In this edition:
- Festive Glamour: When the festive season throws you an occasion, you need to glam it up.
- Andrew McUtchen looks for fun in cricket with former Australian cricketer Damien Fleming.
- Take a look at our Christmas Gift Guide.
At school I was playing with a kid and she fell over and skinned her knee, she says. I took her to the basin, washed her knee and took her into the teacher, who said Ooh, thats a very good job, maybe you should become doctor when you grow up.
It was one of those chance comments. Ever since then I became extremely interested in anything medical. I fell in love with Hawkeye Pierce from M*A*S*H. He was just brilliant.
The wisecracking medico in the emergency tents appears at first glance an unlikely early hero. That is until you spend some time with Professor Kulkarni and witness her warmth and dry wit. It is no surprise to know that compassion and a capacity to listen have been two of her greatest assets in her groundbreaking work in womens health.
Professor Kulkarni is the director of the Monash Alfred Psychiatry Research Centre and the founder of the Womens Mental Health Clinic at the Alfred Hospital. Her breakthrough research on the impact of sex hormones on a persons mental state and vice versa have led to new hormonal treatments for mental disorders and eased suffering and confusion for
many women struggling to understand what they were going through.
I was a registrar at Royal Park (Psychiatric Hospital) working in the long-stay ward, she says. I was listening to some of the stories and it struck me there was a lot that wasnt done well and could be done better. In particular, the plight of women really struck me. I had a lot of concerns that there wasnt enough attention paid to womens health.
There were pointed reminders of the interplay between the hormones and the mental state. For example, there were women there who had been perfectly well until theyd had babies, and then they developed very profound psychotic illnesses and had just never really recovered.
I thought there must be a way that we can explore the link between the hormones and the mental state but also not just understand that link but harness that to come up with better treatments.
Professor Kulkarni conducted her first oestrogen trial in 1992 and published the results in 1994. It was the first time oestrogen was used as a treatment for psychosis.
Since then its been a really gratifying experience, she says. The women with psychosis have an amazing resilience and an amazingly inspiring capacity to overcome. Ive been involved with patients who have active symptoms, quite profoundly impaired by the symptoms. One woman worked double shifts at McDonalds because she wanted to get money to buy her son a bike for Christmas. It was just extraordinary to see. She participated in the oestrogen trial. I was amazed by her story. (She was a) single mum. She had the onset of her illness in the postnatal phase. She single-handedly raised the boy and did brilliantly. The treatment was great for her.
Professor Kulkarni has been rewarded by the chance to watch womens lives change. Comments have been Thank goodness youre doing this work, thanks for listening. One woman had 20 years of auditory hallucinations voices which just wouldnt go away no matter what treatments had been tried. Three days after she had the oestrogen treatment the voices stopped. It was miraculous. She has never looked back. She went from being in hospital with a very poor quality of life to working, being able to enjoy life.
There are quite a few (women) who stay in my mind. Some women made comments (such as) I have noticed that every month, premenstrually, the voices were louder, the delusions were stronger, everything got worse, and Ive told many doctors this but it didnt get taken into account. So when I said Im interested in trying a hormone treatment there was this incredible gasp of relief. One woman said Isnt that particularly obvious that if the problem has, as Ive observed in myself, come about because of hormone shifts then using a hormone treatment is commonsense?.
When I started this work no one else was doing it. There was quite a bit of Youre doing what? There was a little bit of That doesnt quite gel.
Professor Kulkarni had connections to researchers in Germany who were working with animals, so she looked at some of the work they did and applied it in humans. The patients feedback was great. Wed say What have you observed? I think we completely underestimate the observations, the intuitions the person experiencing the illness has and their family. Theyve got a wealth of information and we are more than happy to be collaborators on the project, and thats how we see it.
Professor Kulkarni expanded the program to look at the impact of reproductive hormones oestrogen and progesterone on all kinds of mental-state changes: Started with schizophrenia, have moved into depression, post-traumatic stress disorder and borderline personality disorder and some of the other conditions.
