RUSSELL Meares believes that only the likes of you and me, people whose minds aren't cluttered with arcane theories about psychiatry, will quickly appreciate his ideas about our minds.

In his opinion, much of the psychotherapy on offer today is mechanical, relying on a methodology rather than on the full potential of personal communication.

Meares, 71, is emeritus professor of psychiatry at the University of Sydney and head of the mental health sciences unit at Westmead Hospital in western Sydney.

He has led the development of a system of psychotherapy aimed at treating people with borderline personality disorder, a serious condition often written off as untreatable.

The borderline refers to a condition worse than neurosis but not as disabling as psychosis. Extreme mood swings, black-and-white thinking and intense fear of rejection are signs. Some estimates put those affected at up to 2 per cent of the population.

Those afflicted lead desolate lives, Meares says. They talk about feeling empty or disconnected or dead. What they lack is a healthy sense of self or consciousness, he says, and this is a different thing from a sense of identity, which is a socially constructed idea of the person you are.

The sense of self, according to Meares, means: "The ordinary feeling of existing. Most people have the feeling of more or less continuous movement of mental life - images, thoughts, imaginings, memories and so forth - which sometimes go on just as a background and are sometimes much more prominent. William James (the US philosopher and psychology pioneer who died in 1910) called it the stream of consciousness."

It is this flow within us that gives continuity - and meaning - to our experiences. Meares conceived of treating people in whom that quality is lacking with a system he calls the conversational model, which is intended to expand consciousness in patients who don't have an inner sense of connection with the world.

"The all-important thing about this form of therapy is the nature of the conversation between the doctor and the patient. The aim is to develop a different kind of conversation which has a natural flow but is ... working towards the depiction of the individual's emergent (new) reality," he says. "Essentially it's a homegrown psychotherapy system, the first psychotherapy system developed in Australia."

Years ago, Meares was at a conference in Washington speaking about his system to an audience of US psychoanalysts. He could see many in his audience scribbling away: "I could tell they were having some difficulty grappling with it." He was there with his daughter Amanda, then an art student, who had no particular interest in psychology. "She came up to me afterwards and said, 'That was good, Dad, but it's obvious."'

Meares is a distinguished psychiatrist in the US, having become the first non-American to be honoured with a lifetime career award by the University of California, Los Angeles.

Yet Meares's work has received little acclaim in his own country, although he has come up with what he says is a proven way to alleviate the suffering of people with borderline personality disorder.

"This condition was only formally diagnosed 27 years ago," Meares says. He and his colleagues at the Westmead unit produced the first outcome paper on its treatment. "When we sent it to The American Journal of Psychiatry, they didn't believe that these people could be helped," he says.

While generally regarded as untreatable, people suffering from borderline personality disorder have often been given all kinds of medication, Meares says. "It hasn't achieved anything. But you can't just take people off medication, they've become adjusted to it."

They're not psychotic, however. Instead of the medication being the main line of treatment (as it is with schizophrenia, for example), Meares believes that talking therapy should be the main treatment for those with borderline personality disorder.

There are a host of talking therapies. Cognitive behaviour therapy, probably the most widely used, is directed towards changing negative or maladaptive attributes. There's interpersonal therapy, which is similar to this. The most famous talking therapy is classical psychoanalysis, which is also directed towards changing forces seen as dragging a person down. Psychoanalysis, a long and expensive treatment that was once at the forefront, has moved to the periphery.

"Most of the therapies depend on the idea that the therapist is delivering some specific strategy or form of treatment to the patient," Meares says.

That's not what his conversational model does. "In this case you're talking about trying to restore and generate a state of consciousness. Because the brain is constantly reacting to the environment, the interplay determines the brain state, which affects the state of mind.

"It is the form of conversation which itself is the therapy. This is a peculiar kind of conversation which has some characteristics of a meditative state of mind ... the (therapist's) response in its essential form, including the tone of voice, resonates with the patient's immediate reality."

Meares and his colleagues at Westmead are analysing the analysts, so to speak, by investigating a range of therapies. He is making a rare appearance in the media, agreeing to talk to Inquirer because he hopes to expand the centre at Westmead and, with it, important research.

