A short introduction to psychiatry PDF
Preview A short introduction to psychiatry
Gask-Prelims.qxd 5/21/04 2:36 PM Page i A SHORT INTRODUCTION TO PSYCHIATRY Gask-Prelims.qxd 5/21/04 2:36 PM Page ii Short Introductions to the Therapy Professions Series Editor:Colin Feltham Books in this series examine the different professions which provide help for people experiencing emotional or psychological problems. Written by leading practitioners and trainers in each field, the books are a source of up-to-date information about • the nature of the work • training, continuing professional development and career pathways • the structure and development of the profession • client populations and consumer views • research and debates surrounding the profession. Short Introductions to the Therapy Professions are ideal for anyone thinking about a career in one of the therapy professions or in the early stages of training. The books will also be of interest to mental health professionals needing to understand allied professions and also to patients, clients and relatives of service users. Books in the series: A Short Introduction to Clinical Psychology Katherine Cheshire and David Pilgrim A Short Introduction to Psychoanalysis Jane Milton,Caroline Polmear and Julia Fabricius A Short Introduction to Psychiatry Linda Gask Gask-Prelims.qxd 5/21/04 2:36 PM Page iii A SHORT INTRODUCTION TO PSYCHIATRY Linda Gask SAGE Publications London ● Thousand Oaks● New Delhi Gask-Prelims.qxd 5/21/04 2:36 PM Page iv © Linda Gask 2004 First published 2004 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publicationmay be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Inquiries concerning reproduction outside those terms should be sent to the publishers. SAGE Publications Ltd 1 Oliver’s Yard 55 City Road London EC1Y 1SP SAGE Publications Inc. 2455 Teller Road Thousand Oaks, California 91320 SAGE Publications India Pvt Ltd B-42, Panchsheel Enclave Post Box 4109 New Delhi 110 017 British Library Cataloguing in Publication data A catalogue record for this book is available from the British Library ISBN 0 7619 7138 6 ISBN 0 7619 7139 4 (pbk) Library of Congress Control Number: 2004102657 Typeset by C&M Digitals (P) Ltd, Chennai, India Printed in Great Britain by TJ International Ltd, Padstow, Cornwall Gask-Prelims.qxd 5/21/04 2:36 PM Page v For my family,John and Suzy, with all my love Gask-Prelims.qxd 5/21/04 2:36 PM Page vi One need not be a Chamber to be Haunted One need not be a House The Brain has Corridors surpassing Material Place Emily Dickinson Gask-Prelims.qxd 5/21/04 2:36 PM Page vii CONTENTS Acknowledgements viii Introduction 1 1 Psychiatry: Historical Context of a Profession 4 2 The Culture of Psychiatry 36 3 Experiencing Psychiatry 69 4 The Scope and Limits of Psychiatry 100 5 The Future 126 Appendices 141 1 Information on Psychiatry as a Career 143 2 Glossary of Some Terms Used in the Text 149 References 155 Index 167 Gask-Prelims.qxd 5/21/04 2:36 PM Page viii ACKNOWLEDGEMENTS Several friends and colleagues kindly agreed to be interviewed and/or read early drafts of particular chapters and they are (in alpha- betical order): Elaine Arnold, Tom Brown, Bill Deakin, Dinesh Bhugra, Chris Dowrick, Roger Farmer, Hugh Freeman, Chris Manning, Frank Margison, Max Marshall, Carl May, David Pilgrim, David Richards and Jenny Shaw. Mike Shooter, President of the Royal College of Psychiatrists gave up his precious time to talk to me. I also extend my thanks to the Royal College of Psychiatrists for giving me permission to reproduce material from their website in Appendix 1. Colin Feltham suggested that I write the book and has been a very helpful editor, reading through drafts and posing some difficult questions. Finally I couldn’t have completed this without my husband John, who always supports me even when I get carried away on yet another project. Gask-Introduction.qxd 5/21/04 2:36 PM Page 1 INTRODUCTION This book is not a textbook of psychiatry in the usual sense that a textbook generally contains the knowledge base of the subject in question. Instead it is a book aboutpsychiatry, the profession and its practitioners, in the context of the history and culture of mental ill- ness and mental health care. I hope that it will complement general textbooks of psychiatry and be of interest to psychiatrists in training, as well as to those considering psychiatry as a profession and other readers, including allied professionals, who simply want to under- stand what psychiatry is. Confusion often arises because ‘psychiatry’ may be used interchangeably with ‘mental health care’ and this book is concerned with the specific nature of the former as practised by psychiatrists rather than a broader examination of the provision of mental health care. Johann Christian Reil (1759–1813), Professor of Medicine at Halle in Germany invented the term psychiatry at the turn of the nineteenth century. However, it was not until the early twentieth century that this began to be widely applied in English to a medical speciality. That psychiatry is indeed a speciality of medicine, a branch of medicine with its own training structure, sets it apart from the other mental health sciences and professions. But of all the branches of medicine, psychiatry sometimes seems to have the least connection with the school examinations in chemistry and biology that those who choose a medical career must take, and more in common with the social sciences. In the past hundred years, people have turned increasingly to doctors when they have emotional problems. Psychiatrists have become the latest in a long line of people to manage the ‘mad’, fol- lowing on from the magical healers and priests. But is there reason to think that psychiatrists deal better with such problems than any- one else? Today the person with religious delusions in the psychi- atric unit can still see the priest and discuss his supposed sins, but the priest will probably suggest that he takes his medication too. However, the extent to which each psychiatrist will also explore the meaning of a particular symptom and how it might have arisen in that particular patient at that time in his or her life will vary consid- erably, depending on the weight he or she places on biology,
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