Two books sharing two editors published by the leading university presses in the UK have been bundled together for a combined review. Is this justified over and above their alliterative subtitles? On the face of it, no, it is not. Only the two shared editors out of the 54 contributors write in both books. The first book promises to ‘redefine the professional role’ given a recent debate on ‘doctors as experts and professionals’. The other one seeks to document changes in the ‘implicit contract [that] sets out society’s expectations of psychiatry and mental health professionals and, in turn, of professionals’ expectations of society’. In practice, there is a great deal of overlap, although Psychiatry’s Contract with Society has a broader perspective.
I have spent my working life as a doctor, almost all of it as a psychiatrist. That this was a ‘profession’ was from the start axiomatic. I was aware of the sociological literature that identified the socialisation process involved in my induction into the profession as a medical student and trainee. This process was for me very benign and I assimilated the behaviours and values of my teachers (rejecting some on the way). I hope I learnt skills to put these values into practice and that I have continued to learn as the demands on me as a psychiatrist evolved. Professionalism in Mental Healthcare is focused on how to help mental health professionals follow this journey. It contains chapters on the evolving regulatory frameworks for doctors in a number of jurisdictions and on the teaching of ‘professionalism’. Highlights are chapters by Vikram Patel on what professionalism means in resource-poor settings, by John Talbott on the practicalities of introducing a curriculum for professionalism in a medical school and by Jim Sabin and Steven Moffic on the ethical foundations of professionalism.
It had never occurred to me that as a psychiatrist I had a contract with anyone other than my employer. I have always been aware that in my role I have had to balance competing interests (my own, those of my patients – each of whom might have competing interests for my attention – those of my employers and broader societal concerns). Psychiatry’s Contract with Society seeks to interrogate the ‘contract’ between two abstract entities, ‘society’ and ‘psychiatry’, neither of which is clearly defined. An intriguing chapter by Robin Downie interrogates the concept of a profession from a philosophical viewpoint – quoting Bernard Shaw’s nice put-down that ‘All professions are conspiracies against the laity’. Richard Cruess and Sylvia Cruess provide strong chapters on the teaching of professionalism and the (metaphorical) social contract between psychiatry and society. Others address, with varying degrees of success, very important issues relating to the economics of mental healthcare, evolving regulatory frameworks and the psychiatrist as leader and manager.
Refreshingly, these books provide food for thought rather than definitive answers to highly complex issues. The questions raised sent me on a search through the internet and my bookshelves. I would really like to think that the ability for moral reflection and intellectual curiosity are the twin hallmarks of the professional.
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