When a psychiatrist stops crying…

I’ve attended many conferences at which I met psychiatrists, attending the International Congress of the Royal College of Psychiatrists, however, was my first psychiatric conference. It was an interesting experience, so I would like to reflect on it here. I will start with the good things, then I will say a little about the bad things, and then I will write about the session I participated in.

Before I start, I want to stress, that I am writing about my impressions, I do not presume to write a true and accurate report. This is only how I saw the congress.

Over the years, I’ve been rather surprised by psychiatry. Yes, I’ve seen and acknowledged, shall I say, psychiatric concrete, unmoveable in its certainty about things, but more often than not, I’ve met psychiatrists who are (fairly) open to discussion, who understand the limitations of their discipline and do not fight tooth and nail for the need to maintain nosological codes for disorders. This has also been the case this time in London.

So, I’ve had many conversations both with academic shrinks and with clinicians, I’ve been rather smitten by their openness both to critique and to discussion about what they do and how they do it. But even though I understand that my sample of psychiatrists is limited, I still think it’s worth acknowledging that at the congress (and over the years) I’ve agreed with considerably more psychiatrists than, for example, with (clinical) psychologists whom I find much more entrenched in their views and reliance on measuring things. So, all in all, in London I met a group of (surprisingly) reflective shrinks who show me human, concerned psychiatry which I saw all those years ago in Krakow.

But the loveliness of my conversations with my psychiatric friends does not mean that the congress was only a source of joy. Actually, almost not at all. All too often I had the feeling of déjà vu seeing the same studies, beaten to death with one new variable. How many studies can you have on yourselves, how many new measures of the same thing can you have? I was looking at the programme and I saw studies which told me what I already knew or I didn’t want to know. And while I accept that I have a particular perspective on what I think is interesting psychiatric research, I still think that there is way too much navel gazing in psychiatry. Many studies reminded me of attempts to make tea sweet only by stirring it, however vigorously. I was gratified to hear a newly met psychiatrist say: I’m bored.

I was looking for at least some studies about people’s experiences, about suffering, distress, about humanity of mental illness and I was being disappointed. Biology rules OK, and I heard a number of comments that this was the most biological of congresses so far. If this is where psychiatry is going, I am sorry for psychiatry. I’m not a shrink, but I still think that not much beats a conversation between human beings. Even if one of them is a shrink.

So, having criticised, let me tell you a little bit about our session. Its title was “The new anti-psychiatry. Responding to novel critiques on the legitimacy of psychiatry.”. The session caused  trouble before we even travelled do London. The entire session was represented as an attack on PTM Framework and on critical psychiatry, of which neither was the case. However, the controversy provided publicity, so the turnout at the session was excellent. To be quite honest, I would have considered a quarter of the audience we had as great turnout.

I must admit that I was very apprehensive about the talk. I dislike speaking to the microphone, I try to avoid it as much as possible. I project my voice very well, but the room was too large to even attempt it. But above all, telling a large group of psychiatrists what I think they should do is hardly easy and I was nervous.

After Rob Poole’s introduction, first went Paul Salkovskis with his analysis of PTM Framework, then I presented my suggestion to espouse ‘traditional’ anti-psychiatry in psychiatry, last went Linda Gask with her account of social media maelstrom. Our papers took different approaches to the session’s theme. Paul started with criticising psychiatry and moved to his critique of psychology, I showed how anti-psychiatric discourse could be incorporated into mainstream psychiatry, Linda talked about debate in psychiatric and psychological discussions.

Before the session, we all thought (and probably hoped) that what we were going to say would cause some controversy and debate. What was interesting was that there was no controversy. There were no DSM/ICD warriors denouncing our critiques of psychiatry. No one shouted at us in defence of symptoms over experiences, or that psychiatrists are always right, down with psychology, serotonin forever! I was actually surprised with questions that were asked. Some were more probing than others, some were perhaps somewhat defensive, but on the whole I thought people wanted to talk, rather than ignore what we said, both about psychiatry and psychology. Of course, given that there were over a couple of hundred people in the room, it’s hard to know what most people thought.

Personally, I was delighted that a few people walked up to me and said nice things about my presentation and expressed interest in what I did.

Why was it like that? Catherine Robinson suggested it was because we made reasonable arguments. We didn’t want to shout psychiatry (or psychology) down, we wanted to make arguments for discussions. You can agree, you can disagree, but what we said were arguments that offered a possibility of debate. And it turns out that psychiatry (if I could indulge in a wild generalisation) is interested in reasonable discussion. This is very good news.

But I want to write about one particular question that was asked. We were asked about why there were no representatives of PTMFramework on the panel. And as the question was repeated a number of times also on Twitter, so I thought I’d have a go at responding to it.

First, I find the question extraordinary. Despite that only Paul talked about PTMF, the whole session was hailed as a session about PTMFramework. It wasn’t. Second, the idea that you can only offer critique in the presence of the person who is critiqued, is just nonsense. And I really don’t understand this point at all. In fact, very rarely do we offer critique to someone’s face, so to say. Incidentally, just to offer a little dig, I don’t think that “Drop the Disorder” events include psychiatrists who can defend psychiatry, do they? Third, anyone could come to the session and challenge us all they wanted, which I suggested to a critical shrink who told me that I was going to criticise critical psychiatry (if anything, I supported it). So, fourth, could I suggest that it is considerably more useful to engage with the arguments we make and not whether the panel includes a person from that camp, or that camp.

All in all, I had a wonderful time. I met a number of psychiatrists whom I would trust to treat me, if ever I needed it. In a way, it always worries me when I agree with a shrink, but I agreed considerably more than I disagreed. I met thoughtful, reflexive, caring psychiatrists, only too aware of psychiatry’s problems. I met psychiatrists who were not ignoring critique, but who were engaging with it head on, sometimes admitting that they get things very wrong. Are they representative of your average shrink in Poppleton, probably not, but it’s good to know they’re there.

I want to end with a sentence I heard from one of the psychiatrists I met (I am not naming him, as I don’t know whether he’d want this). He told me something like this:

“If I ever stop crying at least once a week, it will be time to quit psychiatry.”

Let it serve as a motto for psychiatry at its best.

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