A valedictory

As in the rest of medicine, psychiatry is witnessing the demise of ‘the Prof’, a passing akin to Monty Python's ‘Dead Parrot’ (‘E's passed on! … 'e's shuffled off 'is mortal coil, run down the curtain and joined the bleedin’ choir invisible!!’). At his zenith (for the Prof was invariably male), the Prof conformed to a relatively firm stereotype – whether based in the UK, Europe, Asia, Scandinavia or other regions possessing a university department of psychiatry – albeit with a less distinctive expression in the United States. Nuances can be captured, in the spirit of warm reminiscing.

The Prof was considered to be highly intelligent, extremely academic, wise, and the fountain of all psychiatric knowledge. He was foremost a scholar and occasionally a polymath. Expected to be able to answer all questions relating to psychiatry as a matter of course, he was also, as an intellectual, observed to have a masterful knowledge of another discipline or field (such as natural sciences, botany, ornithology, rare books). His lamp-lit office would be bare and ascetic, apart from some memorabilia from Peru or Borneo, overflowing bookshelves, a desk dotted with writing aids (for example fountain pens, notebooks, exercise pads) and perhaps with his professorial ‘chair’ in a corner. His Christian name might be known … but was never used. He was ‘Prof’ in direct conversation and ‘the Prof’ by indirect reference.

The Prof was modest about his intellectual skills. If praised, there would be no narcissistic purring. Instead, he would gently demur and quickly change the conversation, being readily and genuinely embarrassed about any evidence or expression of conceit. As an intellectual, he was well informed about current political events, world history and travel, but quite uninterested in any football code. However, if questioned, he might enjoy contemplating whether he was merely ‘uninterested’ or ‘disinterested’. Just as his expertise in a theoretical field defined him, it also defined his academic department, and obliged department members to be ‘followers’ – knights, if not acolytes – thus risking intellectual incest. His knights would ever be simply profiled on the basis of which Prof they ‘trained under’.

The Prof evidenced one or more eccentricities: some mandatory tea ritual, a smoking implement, absent-mindedness, an overly contrived stutter or a dress style that was individualistic but just short of schizotypal status. He was thought to be asexual. Although generally in possession of a wife – also an intellectual – the Prof's spouse was rarely seen … apart from the ‘Prof's Christmas cocktail party,’ where she coordinated the mingling and otherwise demonstrated genuine noblesse oblige but offered no insights into her personal world. Few staff members ever contemplated the sexual life of the Prof; just as monarchs seem devoid of bladder and bowel, it was presumed that, in the Prof's world, intellect trumped instinct. Of course such reflections were self-monitored as intrusively gratuitous and an impertinence.

The Prof's scholarly bent, and being not quite of ‘this world,’ did, however, limit his capacity to head a department. In favour of convention and tradition, he judged that the department should function into the future as it had in the past and that procedural issues (such as lectures, assigning of academic tasks) were central. But lacking any entrepreneurial skills or interests, the Prof was barren of developmental vision, had little capacity to negotiate (other than via rational but often non-productive logic) with deans and vice-chancellors, had no interest in lobbying politicians and especially no wish to involve himself with ‘stakeholders’ (if he ever heard such a term, he would have been more intrigued by its bastardisation: he could be a pedant at times).

A new breed of professors

In recent decades the Prof has been overtaken and engulfed by a tidal wave of proliferating professors. There are now professors of all stripes: ‘associate’, ‘assistant’, ‘adjunct’, ‘honorary’, ‘titular’ and ‘retired’. Even distinguished sportsmen and businessmen – who might have never completed a university course, nor read or written an academic article – can be appointed ‘professor’ on the basis of their graduation address to graduates (and perhaps a sizeable donation to the university). Akin to a thousand flowers blooming, modern professors have germinated, sprouted and blossomed. But, devalued by omnipresence, the title of professor now has a much reduced meaning. Like most societal changes, such an evolution can be viewed positively and/or negatively, but I'll shortly argue in favour of the positives. How did such changes occur? Certainly not by revolution, but more a seamless evolutionary change. I doubt whether it reflected planning and thus it could not have been predicted. However, by applying the retrospectoscope, some speculations can be offered.

Universities and their departments long functioned in ordered ways, with their traditions reifying a sense of permanence, while their entrance criteria and fees weighted and promulgated elitism. Universities prioritised the provision of knowledge (not necessarily having any practical application) and academic excellence. More recently, government funding has ensured greater access across social classes, universities have ‘pacmanned’ lower-order (and often technological) educational facilities and so diffused their focus, and lack of funding has required universities to reorient their priorities (leading to their gratuitous description as ‘degree factories’). Students are now more likely to attend university to obtain more focused practical knowledge and a degree with some cachet and ensuring a higher salary – rather than aiming for academic excellence across scholarly and esoteric domains. Universities no longer stand alone, and are now forced to vie with each other for funds, fee-paying students and other competitive parameters.

As such changes filtered down to university departments a new academic ‘type’ emerged, albeit with additional nuances tailored to medical and psychiatric departments. Teaching and research became best approached as a team effort: those appointed to an academic position might be expected to have a specialty field of expertise but were no longer required to be a ‘Renaissance man’, or even a generalist. The ‘new’ academics (with women an increasing minority) needed an additional set of skills to handle the competitive key performance indicators (KPIs, such as numbers of papers published, citation numbers and research monies obtained from competitive grants). In medical faculties, a distinctive clinical contribution might be demanded and an academic psychiatrist with poor clinical skills could risk scorn just as much as the academic surgeon who lacked expertise in the operating theatre. Academics were required to move beyond prosaic job tasks (such as writing course proposals and curricular material, chairing subcommittees, examining) to address tasks that required entrepreneurial and political skills. Progression up the academic ladder now emphasises meeting the organisation's KPIs and is advanced by the academic having, perhaps, ‘successful sociopathic’ traits. Exemplar strategies include writing ‘salami’ publications, gratuitously including co-authors on publications so as to ensure reciprocal authorship and thus more papers, writing grant applications that are ‘sexy’ (for example ‘The impact of climate change on rates of domestic violence in minority ethnic groups’), and ‘working the room’ with stakeholders – especially politicians. At conferences, academics with such skills emulate politicians at a meeting of the United Nations – they arrive late and leave early in a distinctive limousine, schmoosing and elbow frotteuring colleagues of ‘high value’. New academia is old politics.

Such changes have influenced all university departments and disciplines to variable degrees. The transition has been distinctive in medical faculties, and here we can invoke one more factor. An academic life has few attractions for those who have been clinically trained. Income is generally lower and the individual may be condemned to a banal existence of unimaginative teaching and examining of students, and, if a researcher, will face belittling criticisms of their submitted papers and grant applications, all chipping away at their self-worth and dignity. What can a university offer as an inducement then? Money is paltry – if available at all. Status? But, of course, and the university plays its key card – according professorial status. However, if as noted earlier, professorial status is accorded so widely as to have little meaning, is that card an ‘ace’ or a measly ‘two of clubs’? And has that not contributed to the decline in recruitment into academic psychiatry as recently reviewed ^{Reference Lewis and Jorm1} and considered in a comprehensive publication? ²