The Stigma of Psychiatry

Having just finished my psychiatry placement (I'm a med student) I can honestly say that, at least in the UK, the regulation surrounding the Mental Health Act (which contains the sections needed to detain and treat someone against their will under law when they're suffering from a severe psychiatric illness) is pretty stringent. Not to mention that commissioning bodies are trying to move as much treatment into the community as possible (partially because it's cheaper).

I don't know if anyone else here has ever met anyone who's floridly psychotic- a schizophrenic suffering an acute relapse, for example- but in some cases there's absolutely no way it would be possible or ethical to allow them to go untreated. Whether they are running around the street stripping off and masturbating, catatonic (a severe type of schizophrenia with bizarre disorders of movement) or attempting to kill themselves by setting their hostel on fire- all of which are real patients I've met and clerked. And what people don't realise is that anti-psychotic drugs actually work. Really well. By not taking antipsychotics after a first episode of acute psychosis in a diagnosis of schizophrenia, you increase your chance of relapse by something like 60% in the next two years. If you've got bipolar affective disorder and don't take mood stabilisers then that risk is even higher. And clearly psychiatry isn't just about the drugs. Psychiatrists here in the UK coordinate the care package of the patient after discharge from the hospital and also administer psychotherapy (forms of which are recommended by NICE- the body that issues clinical guidelines over here- even in schizophrenia so once the patient has some insight into their condition).

I also spent some time on an inpatient eating disorders unit, which was interesting too. If I had to pick between being a psychiatrist on an acute ward or in an eating disorders unit, I'd go for the former. Far less stressful.

As for judgement- why would I judge someone for having a mental illness any more than I'd judge them for having, say, heart disease? I have a close family member with bipolar disorder who was admitted to a psychiatric hospital in his youth (and given electroconvulsive shock therapy) so it would be a bit short-sighted of me! Not to mention it wouldn't be particularly compatible with my future career...

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