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eLetters: Electronic letters published:
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Psychiatry’s Heartland
- Stephen Potts, Royal Infirmary of Edinburgh (6 September 2007)
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A case for synergy
- Raymond F Travers (25 September 2007)
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Stephen Potts, Consultant in Liaison Psychiatry Dept. of Psychological Medicine, Royal Infirmary of Edinburgh
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Stephen.Potts{at}luht.scot.nhs.uk Stephen Potts, et al.
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Goodwin and Geddes ask “What is the heartland of psychiatry?” and mount a cogent argument that bipolar disorder should replace schizophrenia as psychiatry’s defining diagnosis. But why is the question posed at all? Do neurology journals debate whether stroke, or multiple sclerosis, or epilepsy defines neurology? Do cardiologists dispute which of cardiomyopathy and coronary artery disease is their true heart land? Of course not: so what does it say about psychiatry, and its sense of identity, that the question is raised - and so prominently too? Maybe it's a matter of marking where the limits lie. For declaring a heartland defines a periphery, a distant fringe of far-off lands about which we know little and perhaps care less. Those remote regions of mist and myth are where we now find somatisation, personality disorder, addictions, and more. Each arguably causes more distress and disability than the combined effects of schizophrenia and bipolar disorder; yet since they are exiled from the heartland, they must be disorders of the provinces and somehow less worthy of research and clinical services. We should remember how Europe entered the Dark Ages: Rome and Constantinople bickered for decades over which was the true heart of Empire, and all the while the Visigoths were busy overrunning Gaul. |
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Raymond F Travers, Consultant Forensic Psychiatrist Tees, Esk & Wear Valleys NHS Trust
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adapa200{at}aol.com Raymond F Travers
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Millon (2004) noted that the study of the mind and the treatment of mental illness must incorporate a diversity of approaches. But this open- mindedness should not be an invitation to random speculations and ill- conceived notions; tolerance of diversity is not licence for intellectual sloppiness or scientific incompetence. Goodwin & Geddes (2007) rightly underline this when highlighting their concerns about the impact the National Service Framework for Mental Health has had on the delivery of UK psychiatric services. The authors offer a tantalising perspective of how services might have developed differently in the last two decades had schizophrenia not been identified as psychiatry’s defining disorder. Their contention that ‘things might have been different’ had Bipolar disorder been the focus instead, though well argued, is ultimately flawed. Skepticism is the beginning of wisdom for any science. The authors should have indulged in what Heidbreder (1933) referred to as “riotous thinking”. Their coupling of certain assumptions about psychiatry’s alleged focus on schizophrenia in recent decades and current concerns about its purpose is too reductionist to be persuasive. One of Stanislav Grof’s (1988) most fundamental teachings is that truth is usually upside down and backwards from conventional understanding. Assumptions and allegiances in psychiatry, like in modern medicine, have lost the very concept of synergy. Aristotle thought that every life form had an energy, a force, that he called ‘entelechy’ or autocompletion. Carl Jung and Abraham Maslow made similar observations; noting ‘individuation’ and ‘self-actualisation’ respectively (Shannon, 2001). The object of the patient’s art is to have the doctor incorporate healing in the process of curing (Lown, 1999). To heal requires a relationship marked by equality – a key element in a sound doctor-patient relationship – and reciprocal respect. We all go through seemingly endless experiences of disillusionment if we keep thinking and investigating as we go through life. The biggest misunderstanding comes from the placing of supreme value on a world view which lies in separateness, in matter, in materialism, in consensus reality. This hylotropic fixation ignores the ancient mystical teachings that there is another way of being which is primary and causal, which actually subsumes the separateness; the holotropic view that matter arises out of wholeness. The heartland of psychiatry should not be separated into competing diagnostic groupings such as schizophrenia or bipolar disorder. Focusing on diagnosing specific illnesses in order to choose a specific treatment only really works for acute conditions and falls short of any true healing for chronic illnesses (Servan-Schreiber, 2004). Psychiatric practice is above all about dealing with chronic conditions in individuals within given social contexts. Assisting our patients to overcome their chronic illnesses implies capitalising on all their mechanisms of self-healing. Aristotle, Nichomacean Ethics Goodwin, G.M. & Geddes, J. R. (2007) What is the heartland of psychiatry? British Journal of Psychiatry, 191, 189 – 191 Grof, S. (1988) The Adventure of Self-Discovery. State University of New York Press Heidbreder, E. (1933) Seven Psychologies. New York: Appleton Lown, B (1999) The Lost Art of Healing: Practicing compassion in medicine. New York: Ballantine Publishing Group Millon, T. (2004) Masters of the Mind: Exploring the Story of Mental Illness from Ancient Times to the New Millenium. John Wiley & Sons, Inc., Hoboken, New Jersey Shannon, S (2001) Integration and Holism. Handbook of Complementary and Alternative Therapies in Mental Health. S. Shannon, ed. San Diego: Academic Press: 21 - 42 Servan-Schreiber, D (2004) Healing without Freud or Prozac. London: Rodale Ltd |
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