| Description | Dr HARRY MILLAR interview at the Sir Duncan Rice Library, University of Aberdeen on Monday January 23, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) HENRY RANKINE MILLAR, known as HARRY, born 23rd April 1947 in Aberdeen. Retired as a General Adult Psychiatrist in Aberdeen in 2007, continued part-time work, fully retired in 2014 from any psychiatric work. Explains his post was as an NHS consultant, but also held an Honorary Clinical Senior Lecturer post with Aberdeen University. His father was Professor of Mental Health in Aberdeen from about 1948 till the 1970s; father was a psychiatrist, had a brother who was a GP; Harry had an older brother, also a GP; had an uncle on his mother’s side who was also a GP; father was Prof Malcolm Millar. Educated at primary and secondary level at Aberdeen Grammar School; involved with Scouts, keen on rugby. Did consider career in field of Science, but thinks he fell into a career in Medicine, explains; no influence that he can recall from his father. (0:05:19) Studied at Aberdeen between 1965-72, did not consider anywhere else, explains. Talks about not getting the full study grant because of his father’s income as a professor; five brothers and sisters, all living at home. Harry got married while he was still a student. Family home moved from Cornhill Road in a university house, to another university house, in the Chanonry in Old Aberdeen. Recalls his life as a medical undergraduate; lot of classes; First Year doing basic sciences, that year eventually dropped, explains; around his time at university that things were changed. Second Year and first half of Third Year, real grind, explains. Harry did an extra intercalated year, for Bachelor of Medical Biology; encouraged into this by the Professor of Pathology, impressive mentor and teacher, Alastair Currie. Year in Pathology taught him how to think like a scientist and proper doctor, explains. Then went on to the clinical stuff, how to diagnose patients. (0:12:39) Does not remember much about his first contact with patients; process of building confidence, explains. Mentions Alastair Currie again as an inspiring tutor; new course in Human Ecology, which he thinks his father had something to do with setting it up, explains, the leader of this course was impressive, can’t remember his name; in later years someone else who became a mentor was Jimmie Petrie, did clinical attachment with him in final year, then a House job in his department; he eventually became Professor of Clinical Pharmacology; very influential in developing guidelines through the Scottish Inter Collegiate Guideline Network, explains this impacted on General Practice particularly. (0:16:41) After graduation in 1972 did House jobs, six months Medicine, six months Surgery. Medicine he did in the Department of Clinical Pharmacology ward, explains. Then did Surgery with consultants George Mavor and David Blair. Goes back to Medicine and mentions other consultants, Peter Bewsher and Prof Bill Walker, great people to work for. Harry pretty sure he did not want to work in Surgery, explains. Talks about how the system of matching for House jobs worked, both officially and unofficially. Explains in detail how this system affected him personally; stayed in Aberdeen, thinks people who went away had much better experiences. Talks in detail about the way Junior Doctors worked in those days, completely different; on call system eventually led to a shift system, thinks that’s terrible; explains more about how on call system worked; real dogsbody as an on call House doctor. (0:24:00) When he was working with Jimmie Petrie in Dept of Therapeutics and Clinical Pharmacology he was thinking of General Medicine as one of the speciality options. Jimmie Petrie encouraged him to apply to be a Junior Fellow in Community Medicine, which meant he could work half time as a Senior House Officer in General Medicine, and half time on a research project in the Dept of Community Medicine. Met Elizabeth Russell, who was working there at that time. Explains the project was about Jimmie Petrie’s aim for better recording and documentation of medicines in General Practice; explains old Lloyd George system of envelopes and cards that was used then. Was thinking during that year about what to do; General Practice seemed a bit superficial, explains. General Hospital Medicine seemed rather impersonal, gives example from the old Nightingale wards at Foresterhill; patients would be parked in the bays at the ends of the wards, bed-blocking nothing new; explains. Ward rounds would usually bypass them because they had been there for a few weeks, Harry would sometimes peel off to speak to these patients, explains why. Inevitably led to him thinking about Psychiatry; one occasion when he went to his father for advice on where he could train; initial confusion, explains. Advice was Edinburgh the place to go, or maybe London or abroad; James Henderson, who had done some of his time in Canada, encouraged Harry to look further afield, but he settled on Edinburgh. (0:30:46) Thinks his father was quite pleased, though not sure. His father was working in the Dept of Mental Health, quite a broad range of people there, explains. The medics were all psychiatrists, explains about the specialty of Psychiatry; nowadays the terminology describing mental illness and mental health is crazy. Defines in detail what the discipline of Mental Health was then, and now; anti-psychiatry movement in the 1960s and 70s; refers to book by Thomas Szasz "The Myth of Mental Illness", made out there was no such thing as mental illness; practising psychiatrists knew that to be nonsense, explains; introduction a few years ago of the term "Well-being", explains, all mixed up with mental health now. People using the term usually mean mental