A patient's journey: living with paranoid schizophrenia
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38968.608275.AE (Published 21 September 2006) Cite this as: BMJ 2006;333:636
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
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
Competing interests: No competing interests
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
Competing interests: No competing interests
A lesson in our own pessimism
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
Competing interests: No competing interests