The limits of responsibility

Sir: In his haste to point out more pressing issues than the stigmatisation of people with severe mental illness (Psychiatric Bulletin, November 2001, 25, 412-413), Bristow seems to have overlooked just how psychiatry came to be in this state in the first place.

Ever since its inception as a recognised speciality our profession has been hamstrung by a sense of inferiority whenever we compare ourselves to our more physically inclined colleagues. How many of us have never heard, or used, the quip that we are ‘not real doctors’, or experienced that small moment of deflation when we reveal our speciality to an interested enquirer? For decades we have dealt with this professional cringe in several ways. In our rush to embrace biological legitimacy, we seem to have forgotten the other two corners of the biopsychosocial triangle, or at least left them to others. We have also been happy to pick up whatever responsibility was going; in the 1960s and 1970s, when this responsibility concerned a group of people that few cared or even knew about, we were happy to hold onto it as a way of vouchsafing some sort of status. Now that the black pigeons of the asylum have come home to roost, it seems that Bristow is no longer a bird fancier.

Our profession would not have committed itself to the current status quo were it not for the poor regard in which it still holds itself. This regard derives from the unpleasant fact that psychiatrists are almost as stigmatised within the medical profession as our patients have been within society as a whole.

Just who should take responsibility for the behaviour of the mentally ill is a question for which no one yet has an answer, Howlett included (Psychiatric Bulletin, November 2001, 25, 414-415). In the meantime, might psychiatrists not be in a better position than most to carry on making the best of a difficult job, one that they have in any case been doing for decades? Our professional liability will only decrease if we are seen to be confronting these issues rather than running away from them.