ill-health, but don’t want to call it illness, seems to be a taboo on referring to something called illness. Huge discussion about this in the 1960s and 70s, book about this by R.D. Laing; refers to hearing him give a speech once in Glasgow and he was drunk. But did write very well, remembers reading "Sanity, Madness and the Family"; Laing had an important contribution to make. A mentor of Harry’s later on was a psychoanalyst called Tom Freeman, wrote about schizophrenia, explains. Harry holds on to the concept of mental illness as a good concept, as well as mental disorders, explains. (0:39:37) Explains he sees himself as a Psychiatrist, also comfortable with the term Consultant in Psychological Medicine; means the same thing to him. Explains about his move in 1974 to the Royal Edinburgh Hospital; training structure well-developed there, more than in other parts of the country. Explains about his training over three years; did General Psychiatry with consultant Bill Boyd; then in a professorial unit with Prof Henry Walton, also with him in a general hospital unit; Child Psychiatry with Dr Mike Field; then old age psychiatry unit with consultant Sam Robinson. Would also do on-call work, and a day-release course of academic training, explains in detail. (0:43:50) Explains about his move to Dundee in 1977. His goal was to become a consultant, explains. Had heard Dundee was a good place to go, not sure about that in educational value. Talks about career expectations then of young male doctors, wives were just expected to move around with them. Harry was married with two children by this time, his wife trained in Catering and Institutional Management, explains. In Dundee he was a Senior Registrar and Lecturer in Psychiatry at the Royal Dundee Liff Hospital and the University of Dundee; he was more of a student when he was previously at the University of Edinburgh, explains. Then explains his situation in Dundee, regarding NHS and teaching responsibilities. When he was applying for the job recalls getting a call from Prof Batchelor, because there was a vacancy at same time for a lecturer post, explains. (0:51:08) Talks about leaving Dundee in 1980, and moving to Glasgow for the next eleven years. Talks about having applied for, but not got, a job in Dundee in the field of what was then called Learning Disability, explains about the various names this field has gone through over the years. Job came up at the Southern General Hospital in Glasgow; such jobs relatively uncommon in those days, explains in detail. No responsibility for long-stay wards. That was his first consultant job. (0:56:23) Explains that in Glasgow he was a General Psychiatrist, and what he was responsible for; areas of Pollock and Govan. Community Psychiatry became the thing; expresses reservations about it in detail; was about getting away from the doctors, but they still needed doctors. Harry very keen to reach out and work with GPs, explains. But because he was working in a General Hospital, and because of the stigma of going to a Mental Hospital, his unit had previously developed expertise in looking after patients with eating disorders, anorexia nervosa; so there were referrals from outside their catchment area, explains. That was the start of Harry developing an interest in eating disorders, explains. Got to know other people, notably Chris Freeman, a consultant in Edinburgh; and some people in London and Leicester and Oxford. His interests expanded into bulimia nervosa and other eating disorders, explains. (1:03:26) Talks about importance of Prime Minister Margaret Thatcher in the context of the health service in the 1980s, and what he calls his "fantasy" of what she believed about doctors, not very hard-working etc, too much influence on how the health service was run, needed to get proper managers in to sort it out. Second thread of her policy was to reconfigure the health service into units they could sell off to the private sector, explains; recalls govt Health Secretary Tony Crossland (Harry later corrected this, it was actually John Moore), replaced by Ken Clarke; created NHS Trusts. Explains in detail how this worked in Glasgow; didn’t last. Recalls meeting some managers one day, turned out they were in process of shutting his unit down; not making any case on clinical grounds, not interested in what medics had to say. (1:09:12) Chief executive of the health board was Laurence Peterken, comments on him; Harry exercised about this, he and his department colleagues thought they should fight it, he was encouraged to take the lead. Mentions Harry Reid, then editor of the Glasgow Herald newspaper, who had been at school with him; phoned him and told him what was going on. Got a splash in the Herald about it; not really what he wanted to do. (1:11:15) Says he never particularly enjoyed where he was living in Glasgow, explains. Was not really looking for another job, but applied for job in Aberdeen and got it; his wife not happy, she was quite settled, did not want to come back to Aberdeen, but she did. Professionally has no regrets about coming back to Aberdeen, to job at the Ross Clinic, which his father had set up in 1959; a General Adult Psychiatry job which had no long-stay ward responsibilities, explains; no eating disorders component at that time. Ross Clinic in the grounds of the Royal Aberdeen Cornhill Hospital. Harry did clinics out in the community, like the other psychiatrists in Aberdeen at the time, very community-aligned, GP-aligned; compares then with now. No feeling that he was stepping into the shoes of his father, who had been retired for some time by then, explains. After his father retired was replaced by Prof George Ashcroft, very well thought of; new professor came about the same time as Harry did, Prof Lawrence Whalley. (1:16:28) Not