“What are Psychiatrists for? Articles in Guardian - join the debate online”

What are psychiatrists for? – a personal account from Jonathan Naess, Director of Stand to Reason (online blog and related articles – see links at the bottom of this page)

After 200 years of the term “psychiatry” first being coined by the German physician Prof Johann Christian Reil, psychiatrists have taken the opportunity to ask some very fundamental questions of themselves and the service they provide.

To be honest I was brought literally kicking and screaming to this subject. Some are born to be psychiatrists, but I had my interest in psychiatry thrust upon me when I was a sectioned. The independent psychiatrist who interviewed me before reporting to the tribunal where I was subsequently successful in having my section overturned, brought the meeting to a close by saying “Now let’s meet your consultant and find out whether he is one of these psychiatrists who think he is God”. For almost as long as the term has been around, patients or service-users have been asking “What’s the difference between a Psychiatrist and God?” The answer of course is that at least God knows he isn’t a psychiatrist.

Dinesh Bhugra the new President of the Royal College has shown great humility though when he launched the College’s Fair Deal report this week by putting psychiatry to the acid test. He has made it perfectly clear that he would not use an acute psychiatric ward and neither would he let any of his relatives. What greater condemnation can there be?

The report will be welcomed by many of us with lived experience of the system who have been crying out for those at the top of the hierarchy to join us to campaign actively to reform a service that, in the College’s words, “fails to encourage recovery” and runs wards that are “dirty”, “over-crowded” and “unsafe”. When I tried to escape from the first psychiatric ward I was sent to, it is a chastening thought to think that the President of the Royal College might have done exactly the same, albeit for different reasons. When I later complained about the lack of any meaningful engagement from the nurses (who sometimes preferred to hide behind the glass reading the tabloids let alone provide counselling or talking therapy) I was told to be quiet and be grateful because if I had been in Africa I would have been tied to a tree.

The report also rightly acknowledges much that is positive in the reforms that have taken place over recent years. We have moved on from “normalisation” in the 1980’s where at its worst people were simply taken out of institutions and dumped. Giving someone a roof over their heads in the community did not give them a “home”, or a job, or a life. Rachel Perkins one of the trustees of Strand to Reason has argued with her co-author Julie Repper that “any services, or treatments, or interventions, or supports must be judged in these terms – how much do they allow us to lead the lives we wish to lead?”

There is undoubtedly a backlash though from some psychiatrists who reject the recovery model out of hand. These views can offend psychiatrists, which is surprising only if we do tend forget that they are only human beings after all. Others like Professor Nick Craddock, the eminent psychiatrist at Cardiff University who has done great scientific research in the field of bipolar, recognise the value of the psycho-social contribution but has written passionately today with others in the British Journal of Psychiatry that they feel this has come at the cost of downgrading the importance of medical or scientific evidence-based research. They believe that taking the medicine out of psychiatry may in turn do patients great harm and are concerned that although the understanding of psychiatric diseases steadily increases, recent moves away from biomedical approaches to psychiatric illness will further marginalise and stigmatise patients in comparison with those suffering from non-psychiatric illness.

Have I been humiliated, patronised and abused by the system? – Yes. But do I want to write off all psychiatrists and medicine? – No. Many of them are trying to do their best with limited resources and some of them by the way are very good. Personally I agree with Professor Craddock that when I am really sick I do want to be seen by a psychiatrist, but a psychiatrist who is both informed by the best medical research and understands that we are negotiating my treatment between us in order for me to achieve my goals. I also agree that medical research into mental health is grossly underfunded relative to the disability that it causes. The stigma of madness is the key reason why there is no major charity in the UK raising money to tackle an illness which blights so many people’s lives.

If we felt more comfortable about mental health and saw it unapologetically as another health issue then psychiatry would take a huge step forward. The drafting of a new constitution for the NHS is a wonderful opportunity to drive standards forward and ensure parity between mental and physical health. One simple improvement would be to ensure that like treatment for physical illnesses there are guarantees that people will receive talking therapy without spending more than say 18 weeks on a waiting list.

The common thread running through the entire Fair Deal campaign is that of a drive for equality. Work is needed to address the inequalities that people with mental health problems and learning disabilities encounter daily in terms of their health, life chances and inclusion. And the report makes it clear that there is still too great a reliance upon pills and pillows. We will achieve this not by throwing out the recovery model but because of it. [Ends.]

Part of this article was printed online at the Guardian. Please join the debate with your views!
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Read also “Fair Deal” the excellent new report from the Royal College of Psychatrists link

Coverage in the Observer of Dinesh Bhugra’s very candid first interview as the new President of the Royal College of Psychiatry. “Psychiatric patients ‘feel lost and unsafe’” link

Liz Miller, trustee of Stand to Reason and winner of the Mental Health Champion of the Year award, and Peter Beresford were also quoted in Mary O’Hara’s article “Challenging the team ethic” that accompanies Jonathan’s article. link