What is the Difference Between a Psychiatrist and God?

The answer? At least God knows he is not a psychiatrist. Dinesh Bhugra, the new President of the Royal College of Psychiatry, UK, has recently stated that he would not himself use an acute psychiatric ward, nor allow any of his family to be placed there.

The answer? At least God knows he is not a psychiatrist. Stand to Reason is a UK organisation committed to fighting discrimination and changing attitudes to mental illness, led by people who have experienced mental illness and based on research. The director, Johnathon Naess, has written a plea for mental health to be treated on a par with physical health in the UK, and for conditions in many of Britain’s psychiatric institutions to be significantly improved. I think it is well worth reading, and the organisation itself worth joining.

Dinesh Bhugra, the new President of the Royal College of Psychiatry, UK, has recently stated that he would not himself use an acute psychiatric ward, nor allow any of his family to be placed there. He painted a picture of such wards as places in which people who need, above all, a place to feel secure and supported, feel isolated and unsafe. Naess refers to his own experiences in psychiatric “care” (quotation marks mine), in which he was told by nurses to “be quiet and be grateful because if I had been in Africa I would have been tied to a tree.”

Why is this the case, in an economically developed country in the twenty first century? The immediate answer seems to be funding and the priority given to mental health as a part of the overall health budget. This, Naess suggests, is due to stigma. Mental health is not seen clearly and “unapologetically” simply as a sector of healthcare.

Is this because there has been too much emphasis on something we could loosely call the psycho-social recovery model, emphasising the importance of community integration rather than institutionalisation, and talking therapy over the medical model? Some psychiatrists say yes. They feel that medical research in the area of mental illness is under-funded relative to the prevalence of mental illness and the damage it causes to individuals and society, and that the results of research are explicitly downgraded, to the detriment of those who suffer from mental illness.

I am convinced that the causes of mental illness are extremely complex and hugely variable. Sometimes, as the anti-psychiatrists argued back in the sixties, such an “illness” may be a painful transformation from a damaged place, a kind of mystical voyage, or may be construed as a sane response to the insane requirements of family set-ups and society as a whole.

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Such an experience may also be a perfectly logical response to living in circumstances of social deprivation, or the lack of any sense of stability (children who have spent their childhoods moving around between care homes and different foster families have high rates of mental illness), or a reaction to abuse. Or a mental illness may strike a successful professional out of the blue.

There may be a clear organic cause which is fixable by medical means, which does not relieve the psychiatrist of the responsibility to treat the patients with respect as partners in the endeavour. Nor does it mean that social and relational conditions do not matter. Sometimes the clash of biology and environmental factors proves too much. It seems certain that the more we research mind and body connections, the more they prove to be inextricably linked. This means, in my understanding, that treatments need to work on all levels too. So much suffering is caused by not being treated as a whole person, both before the onset of a mental illness and afterwards in treatment.

In the last analysis the important thing has to be what works. Respectful treatment of people, as far as possible as equal partners, in reasonable living conditions, obviously yields better results than herding them into crowded dirty places and leaving them largely to their own devices, surrounded by others who also feel desperately out of control of their own lives and minds. This in no way negates the necessity to conduct research into medical treatments and freely publicise the results, demystifying in the process of those psychiatrist “Gods”. The more information, the better choices can be made.

Maybe you do have to be God to truly understand mental illnesses, their causes, effects, and the dreadfully isolating experience itself. But you do not have to be God to work out that there is a better way of treating those who suffer them than this.

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