sure about difference in medicine in Aberdeen from 1974 when he last worked in the city, to 1991 when he returned, explains. Had contact with a couple of consultants at ARI (Aberdeen Royal Infirmary), who had been trainees with him when he was in ARI, including Anthony Jeffers; Harry asked him to review one of his patients. The way things were running then seemed not that different; thinks they are different now, explains. But being in psychiatry at the Ross Clinic was the biggest difference to being at Foresterhill (Summariser’s note: Aberdeen Royal Infirmary is the official name, Foresterhill is the name of the site on which ARI is built; the two names are used interchangeably in Aberdeen). Tries to remember the structures of psychiatry as he had experienced it before coming back to Aberdeen to how it was when he arrived back in the city. Sectorisation was not dissimilar to how it was in Glasgow, referrals were quite similar; community psychiatric nurse role had become more crucial and was perhaps better developed in Aberdeen; clinical psychology was similar in both places. (1:20:18) Explains who he was working with and what he did. Shared a ward with John Callender, a general psychiatrist; Peter Olley, an old age psychiatrist; that was in the Ross Clinic. Another ward downstairs, the Millar Ward, with another two or three consultants. They were a group of about six consultants, dealing with South Aberdeen. Another group of consultants for North Aberdeen were based at Kingseat in Aberdeenshire, did outpatients in Aberdeen; explains that for historic reasons Aberdeen City patients went to Kingseat, and Aberdeenshire patients came to Cornhill. Another group of Aberdeenshire consultants did outpatient clinics out of Aberdeen, explains. Also explains how other staff fitted into the structure. Describes the Ross Clinic, not large. In the old Cornhill Hospital there were a lot of in-patients wards. Then there was Elmhill House, on the Cornhill site; outpatient clinic and some day patient space; another day hospital there for North Aberdeen. All rejigged when the new hospital was opened on the Cornhill site about 1994, explains. (1:25:00) Talks about the range of patients he dealt with; serious mental illness, schizophrenia, other kinds of psychosis, patients under 65. Different services for over 65s and under 16s. Occasionally dealt with dementia in the under 65s, sometimes help from the old age psychiatry service in dealing with such patients. Patients with alcohol problems, some brain-damaged. Head injury, brain-damaged younger patients. Talks about other conditions, including severe manic depressive illness, now called bi-polar; explains about this in detail, mentions Stephen Fry (contemporary English comedian and actor). Continues talking about other mental conditions, and what he did to help people cope with long term disabling illness. Saw that as a consultant’s job, not sure that would now be seen as a consultant’s job, explains. Raises issue of gender recognition, refers to very recent events in the Scottish Parliament. Feels that because of the push to de-medicalise, some psychiatrists have restricted their willingness to get involved in the wider management of people with mental disorder, explains; talks about ECT (Electric Convulsive Therapy). That was not the way he was trained, found it difficult to give up the view of the psychiatrist as the team leader, explains; compares the amount of training he had with that of other professionals. Another comparison with Glasgow, felt expectations in Aberdeen and Grampian were significantly greater; people in Govan put up with a great deal, explains. More money in Aberdeen, although tensions because people were getting paid the same as in Glasgow, but costs of housing etc much higher. (1:33:11) Addresses the question of how much a consultant psychiatrist can do to cure their patients. Recalls being asked this by a smart-arse neurology trainee when he was in Edinburgh, explains his response, which includes the limitations of neurological diagnosis. Explains that what he does is alleviate suffering, very few doctors cure illness, explains. Talks about what a typical day would have looked like for him as a consultant psychiatrist 30 years ago; just beginning to get computers on their desks, he was keen on them, explains; out-patient clinic; time with new patient; time with follow-up patients; psychotherapy and supportive psychotherapy, explains in detail; (1:40:06) in-patient work, explains he did not like to deal with patients in front of the team, tried to see them by himself or with just one other team member, says he does not think he managed his time very well; talks about ward rounds and daily checks, and weekend rota system; what happened if there was an emergency admission; on-call not onerous; recalls having to go in to the ward when there had been a suicide. Explains he also became increasingly involved in teaching and research. (1:43:58) Explains in detail his interest in eating disorders; started in Glasgow, but frustrating, explains; discovered work had been going on in this area in Aberdeen after he moved there. Consultant John Eagles had been dabbling in it before Harry came. Explains how he became a half-time Consultant for Eating Disorders, gave him time for some research interest; ghost of his father, doing follow-up of patients who had been identified many years earlier in the North of Scotland Psychiatric Case Register, which his father was mainly responsible for in the 1950s and 60s, explains. Also got involved in the post-graduate training of psychiatrists. (1:49:00) Explains in detail about his line of research in eating disorders. Also talks of work initiated by another member of staff that was pioneering the use of Tele-medicine for clinical use, explains, quality