Intended for healthcare professionals

Rapid response to:

Education And Debate

Postpsychiatry: a new direction for mental health

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7288.724 (Published 24 March 2001) Cite this as: BMJ 2001;322:724

Rapid Response:

All in the Family

I believe there is much misdiagnosis and overdiagnosis in the
psychiatric community. However,when a diagnosis of psychosis is made,
based on observed behavior or family reports of a family member's acute
change from a rational,functional being to one who is completely
dysfunctional and illogical,then it is time to coersively provide
medication and support in a safe,confined setting until the person is free
of false beliefs and destructive behaviors.

I agree that there may be,in addition to biological brain
disease,environmental,personal,social and cultural factors that influence
a person's behavior. However,if active symptoms of severe and persistent
mental illness in either schizophrenia,bi-polar or unipolar disorder,are
untreated pharmacologically or even with electroconvulsive shock,there can
be no constructive psychotherapeutic interventions.

Misery loves company and there are vast numbers of mentally-ill
people in support groups who are trying to help each other and
themselves(the hearing voices project et al). But to participate in such
groups, the symptomatic sufferers must recognize that they have an
illness. There are many who never develop insight into their biologically
-based illnesses. Psychotherapeutic interventions have not,in my
experience,helped these ailing people. I speak from experience. The brain
diseases in my family are genetically linked:my mother suffered a
psychotic post-partum depression and committed suicide;my first husband,
the father of my children still suffers from bipolar disorder(he
decompensates frequently because he does not continue taking needed
medication);two of my adult children have bipolar disorder and are doing
well on their medication. I can name numerous other members in my family
tree who need and take psychotropic medications. The personalities and
personal problems of all these people are different. Their cultural and
religious orientations are dissimilar. The one thing they have in common
is their need for medication to function rationally,effectively and
fearlessly in society. Let us never dismiss the importance of medication
for those who truly have biologically-based illnesses.

Competing interests: No competing interests

27 August 2001
Geraldine S Hatfield
Retired Secondary School Counselor
N/A