rob grew up with Warlpiri boys, who are today important community Elders. From his father Murray, who was an initiate, Rob was given the skin name Japaljari, and thus, he was this student's kin. A traditional smoking ceremony was performed for Rob shortly after his death, as a mark of respect for his Indigenous heritage and his relationship to his student, Paul.
Rob's affiliation with Indigenous Australians was reflected in his clinical work at Nunkuwarrin Yunti, a community-controlled center in Adelaide that provides health care and community support services to Aboriginal and Torres Strait Islander people, and his position as an advocate on several Government Committees related to Indigenous mental health. He met with community leaders, and listened to what they had to say, seeking collaboration and ways to best help people in need (Allison, 2007).
His research was reflected in his clinical practice in many ways. For example, Rob took a leadership role in developing models of clinical services that are sensitive to the special needs of patients from different ethnic backgrounds, and he published a number of papers in this area (see for example Barrett, 1997).
Rob's extensive research into schizophrenia and our cultural understandings of the illness, his thousands of hours listening to people with mental illness as a clinician and as a researcher, and his deep intellect, which enabled him to step back and really listen to what was being said, gave him "an empathic ability beyond normal comprehension" and an "ability to walk alongside a person and understand their perspective" (Allison, 2007). He was, quite simply, a remarkable clinician.
While those of us who loved Rob and admired his work are left bereft at his loss, we can take solace in the fact that his influence lives on. He remains with us through the important impact he has had on countless students and others whom he mentored and guided through their careers. He lives on through his beautiful daughter Githie, and his remarkable wife Mitra, the two people in his life for whom his love and passion were greatest. And his work lives on, not only through his published materials, which will be accessed by and influence generations to come, but also his collected data, unpublished lectures and other writings, which have been archived in the University of Adelaide Barr Smith Library, so that present and future scholars can benefit from the wealth of materials that he collected, but sadly, did not have time to finish.
1 am indebted to Dr. Mitra Guha, who honored me with her proof-reading skills, so often drawn upon by Rob himself.
Editor's Note: This memorial to Rob Barrett was originally published in the October 2007 issue of the Monash Bioethics Review. We thank Dr. Chur-Hansen and the Review editor, Dr. Justin Oakley, for permission to reprint it here. Dr. Chur-Hansen is currently preparing a collection of Rob Barrett's anthropological essays for publication by the Borneo Research Council. Included will be a complete bibliography of Rob's published writings, including those relating to the Iban and Sarawak. In the Brief Communications section of the present volume of the BRB Dr. Chur-Hansen presents a brief note on Rob Barrett's unpublished writings that have now been deposited in the Barr Smith Library Special Collection Archives, at the University of Adelaide.
Allison, R. 2007 Unpublished eulogy. Personal communication.
Barker, A. 2001 Mental health reform in South Australia. TV program transcript. Australian Broadcasting Corporation. Downloaded from www.abc.net.au/7.30/content/2001/s431560.htm [last accessed 16.8.07]
Barrett, R.J. 1988 Clinical writing and the documentary construction of schizophrenia. Culture, Medicine and Psychiatry, 12: 265-299.
1996 The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. Cambridge: Cambridge University Press.
1997 Cultural formulation of psychiatric diagnosis: Death on a Horse's Back: Adjustment Disorder with panic attacks. Culture, Medicine and Psychiatry, 21: 481-496.
1998 La Traite des Fous: La Construction Sociale de la Schizophrenie. Trans. Francoise Buillot. Collection: Les Empecheurs de Penser en Rond. LePlessis Robinson: Institut Synthelabo Pour le Progres de la Connaissance.
2000a Foreword. In: Serbian Australians in the Shadow of the Balkan War. Nicholas G. Proctor, pp. vi-vii. Aldershot, England: Ashgate Publishing Ltd.
2000b "Culture, creativity and psychiatry": report on the Adelaide Congress. Australasian Psychiatry, 8: 276-280.
Barrett, R. J. and D.B. Parker 2003 Rites of Consent: Negotiating research participation in diverse cultures. Monash Bioethics Review, 22: 9-26.
2006 Symbolism of community I: the boundary between hospital and community. Australian and New Zealand Journal of Psychiatry, 40: 310-317.
Chur-Hansen, A., D. Parker, M. Henneberg, and R.J. Barrett 2006 Interdisciplinary electives in the humanities for students of medicine, health sciences and psychology: suggestions and implications. Focus on Health Professional Education, 8: 32-39.
Frewin, D. and A. Chur-Hansen 2007 Obituary. Adelaidean, March. Downloaded from www. adelaide.edu.au/adelaidean/issues/17521/news 17545.html [last accessed 16.8.07].
Galletly, C., R. Allison, A. Chur-Hansen, D. Frewin, B. Good, E. O'Brien, D. Parker, I. Pilowsky, G. Smith, and M. Warin 2007 Obituary. Australasian Psychiatry, 15: 252-253.
Good, B. and M. Delvecchio-Good 2007 Transitions. Culture, Medicine and Psychiatry, 31: 131-134.
Handrinos, D. and S. Gill 2007 Under the rainbow tree: Professor Robert Barrett's legacy to the RANZCP College examinations. Australasian Psychiatry, 15: 254-258.
Parker, D.B. 2007 Personal communication.
Parker, D.B. and R.J. Barrett 2003 Collective danger and individual risk: cultural perspectives on the hazards of medical research. Internal Medicine Journal, 33: 463-464.
2006 Symbolism of community II: the boundary between the community mental health professional and the community. Australian and New Zealand Journal of Psychiatry, 40: 318-324.
Parker, D.B., M. James, and R.J. Barrett 2005 The practical logic of reasonableness: an ethnographic reconnaissance of a research ethics committee. Monash Bioethics Review, 24: 7-27.
Ruhli, F.J., M. Henneberg, R.J. Barrett, and A. Chur-Hansen 2002 Die Anthropologie als Teil eines holistichen Medizinstudiums. Bulletin de la Societe Suisse d'Anthropologie, 8: 9-13.
Shirripa, M. 2007 In memoriam: Professor Robert Barrett. Downloaded from the Australian and New Zealand Association of Psychiatrists in Training website www.anzapt.org/content/view/696/161/[last accessed 13.8.07]
(Associate Professor Anna Chur-Hansen, Discipline of Psychiatry at the Royal Adelaide Hospital, University of Adelaide, South Australia, 5005. anna.churhansen@ adelaide.edu.au)
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|Publication:||Borneo Research Bulletin|
|Article Type:||In memoriam|
|Date:||Jan 1, 2008|
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