Graeme Crawford SMITH (1939 - 2023)
Professor of Psychological Medicine (1983 - 2004)
The French philosopher, Rene Descartes, famously saw the body and mind as two separate entities. Emeritus Professor Graeme Smith, who has died two weeks short of his 84th birthday, was a psychiatrist whose work ventured into the realms of psychosocial advocacy and in doing so, bridged a gap between these two distinct worlds.
Smith was an early champion of consultation–liaison psychiatry; a subspecialty of the discipline that deals with mental illness associated with general illness in medical settings such as surgical wards, emergency departments and out-patient clinics. It was a grey area between medicine and psychiatry; an interface that he recognised was a no-man’s land in most national health care schemes. As he wryly noted: “Consultation-liaison psychiatrists are doctors who first alienated themselves from the rest of medicine in becoming psychiatrists and then alienated themselves from the rest of psychiatry by moving towards medicine.”
Smith established consultation-liaison psychiatry as both a respected academic subject and an essential clinical service in Australia, and was clinical director of Monash Medical Centre’s Adult Consultation-Liaison Psychiatry Service from 1999-2002. He had great insight into the breadth and depth of the biopsychosocial discourse, recognising that physical and psychiatric comorbidities, together with somatization – the manifestation of psychological distress through physical symptoms – are common, chronic problems in the community. He knew that psychiatric illness can affect medical conditions or conversely, medical conditions can cause psychological problems.
Smith came to Monash in its infancy in 1964, as a demonstrator in anatomy from Prince Henry’s Hospital where he was senior resident medical officer. He was the warden of Deakin Hall for five years whilst working his way up the academic ladder, becoming senior lecturer in the Department of Anatomy (1966-1979) and senior lecturer in the Department of Psychological Medicine (1979-1982). At the same time he kept up his clinical work at Prince Henry’s, eventually becoming in charge of the Adult Unit (1979-1990). Over the decades, he witnessed the transformation of the psychiatry unit from a traditional general hospital, skeletal in structure, to a comprehensive, innovative service, well-staffed with consultant psychiatrists, psychology, social workers and occupational therapists.
In both the early and mid-eighties he chaired the hospital’s Psychiatric Treatment Centre. In 1983, he was appointed Professor of Psychological Medicine, a position he held until 2004. At the same time, he was made head of the Department of Psychological Medicine which he ran for a decade. In 1987, he became Associate Dean of the Faculty of Medicine.
Colleagues were admiring of Smith’s ability to keep his clinical workload running parallel to his academic one; each informing and benefitting the other. He was, noted one, an “excellent clinician, a first class teacher and a good administrator.”
Smith’s early research was in monoaminergic systems of the brain, known to be involved in a major way in psychiatric disorders. After spending a short time at the Karolinska Institute in Sweden, he brought back to Australia the Falck-Hillarp method for the detection of monoaminergic neurons, becoming the first in this country to use the technique to study the monoaminergic pathways in the brain and the interactions between central monoaminergic and peptidergic neurons.
His results were amongst the earliest to demonstrate the regenerative capacity of the central nervous system aminergic neurons. In a notoriously difficult area of research, he tackled questions as directly as possible and his papers were known for reflecting good techniques, careful observation and critical assessment. Both the quality and quantity of his publications were said to be remarkable, and were often quoted.
As an academic leader and administrator, Smith was second to none. He was, noted a colleague, a master “of the art of the possible,” preparing his strategies carefully, taking as much advice as necessary and implementing it in a humane and nonabrasive manner. He was excellent with people, projecting a warm and understanding image which together with his own exemplary hard work inspired loyalty and enthusiasm in his team of colleagues.
Graeme Crawford Smith was born on February 15, 1939, at Camberwell, Victoria, the son of John and Christina Smith. He was educated at Surrey Hills State School, Box Hill State School and Box Hill High School before graduating MBBS from the University of Melbourne in 1961. He gained an MD from Monash in 1973, and a Diploma in Psychological Medicine from Melbourne University in 1975.
In his role as department head at Monash he initiated a formal program in psychoanalytic studies and played an active role in the foundations of the Monash University Neurosciences Group. Indeed Smith was, at the time, a rare bird in psychiatry; a medical scientist with a biological background who was also deeply interested and concerned at the psychological level. He had an open and enquiring mind in psychodynamic matters and could switch intellectually with ease between organic and dynamic psychiatry, persuading even the most ardent Freudian that the hormone cholecystokinin in the brain may be relevant to mental function. At the same time, he retained a sense of perspective about “chemical phrenology” and its possible pitfalls.
In later years he was an independent advisor to the Victorian State Government Multiple and Complex Needs Initiative, which targeted those people with disabilities in more than one health field for whom existing service structures were inadequate. He practised as a consultation-liaison psychiatrist and psychotherapist for patients with physical and psychiatric comorbidity, and was chair of national and international organisations in that field. Other publications of note included those on the psychological issues of kidney transplantation donation and receipt, demoralisation in the chronically ill, and group psychotherapy for women with breast cancer.
His illustrious career attracted many plaudits, beginning in 1964 with the Australian Medical Association Essay Gold Medal. In 2004 he was awarded The Royal Australian New Zealand College of Psychiatrists’ Medal of Honour for his major long-term contribution to a range of College activities, particularly for his leadership and promotion of consultation-liaison psychiatry in both the academic and general health sectors. He played a key role in establishing the RANZCP’s Section of Consultation-Liaison Psychiatry and was Foundation Chair (1992-2001).
Smith was an outstanding advocate for the training and education of health professionals, particularly in specialist psychiatry training and was a senior examiner for the Australian Medical Council (1997-2013). He was made a Fellow of RANZCP in 1981 and a Fellow of the Academy of Psychosomatic Medicine in 1998.
Upon retiring from Monash, Smith was appointed Emeritus Professor in 2005. He once mused that the decision to become a psychiatrist is probably the most radical choice a doctor can make. Yet he travelled frequently between the two separate worlds of body and mind that can exist in medicine, and found his place in both.
Graeme Smith died on 1 February 2023.
Edited version of article published 9 February 2023.
Photographer: Mark Ashkanasy