Shrink rap

Raj Persaud takes psychiatry to the masses

Hampstead, north London. Outside Britain’s largest centre of psychotherapy, a statue of Sigmund Freud glowers at the traffic. Inside, meanwhile, one of Britain’s best-known living psychiatrists enlivens the rubber plants and dusty venetian blinds with his characteristic blend of vivid clothing and fluent anecdote.

There’s the story of his stint in the US, where he was routinely sent out with armed police to tackle the severely disturbed (“and they pushed me forward to ring the doorbells!”). Or an account of the poker match, soon to be televised, in which he was obliged to stake everything at 4am, because he had a lecture to give at nine.

As these stories indicate, Dr Raj Persaud is a bit of a celebrity, but also a serious practitioner; well known to the public for his contributions to the press, radio and TV and to his peers as a consultant and winner of several major prizes. This potent combination accounts for his recent appointment as Gresham professor for public understanding of psychiatry; in which capacity he will shortly begin a series of lectures that should be both entertaining and controversial.

He doesn’t actually work at the Tavistock Centre, so I ask why he suggested meeting here. “Well, the notion that you can sit someone down for an hour and get them to talk and explore their unconscious is very much in favour here.” The Maudsley, where he works as a consultant, generally favours other strategies. “The view there is very scientific. They use brain scans and take a biological view.” Persaud’s uses both approaches, and avoids attaching himself to factions. “I have never understood why psychiatry has to be like the socialist parties of the 1970s,” he jokes.

On the NHS and in his private practice, he deals with the full breadth of mental health issues: from people who hear voices or believe themselves to be the messiah to others who hold down important and well paid jobs but experience depression, sexual dysfunction and other problems that, according to one study, affect half of us at some point in our lives.

Some private clients work in the City of London. “They say, ‘We have to keep this absolutely confidential.’ What they don’t know – and I can’t tell them – is that others working for the same firms are having similar treatment. My secretary has to make sure that a person on the board of one bank doesn’t meet another on the way in.”

A typical City client might be a perfectionist, he says, unable to cope with minor setbacks. “If 100 things go well and one goes wrong, that’s the thing that keeps them awake at night.” What can he do for them? “Well, the world does need perfectionists: they build bridges that stay up and planes that don’t crash. So I treat them for anxiety.” NHS patients, often brought in unwillingly, may be treated with medication, but self-selecting private clients tend to forgo pills in favour of hard work. “I have to get them to understand what they can control and what they can’t.”

Some of the same clients see Persaud, with their partners, for marital counselling. “I’m a very robust therapist. You can have tea and sympathy, and I do offer that. But sometimes people need to be challenged. That’s something that people in the City particularly enjoy, they like the cut and thrust…

“At first when couples come in, I might not be able to get a word in for half an hour. It’s acrimonious and full of vitriol.” He pauses, then offers this cheerful aside. “Some of the deepest hatreds seem to occur in marriage. It’s warfare!

“Then they stop arguing, eventually, and ask me, ‘Can you help?’ And I say, ‘Frankly, this marriage is over. You’re wasting my time. It’s finished, it’s dead.’ The session turns into Monty Python’s ‘dead parrot’ sketch, I say it’s dead and they start to tell me about the wonderful plumage. I throw their failure at them and that throws them together. They think, ‘Who is this Dr Persaud to tell us about our marriage?’ And they hit me with reasons why their marriage is great.”

Persaud, 41, was born in Reading to parents from the West Indies, and soon afterwards went with them to live in Barbados. His father was a professor of economics, his mother had a PhD in the same discipline. His brother and sister became economists too. “Like me, they’re all interested in human beings and their behaviour.” There’s a difference, he concedes. “Economists have a very simple model of the mind. They just assume that everyone is greedy – and they still make some very accurate predictions.

“My father always said, ‘Never trust a thin chef or a poor economist. He is an academic but has become extremely wealthy – no, I’ll say fairly wealthy to spare his blushes – by playing the markets.”

