General psychiatry, still in no-man’s land after all these years

This article by Dr. Martin Deahl (psychiatrist) has been published in the British Journal of Psychiatry. It begins:

“In 1997 Trevor Turner and I published an editorial in this journal that we titled ‘General psychiatry in no-man’s land’, outlining the trials and tribulations of our work at that time. More than 25 years on I thought it timely to write an update to the sad state of affairs at that time. On the cusp of retirement, I had hoped to report improvement, or at least see light at the end of what has been a very dark tunnel. I reflect on my 38 years in National Health Service (NHS) psychiatry and make a plea to the Royal College of Psychiatrists, the NHS and the government to seize these issues and improve the status quo.

Postgraduate training then and now

In 1985 I commenced postgraduate training in psychiatry at the Maudsley Hospital, London. In addition to my workaday routine, the highlight of my first job on an adult general ward was being allocated one particular patient by my consultant trainer. 18-year-old Elizabeth had been referred with a first episode of a psychotic illness. My remit was to get to know her, her family and her life story better than anyone else, corroborating her history with third-party informants, including school reports and interviews with significant others in her life. Medication free, she remained in hospital for nearly 2 months while my painstaking detective work proceeded. Finally, I had the opportunity of presenting her to my consultant and multidisciplinary team – a 3-h interrogation exploring her psychopathology from multiple perspectives in what was a thorough biopsychosocial formulation. The conclusion – diagnosis and treatment: first episode of a schizophrenic illness, antipsychotic medication, education of patient and an appropriate care-plan and follow-up. Ostensibly, the same result could have been achieved after a routine 1-h assessment. The point of the exercise was to teach me a holistic biopsychosocial approach. However, what it also achieved was trust, empathy and familiarity, creating a degree of concordance that would otherwise not have been possible, a consensual, rather than coercive, therapeutic relationship that became the bedrock of her subsequent care. Elizabeth and her family actually appreciated the experience, the care, the thoroughness and assiduous attention to detail which, they felt, more than justified her lengthy in-patient stay …”

You can read more from here.

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