Sigmund Freud said that a psychiatrist was someone who taught people to stand on their own feet while lying on a couch.
Some wag within the profession itself was more cynical in defining a psychiatrist as a doctor who couldn’t stand the sight of blood.
I have known and worked with a range of psychiatrists. They were a motley but fascinating group.
Because of my own background, the ones I knew all worked in the addiction field. One or two of them worked in the private sector with clients who had the money to pay. But most of them were in public health across a range of facilities, from hospitals to drop-in centres.
One worked in Africa for a time and returned to Ireland raging against the hierarchical medical structures he found here, wherein nurses and other professions were treated as handmaidens to the doctors.
He talked about the waste of human potential he found in Ireland.
Another one, Anthony Clare, was famous for his Radio 4 programmes In the Psychiatrist’s Chair. He had lots of experience treating alcoholism and drug addiction but he often said that addiction services both here and in England were the Cinderella of the health service.
Sadly, those two and most of the other psychiatrists I knew are dead or long retired. I would be fairly certain that all of them would be shocked and saddened at the increasing number of deaths from drink and drug use.
The numbers were growing in their day, but the extent and depth of the addiction problem and the rise in the availability and the normalisation of illegal and legal drug use is frightening.
The amount of money that alcohol and drug addiction costs the health, police and prison service would blow your mind.
In my infrequent sorties nowadays into discussions and conferences about addictions in Northern Ireland, I see and hear fewer psychiatrists from the north. There is a reason for that.
Starting about 20 years ago, the statutory health service here withdrew from what is called rehab, residential treatment, and left it to the voluntary, community sector.
Older readers from Belfast will remember Shaftesbury Square hospital. It did detoxification followed by a six-week rehabilitation programme. I still meet people who remember Noel Moorhead, the psychiatrist who was the director.
The Department of Health closed it down. Omagh and Downpatrick hospitals once had programmes similar to Shaftesbury Square. They are now doing detoxification only and something called stabilisation, a process that my psychiatrist friends would probably scratch their head at.
The reason given for removing statutory services from residential treatment was that it was too expensive and that a more light-touch approach would reach more people and would have similar outcomes.
There is some truth in that but there is also a good deal of blindness in it.
Psychiatrists have now been mainly corralled (allowed themselves to be corralled?) into detoxification services, which is the medical consequences of addiction, or into managing drop-in services.
Those memories came flooding back when I attended a recent event which included the launch of a consultation into the quality of addiction treatment in Northern Ireland. Memories that evoked some sadness and some anger in me.
In the document that was being put out for consultation, there was no mention and little understanding of that history.
Statutory organisations are famous for the cliché that we must learn from our mistakes.
It was probably a mistake to close the statutory addiction facilities.
It was a mistake to allow such a gap to develop between the statutory and voluntary services.
I consider it a mistake that psychiatry in Northern Ireland has allowed its voice be removed from the public square and debate.
The present series of Reith Lectures on BBC are being given by a psychiatrist. She is talking about violence and evil.
The public square in Northern Ireland, including psychiatrists, need to be talking about the storm of addiction that is showing up on the weather map.