Psychiatric Bulletin - Letter: Psychiatry for medical students: need for a more holistic approach to teaching?

From: Psychiatric Bulletin -

http://pb.rcpsych.org/content/38/3/138.2.full

Kristina Rodney and Laura Wilkinson

Kristina Rodney and Laura Wilkinson are both ST4 medical students, Newcastle University, Newcastle, UK, email:k.rodney AT newcastle.ac.uk.

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.

During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically medical students but we were surprised to find that this was not above our level of knowledge. This prompted discussion of undergraduate psychiatry training more broadly, which we felt focused too heavily on the diagnosis of mental illness and less so on the holistic approach to the patient and their presentation as covered by the MRCPsych course. From our experience of undergraduate psychiatry we feel that the assessment by means of a logbook of conditions encourages students to find patients with a certain diagnosis, and in doing so overlooks the true essence of psychiatry. To our mind this incorporates the ability to consider all aspects of a patient’s life and formulating these, while demonstrating compassion for another person at a time of most need.

Through choosing a 6-week placement in old age psychiatry we have been able to explore the specialty more thoroughly and broadly than facilitated within the standard undergraduate programme, and we have realised how little of psychiatry we have been exposed to as undergraduates. We have become more aware of the importance of considering the patient’s personal and social circumstances alongside their diagnosis, and how these can influence each other. Specifically, the importance of a sound ethical approach to practice has been highlighted through the higher-level teaching we experienced, where the Mental Capacity Act was discussed in detail.

We believe that it would benefit undergraduates to experience a more realistic and rounded placement in psychiatry and truly consider the social implications of mental illness. As it currently stands, undergraduate education in psychiatry is oversimplified to focus on diagnosis and does not acknowledge the capabilities of medical students to adopt a holistic approach. An opportunity to consider all aspects of a psychiatrist’s role may encourage more students to consider a career in this field.

<>

I have contacted the authors of this letter to inform them of Hodges' model and its scope in assuring holistic and integrated care. The model could also facilitate curriculum development. The authors of the letter are not endorsing Hodges' model, I am seeking to highlight the need for such a resource.

Thanks to:

Lucy Alexander
Rights and Permissions Manager
Royal College of Psychiatrists

If you must rumple the care domains - rumple them together

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

'A Man’s body and his mind, 
with the utmost reverence to both I speak it, 
are exactly like a jerkin, and a jerkin’s lining; – 

rumple the one	– you rumple the other.’ 1

¹ Sterne L. The Life and Opinions of Tristram Shandy, Gentleman (1761), vol. 3, ch. 4 (eds M New, J New). University of Florida Press, 1978.

Source: Royal College of Psychiatrists (2013) Whole-person care: from rhetoric to reality Achieving parity between mental and physical health. Occasional Paper 88, March 2013. p.2.

Book: The Last Asylum

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

The Last Asylum	-sociology -medicine
medical- social-

group - population

Winwick Hospital remembered

Image source: Metro

4th International Symposium on Pervasive Computing Paradigms for Mental Health

May 8 - 9, 2014 - Tokyo, Japan
NEWS: The paper submission deadline has been extended to February 22, 2014

You are warmly invited to participate in the 4th MindCare 2014 symposium which is focused on the use of technologies in favor of maintaining and improving mental wellbeing. It will be hosted at the University of Tokyo. The symposium will bring together top researchers and practitioners from various technological, medical and psychological disciplines.

KEYNOTE SPEAKERS
MindCare 2014 will feature two state-of-the-art keynote speeches given by:

• Neema Moraveji - Director of Calming Technology Lab, Stanford University, USA
• Manabu Honda - Director of the Department of Functional Brain Research, National Center of Neurology and Psychiatry, Tokyo, Japan

The accepted papers will be published in Springer's LNICST series and will appear in the SpringerLink - one of the largest digital online libraries which covers a myriad of scientific disciplines. In addition, the accepted papers will be available in EU digital library (EUDL) and indexed in Scopus and EI as well as submitted for indexing in ISI Proceedings. Selected papers will be given a possibility to be extended for a journal publication.

two books two islands two doctors II

Book cover: The Story of San Michele

Here are some additional images and text from Villa San Michele (sorry about the accessibility issue):

Description of the Dining Room Villa San Michele

Skeleton mosaic carrying water and wine

two books two islands two doctors - beyond a cappuccino

My uncle Doug (I do miss him) mentioned a book to me when I was some time around 1974. I think I found a copy in their bookcase when the whole family used to visit on a Sunday afternoon.

A decade later 1983, the year before I got married I visited Sorrento and during this holiday took a day trip to Capri.

