l health Prima Watch

caring for schizophrenia ?

" Je suis misanthrope - parceque - j'aime l'humanite~ " .... doubtfully Stendhal ?

 

 

 

 

 

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snippets from a culture war between the post-psychiatrists and academic psychiatry

The Royal College of Psychiatrists has actively promoted service user and carer involvement in its activities through the work of the Patients’and Carers Committee.

[ If you [ a psychiatrist ] feel that you have a user [!} or carer who would be interested in getting involved and would be interested in contributing to the work of the College, please contact Deborah Hart. There will not be formal interviews, but we will ask people to send a brief CV explaining why they would be interested in joining either the patient or carer forum and what they feel they can contribute.

This is a standing committee that acts as a channel of communication between the College and patient and carer organisations which inform the College of 'patients’ [ah ] and carers’ views and who in turn learn about College policies. ]

It's remarkably quiet about carers wanting to speak up for their own position. . Do they hear from 'users' who don't recognise their illness, or don't want treatment, or don't accept a programme of care. Less than half are intouch with services.
They remain patients but not users ? Is a use who doesn't use , still a user. And who puts forward their point of view
Why is there not 'carers views' and 'patient views' rather than 'patients and carers views'.

The College also pledged at its 2004 annual general meeting to involve patients and carers in psychiatric training.

post-psychiatrists - Bracken et al - a radical critique of the medicalisation of ‘madness’ and distress has arisen within the user/survivor movement. Organisations such as the Hearing Voices Network, the Paranoia Network, Self-Harm Network, Mad Pride and Mad Women have emerged.
Some are better organised than others. Hearing Voices Network is now an international network with many branches in the UK and throughout Europe.

For example, the Icarus Project is a US-based network of individuals who come together in different ways to talk about ‘bipolar disorder and related madness.

User/survivor involvement will always be limited to consultation, if psychiatrists continue to assert that the professional position is the only ‘scientific’ one.

how can the insights gained from the biological sciences articulate with the diversity of frameworks used by users/survivors - how our expertise relates to theirs. If we are to engage in dialogue with users, survivors and carers [ ah ha - first reference to us by the post psychiatrist Bracken ] about the benefits and limitations of these different approaches, we must engage respectfully with a diversity of frameworks and understand their values, assumptions and priorities. [ and whatever illnesses they are speaking from and about ? Or is that not allowed ?]


The Department of Health
guidelines for respects
Healthcare is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations (especially social care organisations) whose services impact on patient well-being’.


In the British Journal of Psychiatry

a no-nonsense defence of a medical approach to ‘psychiatric assessment, diagnosis and treatment:- a blunt assertion, by thirty psychiatrists that ‘patients have a right to expect more than non-specific psychosocial support’

[ Abstract ]

The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness.
Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific
psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning.
In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists.
This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry
in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty’s future.

On the 200th birthday of psychiatry, it is fitting to reconsider the specialty’s core values and renew efforts to use psychiatric skills for the maximum benefit of patients.

this ,

Recovery:- Roy. Coll. Psych

and this postpsychiatry approved
Schizophrenia and the Negation of Narrative.

[ Abstract ]

There are a couple of reasons why the topic for this article may strike some readers as curious.
Given the focus of this special issue, it will not be the interest in narrative or self which will be unexpected, of course,
but the notion that these concepts could have relevance within the context of a disease as disruptive and devastating as schizophrenia.
While other people can write narratives about persons who have schizophrenia
like Nassar’ recent biography of Nobel laureate John Nash—the idea that a person with schizophrenia would construct his own narrative may seem at first counterintuitive.
Since it was first identified as the most severe of the mental illnesses over a century ago,
schizophrenia has been described not only as a loss of sanity but also as a loss of one’s sense of self at the most fundamental level of self awareness.

The third edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association,
for example, suggests that "the sense of self that gives the normal person a feeling of individuality, uniqueness, and self direction is frequently disturbed in schizophrenia".
If people with schizophrenia lose this kind of sense of themselves as people, as agents of their own lives, how could they possibly author their own stories?

In addition to the concern about loss of self, the clinical literature on schizophrenia has suggested that one of the core elements of the thought disorder
associated with this condition is the diminished capacity of people with schizophrenia to create coherent narratives about their lives
.While some earlier representatives of the antipsychiatry movement suggested that this difficulty reflected fragmentation
and incoherence in the person’s familial environment rather than in the person,
other more recent theoreticians reflecting a postmodernist consciousness—have suggested that this deficit is actually more of a (potential) asset.
In any case, regardless of the cause, even if people with schizophrenia do not entirely lose their sense of self,
they would still seem to have lost the ability to compose temporally unified and coherent autobiographical accounts.
How, then, can they even construct, not to mention use to their benefit, narratives about their illness, their impact on sense of self, and their efforts to recover?

talking between patient and professional ... click on 'full text' top left ...

Roe D, Davidson L. Self and narrative in schizophrenia: time to author a new story? Med Humanit 2005; 31: 89-94.

patients; their lives ? go to non registered - free access

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