Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
The story so far?
- G. Nick Bolsover (24 September 2006)
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Treating the patient not the illness.
- John M Luck (26 September 2006)
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A lesson in our own pessimism
- Liz Tate (27 September 2006)
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Early Intervention can make the difference
- Alister Campbell (27 September 2006)
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To hell and back...
- B Saravanan (29 September 2006)
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Re: To hell and back...
- Stuart Baker-Brown (29 September 2006)
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Inheritance from the Soviets
- Palmira Rudaleviciene (30 September 2006)
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well done, Onemanmountain climber!
- Anita Damle (6 October 2006)
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How To View Mental Illness
- syed shah (10 October 2006)
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Something more than climbing mount everest
- a- wahab yousafzai (10 October 2006)
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Re: How To View Mental Illness
- stuart baker-brown (10 October 2006)
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Other side of picture
- Muhammad Naim Siddiqi (11 October 2006)
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evolution of medicine
- Sam Srikantha (10 March 2008)
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G. Nick Bolsover, Chartered Psychologist in private practice 22 Station Road, Hessle, East Yorks, HU13 0BB
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I assume there is to be a sequel. This will not only describe Mr Baker-Brown's climbing Everest but his realisation that his diagnosis is part of the myth of mental illness. We will learn more about his life, including the early experiences and concurrent pressures that discouraged him from confiding in friends after his frightening experience in Moscow; and how after psychotherapy, perhaps Paul Brown's continuing help, his experiences now have personal meaning and he no longer needs a label and medication. Competing interests: I am a clinical psychologist and psychotherapist |
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John M Luck, Final year medical student Stockton-on-Tees TS18
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This morning I had a series of lectures on the management of mental illness. I am undertaking my essential senior rotation in psychiatry and tomorrow I start my clinical work. Mr Baker-Brown's article makes for inspirational reading. The article clearly describes, what I guess, must be one the dangers inherent in the management of mental illness; managing the illness rather than the patient. This morning the nurse practitioner who facilitated our session was very articulate in her concern for patient autonomy. Perhaps things have changed for the better since Mr Baker- Brown's initial experiences. I shall see over the next three weeks. In any case I shall strive to remember that each patient has their own mountain to climb and that health professionals, with the help of Rethink and SANE, must facilitate that. Essential reading. Competing interests: None declared |
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Liz Tate, Psychiatry SHO Parklands Hospital, Basingstoke
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Mr Baker-Brown's eloquent account of his journey with paranoid schizophrenia and perceived misunderstanding and persecution from the mental health services stands as an important lesson to those of us providing those services. Doctors have always been notorious for treating the illness rather than the patient, mainly because this was traditionally what they were taught to do. Training is more holistic nowadays but treating the whole person is not easy and only the best doctors learn to do it well. In psychiatry the person and the illness coexist to such an extent that if either aspect is ignored then treatment will inevitably fail. However psychiatrists are only doctors and doctors are only human. Doctors are also pessimists. Mental health care provision is increasingly undertaken by community teams leaving only the most unwell patients in hospital. Psychiatrists days are largely saturated with the treatment resistant, poorly functional and poorly compliant. Their experience of conditions such as paranoid schizophrenia is inevitably limited to the severest cases and serves only to reinforce pessimistic attitudes regarding sufferers abilities and potential. In addition to good medical training, broad psychiatric experience and a big dose of humanity us psychiatrists still, it seems, need to remind ourselves that our patients are people. Competing interests: None declared |
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Alister Campbell, Nurse Consultant Harplands Hospital, Stoke onTrent, ST4 6TH
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I was both saddened and heartened by Stuart Baker-Brown’s story. Saddened because it took so long for him to be diagnosed and to receive the treatment and support that he needs but heartened that in spite of the inadequacies of the services he has succeeded in overcoming the difficulties he experienced. In the early to mid 90s the idea of early interventions in psychosis was laughed at, a diagnosis of schizophrenia was regarded as the beginning of an inevitable decline. Today there are over 50 Early Intervention (EI) services in the UK with a specific remit to provide swift access to a comprehensive assessment and a range of effective treatments and support. The primary aim is a reduction of the duration of untreated psychosis which relies on early detection. Primary health care professionals and others have a key role in early detection. Where there is clear evidence or a strong suspicion of psychosis the individual should be offered a referral to an EI service. Often health professionals are reluctant to refer for fear of stigmatizing the individual or because there is uncertainty of diagnosis. EI teams are able to work with this uncertainty and try to work with people in the least restrictive way possible offering rapid access to modern medications, psychological interventions and family support. Today there should be no excuse for anyone to experience delays in receiving appropriate treatment and support and it is to be hoped that stories like Stuart’s will become a thing of the past. For more information about early intervention see http://www.iris-initiative.org.uk/ or http://www.rethink.org/ or contact your local mental health service provider. Competing interests: I am a Nurse Consultant in an Early Interventions in Psychosis service |
