Medicine And Books

Psychiatry in Europe: Directions and Developments

BMJ 1995; 311 doi: (Published 07 October 1995) Cite this as: BMJ 1995;311:958
  1. Anthony W Clare

    Ed Tom Sensky, Cornelius Katona, Stuart Montgomery Gaskell/Royal College of Psychiatrists, pounds sterling10, pp 201 ISBN 0 902241 71 0

    Europe certainly has a strange effect on the mental health of the British. It provokes either apoplectic outbursts of Little Englander psychosis or overblown sentimental evocations of Britain's role as a sturdy cultural bridge linking the great continent to our American siblings across the Atlantic. Psychiatry in Europe exudes the latter spirit. The cover is a fetching Euroblue with twelve yellow stars (how time marches on!) and the title, like one of those grandiloquent European position papers that pour out of Brussels, promises a veritable grand tour of psychiatric theory and practice from the Urals to the Western Isles.

    In fact it is a miscellany of papers from the autumn meeting of the Royal College of Psychiatrists held in Birmingham in 1992, which attracted clinicians and academics from several European countries (contributors from Scandinavia and Italy were somewhat thin on the ground), and which covered several issues of common interest including service provision, biological treatments, psychological interventions, and phenomenology. The hope of the conference organisers was that by comparing notes and finding out what works in various parts of Europe we might make more progress than lumbering on on our own.

    All of this is indeed laudable but, given that the book itself for the most part consists of contributions in which any kind of cross Europe comparison is impossible, it is all rather pointless. A typical example is the opening contribution—the 1992 Maudsley Lecture on nosological models in psychiatry, delivered by Pierre Pichot—which is an interesting summary of a complex field but not particularly “European” for all that.

    One exception is the section devoted to evaluating attitudes to mental illness in Greece, Sweden, Italy, and the United Kingdom. Here such cross comparison as can be safely undertaken suggests that there is a North-South divide in tolerance, with more liberal attitudes among the general public in Britain and Sweden, less liberal in Greece and Italy. For example, only 8% of British respondents felt that mentally ill people scare them compared with over 60% of Greeks and Italians. The British study was undertaken before cases such as the Clunis tragedy hit the headlines and it is questionable whether such a low proportion of British would now be so relaxed.

    Missing from the deliberations is any informative review of the different funding systems of health care operating in Europe; of the educational and training tensions across the continent; of the growing power of European institutions (in contrast to WHO and UN bodies) in health and social policy; and of the increasingly vocal movement in some European countries on the part of dissatisfied former psychiatric patients and their families. These surely constitute more truly European issues than the use of stereotactic subcaudate tractotomy or defining the genotype for molecular genetic research.—ANTHONY W CLARE, professor of psychiatry, Dublin


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