Magazine article The Times Higher Education Supplement : THE

Interview - 'Psychiatry Is Utterly Dependent on a Relationship': News

Magazine article The Times Higher Education Supplement : THE

Interview - 'Psychiatry Is Utterly Dependent on a Relationship': News

Article excerpt

Focus on people, not technology or manuals, to treat mental illness, Tom Burns tells Matthew Reisz.

A leading psychiatrist has criticised "ultra-scientific" approaches to mental illness and the harm wrought by the hugely influential American Diagnostic and Statistical Manual of Mental Disorders, the fifth edition of which is released this week.

Long before he became professor of social psychiatry at the University of Oxford, Tom Burns had first-hand experience of what was at stake. His mother had a nervous breakdown when he was 15, and he and his brother spent the next 20 years coping with the recurrences. Looking back, he believes he learned three central lessons.

"It taught me that psychiatric treatments do work," he says. "They make a fantastic difference. They are not trivial, they are as good as anything you see in surgery or anywhere else in medicine ... I also saw that there are limits to what we can understand, limits to what can be done - you have to live with that and not keep demanding that everybody can be cured."

Yet Burns also could not help noticing that "some psychiatric teams were markedly better than others. The things that distinguished the better teams were not the treatments they had available in terms of drugs - they were the same for everyone - but the fact that they were able to maintain a more durable, sensitive focus on the individual.

"The thing I took from that and that has never left me is that psychiatry is utterly based in and dependent on a relationship. It is not a secondary, luxury add-on. It is the core of the activity. What I feel anxious about in modern psychiatry is that we have become quite preoccupied with the technology and, certainly in our writings, downplay the importance of continuity of care and relationships."

Such are the central themes of Burns' forthcoming book, Our Necessary Shadow: The Nature and Meaning of Psychiatry, which sets out to separate the many achievements of psychiatry from its equally striking history of incompetence, coercion and even abuse.

Most of the greatest advances, as in the rest of medicine, have come about by chance. The discovery of antipsychotic and antidepressant drugs, for example, was serendipitous, Burns says - "We just stumbled over them, we didn't go looking for them" - but they have had an enormous impact.

"There's a lot of romantic bullshit talked about how wonderful it was" before such drugs were available, he says. "Yet without these drugs, people lead miserable, diminished and often ghastly lives. It would be outrageous to deny the importance of those drugs."

Practical applications

Burns worked as a clinician in the NHS for a decade before taking on an academic post at St George's, University of London, where half his time was devoted to research and teaching. His position at Oxford is in essence a research role, and he is clear that academic analysis can and should transform clinical practice.

"Because our patients are often demoralised and depressed," he explains, "we have to put a lot of emotional energy into the treatment; so perhaps it is not surprising if we are over-optimistic about the effects. The true test of decent research is that it should have the power to confound your expectations."

Burns has recently completed a randomised controlled study of community treatment orders - which allow the compulsory medical supervision of mental health patients - a measure for which he has been "a strong advocate for 20 years", as he reports in the book. And yet the research demonstrated that they produce "absolutely no effect. …

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