Now in his 25th year at St Patrick's Hospital in Dublin - 20 of them as consultant - Dr Patrick McKeon (50), the new director, looks 10 years younger than his age and, rather than making sparks fly as he speaks, takes his time and occasionally struggles for words.
After concentrating initially on endocrinology while studying medicine at UCD, Dr McKeon got hooked on psychiatry during a six-month internship at St Patrick's former unit in St James's Hospital more than 25 years ago. He ignored warnings that someone with his ability should stay away from psychiatry, which had low status then. "I was attracted to the personal side of it, to interacting with people," he says. "Everybody is different, whereas with a heart or a liver, it's still the same old heart or liver.
"I find psychiatry more dynamic and interesting, and extremely rewarding from a therapeutic point of view. Seeing people suffering from enormous emotional distress having their symptoms eased is personally very fulfilling," he says.
An intensely private individual, Dr McKeon, the son of a businessman, promised himself at UCD that he would have two luxuries in life: a car (so he wouldn't have to rely on the bus service) and a wife who worked full-time in the home while the children were being reared. He got both. Dr McKeon's wife, Mary, trained as a pharmacist. While she no longer works in the field, she keeps up with the literature and knows more about the pharmacological effects of many medications than he does, he says. She has raised three children: Andrew (26), a doctor in his intern year at the Mater Hospital, Dublin; Catherine (23), a mechanical engineer; and Ruth (19), who is studying commerce at UCD.
In her spare time, Mary has been a "team member" in her husband's career, working closely with him at AWARE, the support group founded 10 years ago for people with depression and their families. The only other doctor in Dr McKeon's family was a relative who was a British army major and medic, and who encouraged him to study medicine. Dr McKeon suspects that the major, who saw action in the second World War, may actually have been a psychiatrist. "He was notorious for wandering off into German territory," he says, adding drily: "I hope it's not an inherited trait."
"German territory" is one way to describe the way some people who have been psychiatric patients feel about hospitals. Some accuse psychiatrists of being interested in no more than diagnostic labelling and drug therapies. Minds Matter, a consumer group, has criticised the psychiatric service for failing to take a holistic view and wants more talking therapy and community support.
These criticisms are all valid, Dr McKeon believes, though he also says that the "silent majority" who are happy with the psychiatric service don't speak out. Those who are dissatisfied, however, have a right to say so and should feel free of repercussions if they do, he adds.
A consumers' council is at the centre of his vision for St Patrick's Hospital. The 2,000 public and private patients per year who spend an average of 38 days living in the hospital should be encouraged to give honest critiques of the service and to influence its development, he believes.
Seeing psychiatric care as a consumer issue is about as far away as you can get from the dark, hopeless image that so many of us have of mental illness, an image that Dr McKeon is determined to change. We tend to see illnesses like schizophrenia and manic depression (which Dr McKeon calls by its less emotive name, bipolar disorder) as being chronic and incurable life sentences, which adds to the stigma.
Through AWARE, Dr McKeon had hoped to de-stigmatise depression, but he does not feel the group has been particularly successful. The current key mental health issue, for him, is that most people are still afraid to talk about their problems. Two-thirds of people who are clinically depressed do not consult their GP. "We still haven't managed to enable people who have depression problems to be able to speak openly about these things. My own gut feeling is that we've got to see this as an educational issue," he says.
He would like to see an "emotional education" programme in primary schools, teaching children how to deal with frustration, anger and anxiety through speaking about problems and learning relaxation techniques. He'd also like to see the "woefully under-funded" child and adolescent psychiatry services boosted so that young people can be helped to address their emotional problems before they develop chronic mental illness.
While he remains self-effacing and modest about his achievements with AWARE, Dr McKeon seems nonetheless determined to use his new position at St Patrick's to influence the evolution of Irish psychiatry. He thinks that we're only at the beginning of a social learning curve and that, by the next century, our understanding of mental health will be so enlightened that people will look back at the start of the 21st century and wonder why people still saw mental illness in terms of stigma and shame.
Along with changing public views of mental illness, Dr McKeon would like to see a further improvement in the atmosphere within the hospital for those who work there. There is an acute nursing shortage and a reluctance on the part of young Irish psychiatrists to train in this country. "This problem behoves us to look at what is missing here. And the first thing is: we must not have been listening enough," he says.
Low morale, absenteeism and staff unrest comes from dissatisfaction at work, which he wants to address by creating a "horizontal" relationship between hospital staff, so that psychiatrists, psychologists, nurses, social workers and others function together in multi-disciplinary teams. "By listening to the parties involved, I think we can make nursing more fulfilling. Nurses have so much to contribute. . . They are very resourceful people and most are doing postgraduate work, but the job description has not changed in accordance with their abilities," he says.
He will also be encouraging staff to engage in ongoing training to update their skills, with regular evaluations of their career evolution becoming part of the hospital's culture.
This holistic approach should mean that consumers feel they have a responsible role to play in their own healing process, with the back-up of a supportive team of professionals. Feeling like an equal partner can seem a contradiction when people have the power to keep you in hospital against your will.
When power is taken away from someone who is certified for their own safety, Dr McKeon encourages that person, once they are better, to understand why it was necessary and to thank those who committed them. In a stable period, people with recurring problems, such as bipolar disorder, can name one trusted person who is allowed to commit them or who is permitted to take away credit cards, for example, during a manic episode. This gives the person whose liberty is compromised some power over the situation.
Such advances in dealing with the reality of severe mental illness are made through psychotherapy, which for lots of other reasons too is crucial to people getting better. Dr McKeon believes that psychotherapy, cognitive therapy and behavioural therapy offer support, education and crucial practical help.
"Psychotherapy helps people to find the blind spot that drags them back to becoming unhappy in their lives. We all have blind spots and it does us good to know what they are. For people experiencing mental health problems, it is essential that they know what they are," he says.
So what's his own blind spot? "Talking to journalists," he quips.