A letter to Jim Crabb et al

Congratulations on your article,¹ which I have been thinking about since reading it some weeks ago. I fully agree with your aims (attracting doctors into the specialty) and many of your arguments, but also have some reservations, which I would like to share. I am also wondering what kind of reactions you have had from others, and whether you have heard anything similar to the following observations.

In this age of internet ‘click-bait’, it seems, when advertisements are designed ‘to create an anxiety relieved by a purchase’, people are often naturally suspicious of advertising, branding and marketing. It is seldom fully truthful, misleading by presenting opinion as facts, by being selective of data, and by concealing flaws and inadequacies. This is the hype, spin or propaganda designed to sell products and maximise financial profit, and arguably therefore unsuitable for persuading medical students and young doctors to think about psychiatry as a long-term career path.

In the cold light of day, for example, particularly in today's evidence-based, politically governed, underfunded and overstretched National Health Service, people might wonder how truthful are the statements comprising the mantra you propose for ‘brand psychiatry’. The experience of a patient, or family members, might not be exactly as you describe. The rational, materialist, left-brain dominated ‘scientific’ approach – which tends to search out symptoms and diagnoses, and then to provide physical treatments (medication) and brief impersonal psychotherapies (such as cognitive–behavioural therapy), rather than seeking healing for the whole person, body, mind and soul – still prevails over a more holistic, intuitive, poetic, right-brain dependent, person-oriented approach, do you not think?

I am sure, however, that you are on the right track. It is a genuine ideal to be pursued, ‘To understand the connection between the mind, the body and the soul’, and ‘To have the rare ability to treat the person, not the problem’. But might not other doctors, particularly general practitioners, want to make similar claims?

An approach that might work well could be to stress the equal values of biological, psychological, social and spiritual aspects of mental healthcare (see for example, regarding the latter Culliford^{2, 3} and Cook et al ⁴). In other words, giving the message that there is a welcome in the specialty for people with a wide range of knowledge, skills and experience, enabling each to grow – through training and practice – in those areas and attributes perhaps previously less well developed.

There is an important place for those whose abilities and preferences lie within the biological domain, still the ‘comfort-zone’ for many psychiatrists; but the aim, I suggest, is both to encourage such folk to broaden their horizons out of their familiar orbit, and to encourage new people to enter the specialty whose inclinations are more towards (to paraphrase the mantra) ‘feeling with one's mind’ and ‘thinking with one's soul’. Arguably, this means fostering awareness and familiarity with the spiritual dimension of mental healthcare. Some may be surprised to know that this valuable – and hitherto neglected – aspect of our discipline can be taught.⁵

An axiom for this new psychiatry would be that everyone is on some kind of self-improvement pathway towards a maturity that involves personal integration, with continuing growth in terms of wisdom, compassion and love, derived from a sense of belonging not to any faction but to the entirety of humanity, similarly connected seamlessly to nature, to the dynamic structure and energy of the cosmos that underpin all the natural laws known to science. To become a psychiatrist would thus offer an unparalleled opportunity for making progress along this (I would call it ‘spiritual’) path.

As you have hinted, personal sacrifices are necessary. It is a tough, and occasionally dangerous profession. It is not too hard academically, but it is challenging at a deeply personal level. Compassion – ‘suffering with’ one's patients and their carers, also one's colleagues – means feeling and sharing the emotional pain and distress of others. As I have written about extensively elsewhere,⁶ it is this very suffering, acting as a kind of medicine, which affords the best opportunity to initiate healing from life's inevitable psychological traumas, threats and losses, resulting in the deepest satisfaction that human experience can offer, inherent in personal growth. To become wiser, kinder, humbler, more truthful and tolerant, enjoying lower levels of anxiety, anger, sorrow, doubt, confusion, and greater levels of equanimity and self-esteem, accompanied most often by the heartfelt esteem of others, are among the inestimable rewards to be garnered. This is undoubtedly what I have gained from becoming and working as a psychiatrist.