He was attracted to psychology as a child, after reading a book by professor Hans Eysenck. “There were always a lot of books around at home, and this one had personality tests for you to diagnose yourself. I came out as a ‘neurotic extrovert’” – that is, one who worries too much but remains sociable. Young Raj was deeply impressed that a stranger he’d never met could know so much about him. “From that point onwards, I realised that psychology came into everything. I could never understand why anyone does anything else.”

Returning to England, he went to school in north London then medical school at University College London. He’s unusual among psychiatrists in having a degree in psychology. (A simple distinction: psychiatrists deal with mental illness while psychologists study the healthy mind.) He also took part in group therapy, after graduating. “You don’t have to do that, but a doctor in training should experience what patients feel. I was one of eight people, I wasn’t running it – although some people would argue with that.”

He only gave up group therapy, four years later, after getting married. His wife (they have two children) works as a surgeon at Moorfields Eye Hospital. And surgeons, Persaud notes fondly, tend to be plain-spoken: “She said, ‘When are you going to leave that bunch of losers?’”

His first book, the best-selling Staying Sane, courted controversy by suggesting that people can usually find their own solutions to problems; either by changing the world around them or changing their attitude towards it. “Unfortunately psychiatry, psychology and the therapy industry have been antagonistic,” he wrote in the introduction, “to my assertion that the entire body of knowledge boils down to just these two options. They like to make life more complicated than it really is.” (This from an author who spins out a further 600 pages.)

As well as writing books – the most recent, From the Edge of the Couch, revived the old-fashioned art of the case study – and for learned journals, Persaud frequently pops up in the popular press. Why? “That would only be a mystery if you believed that the media does a good job covering mental health. No disrespect to your profession, but a lot of journalists do us a disservice, a lamentable job.”

Every day, he receives “literally hundreds” of letters, emails and phone calls from people thanking him for destigmatising mental illness. Which is great, but does his media work interfere with the day job? He believes it helps. “In other areas of medicine a doctor might say, ‘Take this tablet’, but in this area patients have to do hard work. To do that they must trust you, and the reputation of psychiatrists is largely negative… My point is that because I have become relatively well known, maybe they trust me already.”

Answering this question, Persaud sits with tightly folded arms and jiggles his feet restlessly – body language sometimes associated with unease. It seems the issue of media profile v. serious psychiatry may be a sensitive one. My suspicion on that score is strengthened, a few days later, when Persaud emails me to point out that he no longer has a regular slot on certain daytime TV shows. After that he sends a second message, elaborating his frustration at articles intended to enlighten but written by “someone purporting to be a ‘psychologist’ who in reality has no qualifications, no credentials, no institutional affiliation and sees no patients… behind the scenes the profession is tearing its hair out at the inaccuracies.”

Happily, his role at Gresham College unites the academic Persaud with the populist. His first lecture, on the mind of the terrorist, is likely to furnish a provocative, critical perspective on the war on terror. This is not merely an academic interest: Persaud marched against the war in Iraq and cried when the US started bombing Baghdad. He acknowledges the difficulty facing British and American political leaders – “what can you do to an enemy who, after he has struck you, is already dead?” – but insists that they fail to understand what motivates terrorists.

“In the first months after September 11,” he says, “people stopped flying. And car accidents went up. The research shows that excess deaths – over and above the deaths that would ordinarily have occurred – were more than the number of people who died in the attacks. And that impact on the psyche of the public was just as much a part of the terrorists’ plan as the attacks.

“The American understanding is that these people are madmen,” says Persaud, who argued in Staying Sane that nobody is categorically either sane or insane, and that we all occupy positions – variable from one time to another – on the mental-health spectrum. “And Jack Straw famously called Osama bin Laden a psychotic. Well, he may not be a nice man but he is not psychotic.”

1628 words. First published 3 July 04. © The Financial Times