Psychiatry 2014

I welcomed the October 2013 issue of The Psychiatrist. ¹ The juxtaposition within it of the views of the Editor and the reprint of an interview with Professor Lishman gave me hope that there may be a stronger attempt to address the ‘complete disconnect between research and clinical practice, with a relentless tendency over many years to downplay the medical and biological aspects of mental healthcare’. These are the words of Peter Tyrer, then Editor of the British Journal of Psychiatry, in its bicentennial volume. ²

The nearer mental illness - not mental health - can be made congruent with the position in society held by other physical illnesses, the sooner will its stigmatisation lessen. This happened with cancer, tuberculosis, epilepsy, and now belatedly is being applied to AIDS. As indicated in the Editor's critique, the same standards must be applied to the criteria used to select matter for the Psychiatric Bulletin as are used in other medical scientific journals.

Prior to this edition I was consistently dismayed by the preponderance of matters related to quantitative differences in services and individual traits rather than research for reliable, generalisable tools of diagnosis and treatment. Psychiatry is to do with the qualitative analysis of disease, not supporting the vagaries of personalities within society. The latter are the province of education, psychology, sociology and the law. Of course, all the professionals of these disciplines require the sort of psychotherapeutic skill that Professor Lishman uses - distributive - that helps people to be brought into useful relationship with the therapist and his special tools. His career epitomises to me what psychiatry, psychological medicine, is properly about.

Incidentally, my own slight difference with Professor Lishman relates to his view of Willhelm Greisinger. Greisinger throughout his book emphasises that humanitarian care is a given in serving the needs of the mentally ill. In the first paragraph of his chapter on therapeutics he applauds the ‘great principle of humanity’ in psychiatry. However, he made it clear that in the light of the increasing knowledge of the ‘morbid action of the brain’ humanitarianism will not of itself correct the abnormalities of brain function that underlie disease.

Sadly, this has proven true. Mental illness has remained one of the last areas to develop effective treatments. This is the basis of the remaining stigma. Furthermore, the overarching use of the term ‘mental health’ has unfortunately set psychiatry into a ‘non-disease’ ecology and has thus in my view obfuscated the way of progress within the specialty. We need to address this ‘relentless tendency… to downplay the medical and biological aspects of mental health care’. ²