Editor - Braken & Thomas’s Article on “Postpsychiatry” is
stimulating and touches on the importance to the individual of giving
meaning and if possible value to their experience of psychiatric illness.¹
This constrasts with the traditional model in which psychiatrists’
understanding and explanation of mental disorders are often not found
helpful or acceptable to patients and may lead in turn to rejection of or
non-adherence to treatment. Although implying an holistic, culturally-
aware approach to the management of mental disorders, whilst not seeking
“to replace the medical techniques of psychiatry”, the authors miss an
opportunity to make more explicit the practical implications of their
approach for psychiatric treatment.
Treatments which please and heal (“placebos”) cannot be dismissed as
simplistic or unscientific.²Devising a placebo will require of the doctor
the utmost sophistication and empathy with the patient’s plight if it is
to be acceptable and effective. The therapeutic activity of a placebo
can vary as much as that of any other intervention and there is no reason
to suppose that the final common pathway of a therapeutic effect
necessarily differs in a fundamental way when contrasting holistic therapy
with biologically-based treatments such as drugs. However when drugs with
powerful biological actions are therapeutically ineffective in mental
illness, healing may still occur through accepting and treating the
patient’s own notion of their illness, and this presumably operates
through a different biological mechanism.³Finally, making available to
patients the explanations and treatment they want and find helpful need
not exclude the possibility of also delivering treatments which are
justified on scientific grounds and are evidence-based. In fact this
“consensual management” approach may be crucial for realising the full
therapeutic potential of interventions with proven efficacy but variable
effectiveness in everyday practice.
Phil Harrison-Read
consultant psychiatrist
Department of Psychiatry,
Royal Free Hospital,
Pond Street,
London
NW3 2QG
Competing Interest: - none
1. Braken P, Thomas P. Postpsychiatry: New Direction for Mental
Health. BMJ
2001; 322: 724-7 (24th March)
2. Harrison-Read P, Tyrer P. The Application and Evaluation of Drug
Treatment in Psychiatric Practice. In: King DJ, ed. Seminars in Clinical
Psychopharmacology. London: Gaskell, 1995; 59-102.
3. Harrison-Read P. Neuroleptics in culture-bound syndromes. Br J
Psychiatry 1986; 148: 106-107
Rapid Response:
Placebos and Postpsychiatry
Editor - Braken & Thomas’s Article on “Postpsychiatry” is
stimulating and touches on the importance to the individual of giving
meaning and if possible value to their experience of psychiatric illness.¹
This constrasts with the traditional model in which psychiatrists’
understanding and explanation of mental disorders are often not found
helpful or acceptable to patients and may lead in turn to rejection of or
non-adherence to treatment. Although implying an holistic, culturally-
aware approach to the management of mental disorders, whilst not seeking
“to replace the medical techniques of psychiatry”, the authors miss an
opportunity to make more explicit the practical implications of their
approach for psychiatric treatment.
Treatments which please and heal (“placebos”) cannot be dismissed as
simplistic or unscientific.²Devising a placebo will require of the doctor
the utmost sophistication and empathy with the patient’s plight if it is
to be acceptable and effective. The therapeutic activity of a placebo
can vary as much as that of any other intervention and there is no reason
to suppose that the final common pathway of a therapeutic effect
necessarily differs in a fundamental way when contrasting holistic therapy
with biologically-based treatments such as drugs. However when drugs with
powerful biological actions are therapeutically ineffective in mental
illness, healing may still occur through accepting and treating the
patient’s own notion of their illness, and this presumably operates
through a different biological mechanism.³Finally, making available to
patients the explanations and treatment they want and find helpful need
not exclude the possibility of also delivering treatments which are
justified on scientific grounds and are evidence-based. In fact this
“consensual management” approach may be crucial for realising the full
therapeutic potential of interventions with proven efficacy but variable
effectiveness in everyday practice.
Phil Harrison-Read
consultant psychiatrist
Department of Psychiatry,
Royal Free Hospital,
Pond Street,
London
NW3 2QG
Competing Interest: - none
1. Braken P, Thomas P. Postpsychiatry: New Direction for Mental
Health. BMJ
2001; 322: 724-7 (24th March)
2. Harrison-Read P, Tyrer P. The Application and Evaluation of Drug
Treatment in Psychiatric Practice. In: King DJ, ed. Seminars in Clinical
Psychopharmacology. London: Gaskell, 1995; 59-102.
3. Harrison-Read P. Neuroleptics in culture-bound syndromes. Br J
Psychiatry 1986; 148: 106-107
Competing interests: No competing interests