not great in those days compared with now. Dept became an early adopter for a computer system for medical record and eating disorders, national initiative, explains about what he wanted it to do, and its limitations. He wanted to develop a database for all patients, explains; it couldn’t really do that, explains. Knows there was a new system coming in around the time he retired. Refers back to the system he worked on; showed a lot of promise, but then the funding was pulled. (1:54:22) Talks about changes in ways patients were treated, reduction in long-stay beds, increase in supported accommodation. Very unsatisfactory the way this worked, explains in detail. Increasing defensiveness came into Medicine generally, into peoples’ attitudes, explains. (1:56:18) Alludes to a famous patient, in the Press, who had anorexia nervosa and a disturbed personality, explains; very difficult to deal with someone who is absolutely refusing food, serious human rights issues come into it, explains. Parents also disturbed accused Harry and his colleagues of allowing their daughter to die, smuggled journalist with camera into the ward. Made Harry more cautious afterwards; general feeling of medics being more cautious; refers to the Harold Shipman case, and what happened subsequently, and the irony. Doctors more defensive, know they are going to have to sit in front of an appraiser every five years, explains this came in towards the end of his career, felt like an awful ordeal. (2:00:32) Refers to new version of the Mental Health Act that came in about 20 years ago; no longer trusted to prescribe for patients that were detained, without outside scrutiny; whole detention process became more elaborate, explains. Refers to Millan Committee (chaired by Bruce Millan, a British Labour party politician, between 1999 and 2001, it proposed reforms to the provision of mental health care in Scotland): Harry represented the college (Royal College of Psychiatrists) in front of the committee. Recalls Bruce Millan kept referring to the European Convention on Human Rights, clearly it was driving the review. Made work of a general psychiatrist more difficult, explains, including in his own work. Remembers once being furious; recalls in detail a very difficult patient who was a double amputee: difference between positive and negative symptoms, the latter are a real killer, explains. This patient very difficult to treat, wouldn’t really talk; Harry was furious because after much deliberation decided that he would be detained and given an antipsychotic drug, usually given in the buttock; nurses not happy at this, said they had phoned the Mental Welfare Commission to check before they gave it to him. Harry reflects upon this. Recalls his very first psychiatric job, at Kingseat as a nursing assistant when he was a medical student. Reflects at length on the changes in the way patients are treated, including from personal experience when he had his prostate removed, getting more information than he needed. (2:10:05) Explains about his role from 1994-99 as Chairman of the Scottish Eating Disorders Interest Group. Initiative came from Edinburgh, consultant Chris Freeman; key thing, involved clinicians of all professions, and carers and patients; explains how group operated and met, usually in Murray Royal Hospital in Perth. Explains about Chris Freeman’s skill at orchestrating people. Mentions the Needs Group, a self-help group in Aberdeen. Talks about being on the Trust Discretionary Points Committee from 1996-2006, which he chaired for four years. Explains about gradations of consultants, about money, for excellence, higher awards run by the profession; not sure it still exists in Scotland; how the system operated, the lower awards became restructured into Trust Discretionary Points, explains; NHS Grampian Healthcare Trust. Harry talks about chairing the committee, and keeping the management in order. (2:17:22) Talks about in 2001 being a member of a working group on services for eating disorders in Scotland, set up by the Scottish Executive. Explains he was part of a fairly narrow interest group in eating disorders, thinks he was the only paid consultant in this in Scotland at that time; was beginning to be able to exert pressure through the Royal College of Psychiatrists. Explains what would happen; and his realisation that people in the Health Dept did not know anything about developing health services. Addresses question of whether Aberdeen as a medical centre has made any contribution to the field of Mental Health. Refers to his written history of the Dept of Mental Health, and the psychiatric services as they developed in the 1950s, 1960s and 70s; big change in moving away from the dominance of the mental hospital, explains. Thinks that through his father and the Dept, Aberdeen made more movement than other parts of the UK during that era. (2:22:10) In the 1970s and 80s Aberdeen did pioneer the use of brain-imaging in psychiatric disorders, thanks to the work of Prof Mallard and Medical Physics. During his time thinks that getting the in-patient unit for eating disorders up and running was ahead of the game, explains; before that he was reluctantly making referrals to private psychiatric clinics, the Priory in Glasgow, and Huntercombe in Edinburgh. Harry managed to make case for saving money by having beds in Aberdeen, explains. Talks about critical mass of population needed to produce number of patients you need to have expertise in one place; led to development of an in-patient unit for South-east of Scotland. Explains what happened in East of Scotland. Talks about importance of managing to maintain a centre of psychiatric practice in Cornhill; enormous benefits for training, explains. (ENDS 2:30:09)
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