So you want to be a rock 'n' roll star?

Rick Fraser argues that early training in rock music will put you in good stead for a career in youth psychiatry

I can remember my dad saying to me that I shouldn't worry too much about where I was heading in life because in the end I would get to where I was meant to be. In retrospect, he must have been a bit of a Buddhist although I don't recall him wearing hippy clothes or anything like that. Otherwise, in some ways I think he was probably right. Although some people might not agree, I would argue that my years spent playing in a rock 'n' roll band were not wasted as far as my psychiatric career is concerned, and this is why.

Between rock and a hard place

I started my own adolescence as a bit of a nerd but quickly realised that music really is a universal language. I bought an electric guitar, learnt how to play, and got in touch with the part of me that was into making music. A longstanding desire to be a doctor now had to battle with a new desire-to be a rock star.

Full circle

I made it through medical school in London, and after doing my house jobs took a year out to really concentrate on the music. One year became several. The band toured the United Kingdom a couple of times-sweet memories of our old blue van, and the British countryside rolling past. I've flown and I've fallen. I ended up writing and producing, working in New York and Paris, and building a small studio. I still felt incomplete. I decided to return to medicine. Intuition perhaps steered me towards psychiatry where my musical abilities and experiences seemed to make sense. After basic training I specialised in child and adolescent psychiatry at the Maudsley.

Clinics are a bit like gigs

In psychiatry, as with all medicine really, there is a "bums on seats" principle governing our effectiveness as clinicians. By this I mean that if we are unable to engage and retain patients then no amount of drugs or other interventions will make a difference. One difficulty in psychiatry is that our patients do not always believe they are unwell or in need of any help. The first couple of minutes with a young person can be make or break. A bit like a gig really. You can't go in too strong. You can't be disinterested either. Too loud and you'll scare them off. Too quiet and they're bored. Pace is so important.

A PhD in hanging out

Of course it helps if you have a set list; however, what do you do if you've got a rock set and the crowd is clearly hip hop? It's all about flexibility, acceptance, just "being" for a while and finding some common ground. To actually know what it's like to play in a band puts you at an advantage. You don't have to say as much; in fact that would probably end the session right there. No, young people know when you are for real and they have a natural intuition far superior to ours to acknowledge that this is important. It can't be faked. Something else you get from a few years on the road is a PhD in hanging out. Then when you're all ready you can start to find out a little bit more about what's going on.

Striking a chord

When we talk to someone there are several levels on which the communication takes place. Not only is the content important (the lyrics) but also the form (the music). Through the "music" we are able to access some of the emotions the young person has hitherto been unable to verbalise. I remember very well the power of a few guitar chords-with the bass and drums that was all we needed to communicate anger, sadness, happiness, frustration, hope. Add to this the "lyrics," and the "song" is starting to take shape.

Crying over Kylie

A "song" can be played in any number of ways. It all depends on the context. I recently heard a version of Kylie Minogue's Put Your Hand on Your Heart and Tell Me performed by José Gonzalez, and nearly cried. In psychiatry the context is crucial. Sometimes to close your eyes and really listen to the "song" can tell you so much.

A different tune

So how to proceed? Having played all manner of pubs, clubs, and bars I've developed a sense of being able to gauge the temperature of a gig. You need to be able to reflect something back that will show you have understood-empathy-either that, or the beer cans get thrown. As I said before, it's bums on seats. And here's the crunch-how do you maintain engagement when the young person doesn't want to? Play louder? Play quieter? Certainly don't panic. Play a different tune. Tell a story. There's nearly always time; it's just a question of whether or not you're prepared to take it. Sometimes you do have to postpone the gig.

Not the same old song

Working with young people is exciting and rewarding, where no day is the same as the last, a bit like being on tour; I know that musicians often complain about how one town looks the same as another, but I don't think they're looking hard enough. Similarly, no person with psychosis is exactly the same as another-especially when you listen properly to their song.

And in the end

I guess my dad was right. The path I've taken makes perfect sense to me now; in fact, I think being in a rock band should be part of the training for all adolescent psychiatrists. I'm getting that urge to go out and play some loud music again.