Friday, November 04, 2016

Improving psychiatric training

Mary-Ellen Lynall in a BMJ blog says she'll be "deeply concerned" if new and better mental health treatments don't grow out of a deeper understanding of brain function. I haven't written a piece potentially undermining a trainee for a while (eg. see previous post) and I don't want to dull Lynall's enthusiasm, but I worry it's misdirected. I don't know what she means about "improved understanding of the neuroscience behind psychiatric disease ... recently".

I'm sure there'll be different medications introduced in coming years but whether they'll be any better than placebo is open to question. She worries that she won't be able to "explain the complex neurobiology of conditions such as depression, addiction, and psychosis to patients in an understandable way" and I agree this might not make sense. I hope she learns how to do the fundamentals of a history, mental state and formulation of people's problems (see previous post).

I don't understand why the Royal College of Psychiatrists is only reviewing its teaching of neuroscience and not its whole training. I guess it's easier to get funding just to look at neuroscience. Simon Wessely denies that this initiative reflects a biomedical bias but it would be nice to see a more balanced response from the College to improve training. I've said before we need to train open-minded psychiatrists (eg. see previous post). We need to return to modern psychiatry's educational roots in Adolf Meyer and Aubrey Lewis.


cobweb said...

Enthusiasm for your passion needs to be tempered with wisdom and a knowledge of the harms caused by those interested in probing peoples' brains. The idea that a diagnosis of brain abnormality would reduce stigma around 'mental illness' is frankly so lacking in understanding that service users have reason to worry how such research would impact on them. In years to come hopefully there won't be another campaign needed to curb the excesses of neuroscientists,
On another note is it acceptable for the BMJ to be used by researchers such as Mary Ellen Lynall together with the other institutions she mentions - to be drumming up donations for research at all? The College of Psychiatry is a charity - the link used by the author channels readers to a request for 'donations' I raised the issue in reply to the essay but my response has not been published in the BMJ.

Adam said...

I posted the following response to the blog, but so far it doesn’t seem to have made it through moderation:

I’m not anti-neuroscience as one strand of mental health research, but Goldacre’s (2010) summary of the evidence on social attitudes suggests that stigma might not be one of the areas that will be aided by this discipline eventually winning out (or continuing to claim to) over the social sciences. It seems that the public think faulty brains are more dangerous and unpredictable than people caught up in stressful psychosocial situations. I just think this needs bearing in the minds biopsychiatric thinkers who advocate the (admittedly attractive) “mental illness is an illness like any other” line.

I wish the blog writer all the best in their research.

cobweb said...

The blog editor let me know that she had been on holiday so comments were posted late. I wrote another comment specifically asking what the position is re using the BMJ to drum up funds for the College of Psychs ,which is a charity, and the other institutions involved in this project.
It looks like Adam's comment has been posted now.

Unknown said...

You said: "I don't understand why the Royal College of Psychiatrists is only reviewing its teaching of neuroscience and not its whole training."

I think you'll find the answer in Prof. Sir Simon's "President's Blog" April 2016:

"I am delighted that we have secured substantial funding for this process from the Wellcome Trust and the Gatsby Foundation. With this funding, we will be setting up a Commission that will review the current teaching of neuroscience in the specialist training of psychiatrists and will make recommendations for a new curriculum incorporating modern developments in clinical neuroscience.

In so doing we are consciously following in the footsteps of the US National Neuroscience Curriculum Initiative (NNCI) The project is beginning this month, with a lecture by Dr Jeff Lieberman who will fly over from the United States specially to talk at the College on 20 April – more details here if you’re interested in coming." [emphasis mine]

It's worth checking out the NNCI.

DBDouble said...

Thanks for the link to NNCI, Frances. I've just created an account! I have previously commented on Jeffrey Lieberman on the blog (eg. see previous post).

cobweb said...

America does not have a great record re the treatment of people with 'mental health problems' especially by the use of very bizarre invasive brain procedures.. so why is UK being guided by USA. Money involved? You don't need to follow every offer of funding..why does it need a visit from America - never heard of I.T

cobweb said...

Youngsters are already being used by researchers who are giving small financial rewards to those enrolled in brain imaging which is supposed to lead to behaviour change...

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