Jayashri Kulkarni was born in India and migrated to Melbourne with her parents and younger brother when she was three. Her grandfather and uncle were medical practitioners in India. Her father was a research scientist who was asked by the Australian government in the early 1960s to set up the ozone research program for the CSIRO. He predicted the ozone depletion by mathematical formula in the 60s, she says. He was going to be here for two years to get up the research and then go back but loved it so much we stayed.
The family lived in Parkdale. After Parkdale State School, Kulkarni attended Kilvington Girls Grammar and then Monash University. During medical school in second year we had the most brilliant psychiatry lecturer who used to lecture on depression, schizophrenia and various other disorders, she says. He was very inspiring. It evoked a lot of interest.
She enjoyed mixing research with hands-on involvement with people. That way you would get to know people and work at a much more meaningful level with a patient.
It was not a crowded field. No one else was particularly interested, she says. It was the daggy part of medicine. It was the Cinderella of the medical profession. Everybody was interested in surgery and the more technical end of medicine. I would go in in my spare time and hang around the psychiatry wards.
After graduating she became interested in working in an emergency department. It was great. I was the senior admitting officer at Prince Henrys Hospital in the casualty department.
But she needed change. It felt you were one part of an assembly line and you would patch people up as quickly as you could and obviously there were times when your interventions saved lives but I wanted to work more in-depth with patients. Prince Henrys had a training program for psychiatrists and I joined that. Ive met a lot of inspirational psychiatrist who over time have had great influence in helping me train first and then develop the research interest.
At Royal Park Hospital she worked closely with 2010 Australian of the Year Professor Pat McGorry setting up the early psychosis program.
Her work later led her to look at the contraceptive pill. We have a real problem, she says. The oral contraceptive pill, which is widely used, is awful for creating depression in a significant number of women. This feedback came back from women experiencing depression when they were on a certain kind of pill. Were doing a study now to find out what is the least depressive pill to the most.
She says the link between depression and the pill is in that point where theres a lot of anecdotal evidence among women millions of women around the world, so its not a small group but it has not received the level of research attention. And Im stunned that it hasnt because weve had the pill for more than 20 years now and its so widely used and its fantastic for women to have control and men so women have control over their reproduction, but the depression that women experience is widespread.
The women know about it and yet we dont have good clinical trials. I think women need to understand that if shes feeling depressed on the pill that she needs to go and tell her family practitioner to say Try a different brand, try a different kind of progesterone in the pill . The first step is to validate her own finding, and thats been an issue. Many women have said to us Ive told three different doctors and they all say Well, youre just complaining or youre just whingeing or its not true?.
Often a lot of the research we do is about empowering the observations of the women themselves. That keeps driving us, and it makes you feel incredible because with a small action you can make a big difference sometimes.
Professor Kulkarni says she has been blessed in a lot of ways, one of which was that her parents valued education beyond everything. Her mother taught science at Bonbeach High School.
But life in Australia wasnt always easy. It was difficult for them in some ways. Asian immigrants (as families) were very few.
My parents had an incredibly positive attitude towards it all. They met with a lot of positivity. I remember mum coming to the primary school and teaching kids how to put on a sari. So there was an interest in a different culture. Occasionally there were racist comments made to me and my parents were very good at turning it around and dealing with it. I think I was encouraged to say Yeah, yeah, OK, bit of a problem for them, dont worry about it. I was a very good student so I got a lot of positivity about that.
Professor Kulkarni has two daughters: a 23-year-old who is studying law at Monash, and a 16-year-old in year 11.
Outside work, running is a passion. I was pathetic at sport at school, really hopeless. We played softball and Id be out on the outfield making daisy chains and the ball would come my way and Id run in the opposite direction.
I discovered I really enjoyed running. Ive done three marathons, last one last year. She tries to run three times a week. I have a daggy running tape, Eye of the Tiger, Rocky, AC/DC. Youre running along thinking Is my knee hurting, is my hip hurting? and then Rocky comes on and you forget about it.
I ask whether her daughters feel a connection to their Indian heritage. A little. Not so much. My husbands a fourth-generation Aussie. Its more family connections rather than heritage connections.
She loves crap films and loses herself in feelgood comedies. I think its possibly because we hear a lot of sadness and awful stories in the clinic. People think youre academic so you must be reading philosophy and I dont like to tell them I like to lose myself in comedies. I want to see The Dictator.