My life as a Child Psychiatrist - Then and Now
Klaus Minde, M.D.
Professor emeritus of Psychiatry and Pediatrics
I think my life as a child psychiatrist began with our pediatrician a long time ago. He used to come to our house for our semi-annual check-up and would tell me that he always looked forward to see me since I was so competent in opening my mouth widely and helped him keep me healthy. Even at age 5 I felt that we were partners and that I wanted to do such work with children when I grew up.
As I grew up in East Germany and was not permitted to go to university there because of my "failing commitment to the new social order", I escaped to West Germany to study medicine in Munich and London. Cut off from my family and without any financial support, I was fortunate to eventually receive a scholarship that required me to do well in medicine but also to see lots of plays, go to concerts, read non-medical books, and write an annual report, highlighting my non-medical activities. I experienced this as being allowed to learn by playing and exploring.
Following medical school I got a Fulbright scholarship to train in pediatrics at Bellevue Hospital in New York City. At that time patients there were primarily poor and immigrant children whose health status was often severely compromised by their environment. Hence our interventions, based on the traditional medical model, often did not prove to be helpful. To learn more about the effects such psychosocial challenges have on the development of children I did a masters degree in developmental psychology at Columbia University. At the same time I also worked at the Sloane Kettering Institute as a research assistant and saw the influence the family environment had on children battling cancer and vice versa. During that time I also experienced how much collaboration between different professional groups can enrich clinical work and research and became convinced that Child psychiatry within a pediatric academic milieu would be the way to pursue my goal of capturing both the body and the mind of children and their families.
My subsequent training in adult and child psychiatry at McGill University in Montreal brought to life other possibilities opening up in our field at that time. John Werry and Gabrielle Weiss had just started the first prospective long term study on hyperactive children and invited me to participate in their research. As this study was based on the collaboration with various non-medical partners, it was another exciting exposure to multidisciplinary team work as well as an opportunity to learn about the persistent and development specific patterns of psychopathology over time. Then there was the additional psychoanalytic training that was almost obligatory at that time. This often required young psychiatrists to take sides in their understanding of psychopathology. However, my training analyst, Eric Wittkower, was also one of the original researchers in the field of psychosomatic medicine as well as a co-founder of the sub-specialty of Transcultural Psychiatry and the first editor of its journal. This meant that I was never exposed to the often personalized schism between psychodynamic teaching and evidence based clinical work as he would read some of my manuscripts and discuss them with me.
In fact, Wittkower's work and my own experience of being an immigrant made me accept a WHO position in Uganda where I founded the first division of child psychiatry in East Africa. It was an interesting place to be at that time. Makerere University and Medical School was founded in 1922 and called the Harvard of Africa. Uganda had been spared a colonial history and as a result was ready to be a leader in post-colonial Africa. While I was able to do some epidemiological studies of child psychiatric disorders in different regions of the country, these were also transformative years for my wife Nina and our 3 young children. Idi Amin who had just become president and was initially very well received turned into a dictator. We experienced and tried to deal with the pain and mental anguish his reign caused the people of Uganda. It became yet another place where a political regime was able to nearly destroy a young independent country and a lesson for us of sharing common human experiences within a transcultural context.
Following our return to Canada I took on the directorship of psychiatric research at the Hospital for Sick Children in Toronto, and again past life experiences guided my special interests. Our first son had been a premature baby, born when I was a resident in psychiatry. We were not allowed to visit him and could just look at him through a window at the nursery, a forlorn baby in a seemingly huge incubator. A few years later, Marshall Klaus and John Kennell began to talk about bonding and the alleged high abuse such children experienced later, and I had long wanted to see whether this was true and how one can help this population. As the Hospital for Sick Children in Toronto had a 70 bed intensive neonatal care unit with 120 nurses it was an ideal place to study this population and assist in developing the sub-specialty of infant psychiatry. During a later sabbatical year I had a chance in London to regularly meet with John Bowlby for 6 months and observe the therapists running Anna Freud's Hampstead nursery as well as spending 6 months at Yale Child Study Center with Sally Provence and other outstanding professionals working with infants and preschoolers. One result of these explorations was the first textbook of Infant Psychiatry that I wrote with my wife who is a psychologist.
As happens in many careers, my later years were spent as the chairman of an adult and then the child psychiatric department at Queens and McGill University where I learned much about administration and its associated challenges. However, my dream to create a department of developmental psychiatry based on the idea that life is an ongoing developmental process and disorders should ideally treated within that context, was not acceptable by my adult colleagues.
So what about my life as a child psychiatrist now?
Following my 10 years as chair of child psychiatry at McGill, I used a last sabbatical at the University of Johannesburg in South Africa to work in a number of clinics in Soweto and Alexandra as well as investigating attachment patterns in children there. I met many children whose mothers had died of AIDS and who were cared for by their grandmothers. Many of the children had AIDS themselves. The grandmothers grieved for their daughters and the grandchildren for their mothers. While a bereavement group was started for the children, their grandmothers also needed help. Since we had just become grandparents ourselves, Nina and the head nurse of one clinic started a support group for grandmothers which was and continues to be extraordinarily successful. The model of helping AIDS orphans by supporting their grandmothers has now become the main focus of at least one major charity in Canada.
In a return visit to Africa this year, we saw that where there had been one small AIDS hospice, there is today a big village where more than 200 orphans from infancy to teenage grow up with the support of trained caretakers. Our old grannies are still active, and the head nurse is now the CEO of the AIDS village. Moreover, one of my Ugandan medical students, Seggane Musisi, who was able to do his residency in Toronto while I worked, there is now the chairman of psychiatry in Kampala at Makerere University and I could teach some of the medical students with him together. Uganda now has also a second medical school in Mbarara and I spent some time with the recently appointed first child psychiatrist there to discuss the challenges of developing this new opportunity. I was also thrilled to meet again some of the staff members who worked with me 40 years ago and find them engaged in caring for children and living lives that helped their communities. Since Seggane Musisi and his family have been very good friends of our family for many years and he has become like another son in our family, the new colleague in Mbarara, as a representative of the next generation, is in some way almost like a grandson.
There are additional aspects of the "Now" child psychiatrist. I am never on call anymore, see only patients referred by 5 pediatricians I have known for 25 years, learned CBT and have modified it to help anxious preschool children with good results. I am also the first child psychiatrist who has joined the group around Michael Meaney, a psychologist in Montreal who has done transforming work by documenting the epigenetic aspect of development that recognizes the plasticity of our genetic heritage toward environmental experiences in early life and in that sense provides a possible base for conceptualizing preventive maintenance for children with specific "at risk" conditions. It is especially rewarding that one of my past residents Ashley Wazana is the PI of our initial grants and that it may bring us a bit closer to the marriage of biology and evidence based psychosocial treatments.
Finally, one of our teen aged grandchildren who live with their parents in Germany wants to go to school in Montreal next year and will live with us then. There could be no better Christmas present for us.