Thomas McKeown, author of The Role of Medicine: Dream, Mirage or Nemesis? wrote in l979:
“If I were St Peter, admitting to heaven on the basis of achievement
on earth, I would accept on proof of identity surgeons, the dentists
and with a few doubts, the obstetricians; all, it should be noted in
passing, dealing mainly with healthy people. The rest I would refer
to some celestial equivalent of Ellis Island for close and prolonged
inspection of their credentials”.
It could be argued that the profession of psychiatry is in good company amongst medical professions. McKeown demonstrated convincingly that increases in life expectancy during the first half of the 20th century were largely attributable to improved nutrition and cleanliness, leading many health professions to concede that the impact of medical science on society was less dramatic than commonly perceived.
Nevertheless, credit has to be given to some tangible advances in the treatment of illnesses such as heart disease and cancer. Psychiatry appears different. Their catalogue of failures has been the result of rigidly held, but seriously erroneous assumptions, about the nature of ‘mental illnesses’. Even the term ‘mental illness’ itself is such a misnomer because it equates human distress with physical diseases and totally ignores the contexts in which an individual’s tortured state occurs. Not only
does it ignore the outer contexts but it fails too to explore the inner world of the person seeking help.
Why am I writing about psychiatry once again? I am doing so in response to a recent article in one of the national newspapers on schizophrenia and my disappointment that no shift in perspective is shown by the writer and by the psychiatrists she interviewed.
Indeed, what emerged in the article was a type of intellectual myopia, which, sadly, has blinded many mental-health professionals to the strongly established fact that human distress – no matter what its depth or breadth or how it manifests – inevitably, is linked to deeply disturbing relationships with significant others, most notably, parents, teachers and other important adults in the distressed person’s life story – grandparents, childminders and siblings. So-called ‘mental illnesses’ are the result of ignoring what has been obvious to most ordinary people that love, kindness, empowerment are necessary in the promotion of psycho-social wellbeing.
How is it that in all my years practising clinical psychology I have yet to encounter a person whose troubling and troublesome behaviours did not relate back to early childhood relationships and the reoccurrence of these traumatic experiences throughout their lives to date. How is it that when a person presents himself to a psychiatrist with delusional, hallucinatory, obsessive-compulsive, depressive and other such distressing signs that the early and present contexts of this unhappy individual are not explored? To diagnose a ‘mental illness’ without such an in-depth examination of the person’s life only adds to the rejection and misunderstanding that have been part and parcel of the person’s story. As I have said time and time again there is no attempt here to blame parents and other significant adults. Parents,
teachers and others do their best but there is none of us who do not enter our professions, marriage and parenting without unresolved emotional baggage. Such unresolved inner and outer conflicts can play havoc with the secure holdings children require for their overall wellbeing. It is my experience that when a young person is referred to me for help – and it is recognised that severe distress is more common in adolescence (most challenging stage of life) and early adulthood – that the parents and, sometimes, the teachers, childminders and grandparents need more help than the young person himself. Very typically mental health practitioners can miss this critical factor and the consequence is that the young person is seen as the ‘identified patient’, the ‘problem’ in the family and the parents and significant others are let off the hook of responsibility.
Being let off the hook does no service for these adults because their inner distress and their outer manifestations continue to be flown in vain. It also helps enormously when all members of the family of the distressed individual seek help for themselves. When the young person witnesses this authenticity and accountability, it considerably raises his hope of the emergence of relationships that enhance wellbeing.
Given the emergence of alternative psychiatric services in Europe and North America that prioritise the fostering of close collaborative relationships between service providers and service users there is after all a possibility that psychiatrists may get direct access to heaven! In these new developments care is supportive and based on close examination of the distressed person’s needs, rather than authoritarian, intrusive and driven by the search for a psychiatric label. There is an emphasis too on providing individuals with choices between a range of therapies whenever possible. What gives grounds for optimism is that this approach has become official doctrine in some parts of the United States.
Finally, whether it is medicine or psychiatry, what is needed is a more compassionate approach that places the therapeutic relationship at the centre of clinical practice.
Dr. Tony Humphreys is a practising Clinical Psychologist, Author and National and International Speaker. He is also Director of three UCC (NUI) Courses on Interpersonal Communication, Parent Mentoring and Relationship Studies; for details contact Margaret 021 4642394