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B Saravanan, Research Psychiatrist IoP, London, SE5 8AF
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As Stuart Baker-Brown's construction of the narrative comes from his own experience, his conclusions are penetrating. When I reviewed this manuscript, I expected a flurry of responses from mental health professionals, especially people who are working on issues like mental health service and policies. However, unfortunately it was left to a few empathetic people to address this issue. Let’s get this straight here: Stuart Baker-Brown is not alone, there are quite a lot of patients who are unhappy with the way mental health professionals deal people with schizophrenia. "Why did we become psychiatrists? I think most of us became psychiatrists because we are interested in what makes human beings tick. We chose psychiatry because we want to understand the human mind and spirit as well as the human brain. We chose to join a very clinical specialty because we are interested in people and we like to work with them as individual people" said Prof Andreasen in her editorial. But that seems long now. I think Stuart Baker-Brown's narrative gives all of us an opportunity to reflect on who we are and why we chose psychiatry as Prof Andreasen said. Competing interests: BMJ Reviewer |
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Stuart Baker-Brown, Author of Article Home. DT2 7JX
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From my own personal experience of mental health professionals, many fear speaking out about the poor services sufferers of severe mental illness often receive. I have had, on a few occasions, mental health professionals, 'off the record', praise me for what i am trying to achieve and telling me that they admire my guts to stand up and highlight the failings of mental health services in the UK. I feel the flurry of response that was expected by the BMJ for my article has not materialised because mental health professionals fear repercussions if they speak out. I believe this is fact. The only way things can improve is if mental health professionals do have the guts to speak out and stand their ground. I know its hard to speak out, and it takes guts, but its time for change. Many people are hurting, not just in the UK but across the world. Mental Health Professionals must help people like me and demand change for the better and for a greater understanding of severe mental illness. If we all do it together and have one voice, then it will happen. sbb. Competing interests: None declared |
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Palmira Rudaleviciene, Consultant Psychiatrist, Chairman of the Lithuanian Cultural Psychiatry Association Vilnius Mental Health Center
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A lot of similar examples,as described in Stuart Baker-Brown's "A patients journey..."could be met at my end , in Lithuania. We are so quick to define paranoya and to give a prescription for Olanzapine, Risperidone, or any other neuroleptic.I think,it is becoming a luxary for our patient to become granted with true attention,compassion and understanding- not only the psychopathology, but his or her needs,humanistic feelings. Firstly we are quick to look for and to find the symptomps!Findig delusions, we leave the patient to develop depression next-as so nicely presented in the story.Soviet surroundings could course a fear to many. This fear could be adequate, and should be differentiated from paranoya. Living in Soviet system, created that style of life-when one should be very cautious,what to say,to whom to say, to be tense all the time. Even the "best friends" were the agents of the KGB, that was our reality.As God was taken away from us by force-to pray -was a crime,so people were praying secretly,or could be diagnosed as having delusions.Long years of Soviet occupation has left it's cultural inheritance- a conflict between the Lithuania nation and religion, and surroundings- you were aloowed to see the wold the way , as it was suggested. Any real seeing was delusion...Still the healing is in process. As well as the way,the doctors psychiatrists performance. Competing interests: Transcultural psychiatry, content of delusions |
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Anita Damle, Consultant Psychiatrist Northampton
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I have just read Mr. Barker-Brown's account of a courageous and successful journey and his achievements, largely by his own efforts and determination. I was however saddened to learn how long and how far he had to travel to get the proper care and treatment that every person suffering from such a devastating illness deserves. I also agree with him that us, the "professionals" do not always show the "guts" and courage needed to stand up and demand the appropriate services in the community. We are rather bullied into accepting, at times, a substandard service in order to meet the targets set by Management or the government with different agenda.(also some of us do not like to rock the boat for the fear of losing our medals!) I believe that the continuity of care is the key factor in the recovery which is often lost in the endless restructuring as noted in the article (Damle A. Complete A-Z of community care: Hospital Doctor, 10 February 10 1994) sadly not much has changed in some services to date. Good luck to Mr. Barker-Brown in his quest to climb the Everest! Competing interests: None declared |
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syed shah, staff grade co12yn
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as a ex psychiatrist - of only a few weeks though, the story did hit some of my nerves hopefully the experience of mental illness for most isn't as bad as for this individual, though i fully understand why it could be our profession is based so much on the personality of the treating professionals, how they view things, their agenda and hopes and fears - the more inexperienced were always the worst in this regard. managers / admin don't help with their demands of targets, form filling and the feeling that stats are more important then the patient. if staff feel devalued then it is hard to provide emotional support for others political correctedness has been a problem, i refused to call patients clients or service users, i was the doctor and they were the patients - this was not to reflect a power balance between us, but to reflect the fact that the docter - patient relationship is a very powerful medicine and to see it in terms only of a power relationship can result in a loss of a powerful tool. we are there to help and hopefully get patients to engage fully, by the use of empathy, trust and looking at the patient as an individual - in fact most of the benefit i felt i had came from simple human interaction there is no need to use fancy models, neuroreceptors, freudian theory - i hate the word empowering, just deal with people as if there humans being and your halfway there to getting the patient feeling better about themselves it is sad that, staff gave out negative comments, i would had qualified such statements by the words 'in all probability' leaving the hope open for something better in the end, the strength of the individual is what counts and hopefully this is located in a supportive home and community structure and remember that mental health can be treated in many many ways e.g. religion, exercise - what ever helps and doesn't harm is good enough for me good luck and never give up Competing interests: Ex psychiatrist |