"The whole system has implications for understanding human consciousness and how it comes into being," Meares says at his home in Sydney.

The large light-filled apartment he shares with his second wife, Susanne, a neuropsychologist, overlooks the western reaches of Sydney Harbour. There are walls lined with books and paintings and photographs by two of his three children.

Daughter Amanda, an accomplished artist, illustrated the covers of his books The Metaphor of Play: Origin and Breakdown of Personal Being and Intimacy and Alienation: Memory, Trauma and Personal Being. Both are highly readable works in plain English. Meares says he writes for professionals as well as laypeople, including those with borderline disorders.

His idea that language is the medium through which the sense of self emerges draws on concepts that were around more than a century ago. James suggested that the feelings of warmth and intimacy at the core of the sense of self flowed from the interplay between a baby and its mother or carer.

These ideas were cast aside at the time of World War I, when there was a shift to a behaviourist approach in psychology, Meares says. The behaviourists distrusted what couldn't be measured as change. Ideas about things as nebulous and unruly as feelings of warmth and intimacy went right out the window and James became a footnote in the history of psychology.

However, when Meares was investigating borderline personality disorders, he went back to the idea that the sense of self was not a given but a kind of consciousness of ourselves and our place in the world that grows out of the proto-conversation between mother and baby.

His patients seemed to have been deprived of that interplay or to have suffered a series of psychic shocks. These traumas, as psychiatrists call them, are most obviously caused by physical and sexual abuse, but may also result if children are subjected to chronic disparagement.

"When you talk to the patients, they can describe being beaten," says Meares. "They can tell you that was something that was unpleasant. But they can't describe the atmosphere, they think it's normal."

Yet the reverberations of these painful experiences will cause a disturbance of the sense of self. "Instead of the warmth there's a painful feeling of emptiness, which is not in the standard definition of the borderline condition," he says.

"There are plenty of people in the world, there are politicians and people in the corporate world, who actually manage well. It's been said that the so-called psychopath, the antisocial personality, is a master in dealing with the environment, they can take people in and turn on the charm.

"On the other side of the ledger there's this internal desolation. People can talk about it when they come to see you."

One in every five psychiatric in-patients and one in every 10 outpatients can be diagnosed with borderline personality disorder. There are degrees of severity, of course. "The condition can cause desolation for the individual, wreckage for the family and huge consequences to the community in terms of costs of mental health," he says.

Inquirer has investigated cases where people with a history of suicide attempts have been turned away from mental health units on the grounds that they're "borderlines" and there is nothing to be done for them. In contrast, Meares and his colleagues are refining a method already shown to have some success.

It must be said that, for someone whose contribution is in developing the conversational model, Meares, whose own voice is somehow drained, seems a little detached from this humdrum world. His manner makes it clear he is a toff and the product of a sort of late Victorian upbringing. In chronological terms, he was a child of World War II and the Melbourne establishment. When he was young the family lived on the countrified edge of Melbourne. He says it was a paradise that, like all childhood paradises, inevitably came to an end. His father, a doctor, left for the front; he, his mother and younger sister moved into his grandparents' house: he recalls its hushed atmosphere and sense of constraint.

In later years his father, Ainslie Meares, would become a renowned if somewhat mystical psychiatrist. Once the younger Meares had graduated in medicine, he headed to London and sort of fell into psychiatry, studying at Maudsley Hospital in London with Jungian analyst Robert Hobson, who became a great friend. Meares says Hobson and he began to develop a model for the treatment of people with what came to be called borderline personality disorders. "They were the rejects of the system. People didn't know what to do with them. We were working in a country without maps," he says.

They worked together until Meares was offered an academic position in Australia. He continued to develop the conversational model over the following decades.

"I wouldn't want to be saying we can cure people," he says. "What we can do is to help people live better." That in itself is remarkable but his hopes encompass far larger ambitions. "In a way you would hope this would be able to bring back what you might call the soul, or the heart, of psychiatry."