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Dr. Perfect: Meet Dr David Graham

At Mr. Perfect we regularly communicate our non-clinical purpose, but of course, seeing a healthcare professional if your mental health becomes poor is a vital part of your strategy and toolbox. THEY are the experts.

So here is our Dr. Perfect series, and you may not be surprised to learn that healthcare professionals such as GPs, Psychiatrists and Psychologists need as much support, connection and community as we do, and want it for us too.

This post is one that pleases me more than most, as I have met this great human and keep in semi-regular contact, being someone I admire.

Meet Dr David Graham. Depending on how you count it, Dave is embarking on his 3rd or 4th career. After completing postgraduate research in mathematics he spent the next decade working for Defence, which included deployments to Afghanistan and the Middle East. He’s now a Psychiatry Registrar, a research fellow, a fiction writer, and loving life as a dad of three.


Terry: How did you hear about Mr. Perfect?​

Dr Dave: It was actually over coffee with you back in 2015. I was a medical student and you and I were talking about mental health. I don't remember how we met, maybe Linked In through a common connection.

I wasn't sure which direction I'd take with medicine, but was interested in psychiatry. I'm not sure when we got onto your idea for Mr. Perfect, but you slid your new Mr. Perfect card across the table and sketched out your idea. I thought it sounded pretty cool and offered to write a few blog posts. ​I think I still have the card!

Now it's so much bigger than it was back then, with so many BBQs across Australia and MRP FC. It's amazing what you've grown. I've recommended Mr. Perfect to a few patients who I felt could benefit from the support offered by Mr. Perfect.​

Terry: What made you choose the medicine specialty you did?​

Dr Dave: It's hard to pin down the factors that contributed to my decision. I love psychiatry. I really enjoy seeing people at their best, after overcoming their battle with mental illness. I enjoy being there at their darkest moments. I enjoy really getting to know my patients, their hopes, their dreams, their journey along the way. ​

Medicine is a second career for me. A touchstone moment came before med school while I was doing some work in Afghanistan. I remember talking with a young commando about his tour. His thousand yard stare said so much and the trauma really resonated. He really opened up over ice cream in the dusk heat outside the special operations mess.

I don't remember how many tours he'd done, but he'd been shot 4 times and lost 4 friends. And there was no down time at the end of the tour - he was going straight back home to counter-terrorism operations. He talked of the family break downs and there was a sense of despair glimpsing through the duty he felt he owed.​ I've since had friends who were medically discharged with PTSD and endure a daily battle with their invisible wounds.

I think he had a big influence on my choice of specialty, and in the last few months with Defence, I ended up scouring the literature on PTSD in soldiers who had been involved in roadside bombs blasts. But I also think I would have landed in psychiatry anyway as I'm very interested in the human condition as understood through philosophy, art, and literature. Plus I think that having made a few big mistakes in my life helps build an authentic alliance with people at their lowest ebb.​

Terry: If there was one superpower you wish you had for patients, what would it be?​

Dr Dave: Having more time.​

Terry: What does connection and community mean to you?​

Dr Dave: We're social creatures. We evolved to live in groups, and the weight of evolution has deeply ingrained that into us. We grow through interpersonal connectedness. We become who we are through our experiences and our relationships. And these vibrate throughout our lives - we bring an image of our community with us, through patterns of behaviour that we may not even be aware of.​

Social connectedness has been well-established to enhance mental health. But is it really enough? As a patient of mine once said, "it's not being alone that hurts, it's loneliness." Connecting people together in a community fosters belonging; loneliness is about that (lack of) belonging.

Yet a community is so much more than connections. Whatever shape that community is, in whatever realm of reality or virtuality, together in community, we create a shared narrative with a shared stable of signs and symbols and rituals. Through that narrative, we create meaning from hardship and develop a better understanding of who we are in context with the community. And so, with a place in the world, we can feel empowered.​

Community creates a safe base. As we grow from infancy through childhood and onto adulthood then old age, the span and nature of that community changes. Along the way, different brain structures mature, enabling us to engage in different ways with increasing complexity. This engagement establishes and strengthens brain circuits that foster social connectedness, which in turn open up new communities.​

There's a flip side: it can be disrupted. ​

Trauma (particularly childhood trauma), mental illness, drugs, neurological pathology, and so on, all disrupt these brain structures and brain circuits. Depending on the brain structures and circuits, this disrupts the capacity to connect, and social withdrawal follows along with loneliness, which further deepens the withdrawal and the disruption of structures and circuits. You literally become hardwired to repeat that pattern, and with repetition, the wiring becomes stronger to the point that you anticipate rejection and expect to remain lonely.

To be sure, depending on the disrupted brain circuits, you may not actually be concerned about connection or community. And that neurodiversity is ok. The problem is when it eats away at your very sense of self, or your behaviour patterns unwittingly destruct your precarious world.​

Reconstructing a community is the key to recovery. After all, we bring an image of our community with us. So building the scaffolding through community helps to build the capacity to connect, which in turn rebuilds the brain structures. Start from the top and work your way down accepting the dignity of risk. It's a long process, but building those brain structures was a long process anyway.​

Terry: If you had one piece of advice or quote that you think is helpful in times of struggle, what is it?​

Dr Dave: "There is no sun without the shadow, and it is essential to know the night." Albert Camus.


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