World Mental Health Day 2018
Why choose psychiatry?
Professor Dinesh Bhugra, CBE
When you mention the word psychiatry or mental illness, people start to think of odd behaviours. When I was in my second year at medical school in India I announced that I was interested in psychiatry. Many of my class mates and several professors thought I was too bright and crazy to choose psychiatry. I decided to do so because it was really interesting to think of patient as a whole individual who has family, has a job and wants to get better to function better. I have never regretted that decision; I have enjoyed every moment of my clinical work as well as my research and teaching.
Which other medical specialty allows you to be particularly curious about the patient, their childhood development, schooling, sexual functioning, employment, relationships etc. Which other specialty allows you to combine physical or biological factors with psychological and social factors, anthropology and spirituality.
The argument that psychiatry is not scientific is pure nonsense. With developments of psychopharmacogenomics, large trials are taking place to differentiate rapid and slow metabolisers so that appropriate doses can be given. On the social determinants side, urbanization and globalization resulting from industrialization can lead to poverty in many cases, as well as overcrowding and unemployment, leading to increasing distress. As Virchow reminded us: “Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution”.
The combination of sociology, anthropology and culture studies fit in very well with the study and practice of psychiatry. Thus, as doctors and healthcare professionals we have a major role to play as advocates for our patients but equally importantly as members of society. The advent of e-mental health and tele-mental health has opened new doors for delivering services. One can be on the tube or at the bus stop playing with their phones, and for all we know they are doing cognitive behavior therapy. Psychiatry is one medical specialty where psychiatrists have the legal responsibility of assessing risk and managing risk in on behalf of the society and the community within which they practice this has major ethical aspects that need to be remembered.
A major aspect of psychiatry, which is often ignored, is public mental health. There is considerable evidence from research literature that half of the psychiatric disorders in adulthood start below the age of 15 and three-quarters below the age of 24; thereby providing a clear indication of how public education and public mental health can influence prevention of mental distress. These are truly exciting times for psychiatry as it is at the cusp of major changes. Our understanding of brain and its functioning is improving, as is the interaction between social and biological factors. Technological interventions , innovations and social media offer new platforms for clinical practice. Seeing the whole patient rather than a diseased organ is more satisfying professionally and also provides an insight into what medicine should be about.
Practice of medicine is getting increasingly complex and also technical thereby producing more stress on doctors and healthcare professionals. Changing patient expectations and the impact of social media are also critical in contributing to the stress. It is important that doctors and healthcare professionals look after their own mental health and well-being in order to provide the best care. One way of preventing burnout and stress is to combine clinical work with other skills e.g. teaching, leadership, research etc. It is critical to keep the social networks going. Leadership skills in working with teams, sharing ideas and vision can be extremely helpful.
On the World Mental Health Day this year the BMA are launching two campaigns. One is for Health Justice for people with mental illness as only 40% of countries around the globe give full legal protection to the rights of people with mental illness. Equally importantly, the BMA are launching a survey of mental health and well-being of medical students and doctors across all specialties. This quantitative survey will be followed by a qualitative survey early next year. The BMA is also committed to exploring Medicine’s Social Contract early next year.
Dinesh Bhugra, CBE
Institute of Psychiatry, Psychology & Neuroscience
King’s College London
President, World Psychiatric Association (2014-2017)
President, BMA (2018-2019)