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a- wahab yousafzai, chief resident psychiatry department Aga Khan University Hospital karachi pakistan
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Stuart Baker-Brown's story is facinating, i hope he climbs mount everest next year, but to me living with schizophrenia happily is not less than conquering mount everest because it is the psychological being which pays the price more than physical in this case. coping with psychic pain requires a lot of psychological energy which is always meagre and difficult to replenish in psychiatrically ill population. Someone who chanelled his energy in socially acceptable manner is always a good start in the context of psychoses. It boosts self esteem of the individual which is a real shock absorbing capacity bound to minimize the relapses in schizophrenia, at the same time good self esteem is a rich source of psychological energy, which sets a stage for a self generating energy cycle to cope with psychological anguish. This is the main stay for rehabilitation in schizophrenia. As far as the demoralizing statement, mentioned in the paper is concerned, i think this is about time to change the dogmatic stance in psychiatry. This discipline probably requires more to adopt the value based approach than any other field. I myself do not know with certainty, what the course of schizophrenia is like, hence how can i go and break the news of schizophrenia in a colonial manner. I do not know what causes this illness, whether increased dopamine, increased dopamine receptors or accentuation of receptor sensitivity is responsible for initiation of this illness or something other than that. With this limited information i have no right to demoralize my patient by portraying a dreadful picture in a dogmatic way, i can discuss with my patient cluster of symptoms, keeping in view the syndromal model of this disease with great variability in its course. Stuart Baker-Brown's story is an eye opener for us specially in a situation where there is question of psychoeducation. Appropriately stimulating the patient is a good approach after discharge. Competing interests: None declared |
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stuart baker-brown, Author of Article Home. DT2 7JX
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being viewed and treated as a 'patient' of the nhs would have helped me to feel so much more valued by psychiatry. having the label of 'service user' or 'consumer' is so disrespectful to me and the likes of me who turn to psychiatry for help and understanding. service user and consumer means a 'person or thing' that eats or uses something up. it makes me sometimes feel that psychiatry and the nhs somehow resents my illness. i believe that using the word 'patient' more often would help bring people like me and psychiatry closer together and would reintroduce much needed respect to all who are diagnosed with a severe mental illness. stuart baker-brown. Competing interests: None declared |
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Muhammad Naim Siddiqi, Assistant Professor and Consultant psychiatrist Department of Psychiatry . Aga Khan University Karachi Pakistan
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It was heartening to see the courage of Mr Brown to not only in accepting his illness but also in taking us through his difficult journey. However i was saddened when i ocmpared this picture with that of Pakistan. I worked in the NHS for over 10 years and have now worked in Pakistan for 3 years. Many of the things he talked about are unheared of on in this end of the world e.g there are hardly any NGO like Rethink or SANE. The family system which at one time was believed to be the major source of support and strength is rapidly disintegrating. A few years ago we believed that the "prognosis" of schiozophrenia was better in developing countries. Would that be true if the same study is repeated? I am not sure. I know about the early intervention and metabolic syndrome bcause I work in a teaching centre. I am sure my other colleagues also know about these, yet we don't know how common the illness is in Pakistan; neither is it a priority for "policy makers" nor for "budget holders". In spite of that when I read this article I had something very useful to share with my resident who insisted that a young man should not get into marriage because his illness is so serious. Competing interests: None declared |
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Sam Srikantha, ex-medical officer Australia 3185
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I firstly extend an apology to those whom suffered from major psychiatric illness such as schizophrenia and manic depressive psychosis from a doctor who has prescribed major psychotic drugs...what these drugs did was to suppress/change neurotransmitters concentrations in the brain...end result was to suppress brain function to different extents and which may have suppressed prolific symptoms but made the person a little better that 'a walking robot'...lacking ability to live the basic of human life including building meaningful relationships... But I offer hope for the future as well...as its slowly but surely becoming clearer that these illness are actually disorders of emotions...and if one can call all areas of the brain that codes for recognizing, remembering and responding with emotion as 'the emotional brain'...so its illness of the emotional brain... As such the fundamental and primary medical role is to establish a trusting dependable relationship to a much higher mark that usual and to be readily available...yes a huge demand on careers and only for those special people who understand, empathize and willing...which will advance patients improvement and ease the suffering at those darkest of moments when the body is in full flight negative emotions of fear, dread, and disconnected with the world and its apparently smiling happy people... Sam Competing interests: None declared |
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