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Rapid Responses: Rapid Responses published:
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A problem of language
- Linda Gask (1 June 2005)
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Re: A problem of language
- Roelof A. Bijkerk (3 June 2005)
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Re: Re: A problem of language
- Gertrude Jones (4 June 2005)
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Patients’ attitudes towards mental disorders in primary care – consequences for postnatal depression?
- Gerhard D. Schmid-Ott, Martin Konitzer, Sabine Schallmayer, Burkard Jaeger, and Friedhelm Lamprecht (15 July 2005)
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Linda Gask, Professor of Primary Care Psychiatry University of Manchester M13 9DL
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Dr Lester and her colleagues have clearly demonstrated the importance of bridging the gap between our patients' hopes and aspirations for their problems and the often reality of mental illness as a chronic or relapsing problem. In sessions where I have been introducing mental health professionals and service users to the framework of the 'Chronic Care Model' (1) I have faced considerable resistance and sometimes anger from those who consider this approach to be in appropriate in mental health service development, even for serious disorders such as schizophrenia or bipolar disorder, because I have used the 'wrong' language.
I have considerable sympathy with this viewpoint. Medical models of 'chronicity' particularly in mental illness, have been notoriously negative in their view of prognosis and laissez-faire in their approach to management. Perhaps we should not use the phrase 'chronic disease management' in relation to mental illness at all, but find a new term for care that seeks to collaboratively achieve the best outcomes for an individual and prevent relapse. That is what I mean by chronic care, but that could also be a form of 'recovery' too, as recovery can take many forms. Recovery also requires very often hard work on both sides and not simply a measure of hope and goodwill, so there is no reason why we should not work with our patients in systematic planning their recovery goals and how they intend to achieve them. Such an active approach to recovery follows directly from the principles of the chronic care model and is a good deal more likely to achieve better outcomes than the status quo. (1) Chronic care model described at www.improvingchronicare.org Competing interests: None declared |
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Roelof A. Bijkerk, Human Being Grand Rapids MI, 49505
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A problem of language indeed. There is reference to the hopes and aspirations of a patient and also what Linda Gask refers to as "the often reality of mental illness as a chronic or relapsing problem" I don't know where to start I could start with the need to see how much emotions affect a person's well being and how important it is to acknowledge the fact that the imagination is a place where the emotional reality can emerge; or rather find the space to express itself so that the patient can become aware of what is really going on, what he is feeling and who he or she is. In order for this to emerge a person needs the space to act out what he is feeling without it being inhibited (if it was inhibited then it wouldn't be his true feeling but feeling based on what it controlling him). This type of behavior then is called delusional by the mental health system because a person does not adhere to the manner in which society suppresses what it does not want to become aware of. Given this valid view point, when a person "relapses" in reality it is a chance for them to become enlightened as to what is really going on. There are many people who have done this but again the mental health profession does not acknowledge this because it is not based on the model that the relapse in an illness and that there is something organically wrong with the brain when such a relapse occurs. This brings up my other point, There to date is not proof that mental illness exists as an organic disease and yet it is treated as such as if the evidence does exist. This is not honest, it is in fact coercive scaring people into believing there is something wrong with their mind which will cause problems. If you would follow this logic a bit further, that when a person exhibits emotional problems that it is a disease it would be the same as saying that someone when he has been physicall assaulted and feels pain that the pain is the disease rather than that there is something wrong with him being assaulted. The patient is then given medications to turn off the pain and told that the pain is the disease. When the person again feels the pain from being assaulted he is told he is relapsing. Why is the psychiatric profession so scared of the mind's ability to see cause and effect and truth that they promote, as a reality, that there is an organic illness (which there is no proof of) and then say they are medicating this illness when their own science shows them that they with these medications are creating chemical imbalances which weren't there before (and this all in the guise of saying they are balancing a chemical imbalance when in reality according to their science they are creating one and they know this)? Competing interests: I don't believe the psychiatric profession can tell me what reality is. |
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Gertrude Jones, Musician London
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In response to Mr Bijkerk, I would like to argue that there is an organic basis for mental distress. I have a mental health condition and when I'm not treated with the medication of my choice, I can only describe my condition as being more distressing than any physical pain that I have ever experienced. The process of relapse is a bit like being hit by a bus, with so much pain I feel as though I'm going to die. My mental distress is organic. My reality is simple. I don't like being in pain. Competing interests: None declared |
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Gerhard D. Schmid-Ott, professor for psychosomatic medicine Hanover Medical School, 30623 Hannover, Germany, Martin Konitzer, Sabine Schallmayer, Burkard Jaeger, and Friedhelm Lamprecht
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Editor – In their article, Lester et al.(1) emphasise stigmatised attitudes as an example for barriers to diagnosis and adequate treatment of mental illness. Focussing on psychosocial and psychological interventions for prevention of postnatal depression, Cooper and Murray(2) as well as Dennis et al.(3) do not mention the problem of stigmatisation associated with psychotherapy in women suffering from this condition. Though Lumley(4) does not explicitly name fear of psychosocial discrimination in this context she describes that affected women reject the term postnatal depression as a severe psychiatric illness which moreover seems to be unacceptably related to their babies. The fear of stigmatisation associated with diagnosis and psychotherapy is also relevant in women suffering from this condition(5) and has to be considered a critical component in seeking adequate treatment. References 1. Lester HE, Tritter JQ, Sorohan H. Patients’ and health professionals’ views on primary care for people with serious mental illness: focus group study. BMJ 2005, 330: 1122. 2. Cooper PJ, Murray L. Postnatal depression. BMJ 1998;316: 1884-6. 3. Dennis CL. Psychosocial and psychological interventions for prevention of postnatal depres-sion: systematic review. BMJ 2005;331: 15. 4. Lumley J. Attempts to prevent postnatal depression. BMJ 2005;331: 5-6. 5. Shakespeare J, Blake F, Garcia J. A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale. Br J Gen Pract 2003;53: 614-9. Competing interests: None declared |
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