With my fiancé I found myself walking around the Villa San Michele. The book was The Story of San Michele by Axel Munthe. I don’t recall consciously deciding to go to Anacapri, but I found myself there. It really made an impression on the 24 year old. What an amazing place to be, study, to try to be creative if not grandiose.

I’m sure I read the book after this visit, it dawning on me that this was - not just - that place, but the story too.

In between on holiday in Kefalonia in 1995 and read Captain Corelli’s Mandolin while there. Axel Munthe was a doctor and there’s a doctor in de Bernières’ book.

Two islands, two doctors, two books: fact and fiction and the spaces in between.

Thirty years later it was a lovely experience to take the bus to Anacapri this September and spend some time at San Michele.

Now the mix of history and styles is a bit jarring, but it is still, for me at least, an amazing space to be. The views of the Bay of Naples are stunning.

The light, the air, the sky.

Inspirational.

At some point if I could spend some time there, beyond a cappuccino...

The Bay of Naples - Vesuvius from San Michele 4 Sept 2013

literatureandmedicine

Training Needs of Psychiatric Mental Health Nurses: Study

Dear all,

We're currently collecting data for a study regarding the training needs of psychiatric mental health nurses in collaboration with Horatio - European psychiatric nurses. Anyone interested in receiving an online (editable pdf) self administered questionnaire or a printed version is more than welcome to contact me on / off list (stephendemicoli@yahoo.com).

Thanks in advance and kind regards to all,

Steve Demicoli
E-mail: stephendemicoli@yahoo.com

Source: Psychiatric Nursing list
The questionnaire is not long, I will be taking part.

Hodges' model - DSM V: the Politics of (Well-being (Health [Mental Health])) salience, books and domains

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

individual

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 'salience'  ‘Salience syndrome’ replaces ‘schizophrenia’ in DSM-V and ICD-11: psychiatry’s evidence-based entry into the 21st century? J. Van Os bereavement medical, bio-psycho-social, recovery model self-efficacy self-stigma DSM5 and Ethical Relativism Ultimate terminology:  self, person, patient, service user, client,  Mr, Miss .....	Diagnostic process 'Evidence', objectivity,  repeatability, validity, treatment, drugs Credit Heidi Cartwright, Wellcome Images
The history of DSM: APA : Wikipedia stigma social services social network (size, quality) anti-psychiatry social norms? Media: Books review - essay; Stevenson, T. (2013) Mind field, FT Weekend, May 25-26. p.8.	American Psychiatric Association APA dx revision watch Opinion - commentary: DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice Is Criticism of DSM-5 'Anti-psychiatry'? Goldacre: Bad Pharma .... and much more...!

group - population

Image: http://wellcomeimages.org/

Jordan: hospital, hospitality and the global research nurses network

The Jordan conference and experience prompted me to reflect upon 'hospitality' and 'hospital'. Also hospital as a physical environment and the way this contrasts with community care; and those without access to either.

At the research workshop on Monday with Nicola McHugh Project Coordinator for the Global Research Nurses' network, we were asked to consider and record how our respective job had changed. I jotted down the following also expanded here:

Winwick Hospital - Institutional care.

Issued with a (grey) suit and waistcoat.

White coats. Union lapel badges.

Witnessed (not overnight and still ongoing ...?) the transition to community care.

Development of primary care mental health.

The emergence of information technology.

From frontplate - nursing process and models, theories of nursing.

Nurses as advocates - now the addition of independent advocates.

Revisions to the Mental Health Act.

Changes in organizational hierarchies.

Changes in nurse education.

The increase in significance of the POLITICAL care domain:

informed consent, mental capacity, public engagement, litigation.

The cycle of re-organisations - NHS and Social Services.

Community Mental Health Nurses as therapists to assessors.

The development of the care programme approach (CPA).

The reduction in the number of injections / use of electroconvulsive therapy.

New drugs, evidence, specialist teams.

From in-house system to Körner to National Programme for IT to ..........

Less stigma for some conditions: epilepsy, psychosis but much remains

Diseases - Recovery - Self-care

Here are hospital and hospitality:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

During the Middle Ages hospitals served different functions to modern institutions, being almshouses for the poor, hostels for pilgrims, or hospital schools. The word hospital comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, hospitable reception.

The word hospitality derives from the Latin hospes, meaning 'host', 'guest', or 'stranger'. Hospes is formed from hostis, which means 'stranger' or 'enemy' (the latter being where terms like 'hostile' derive).

group - population

Sources:
http://en.wikipedia.org/wiki/Hospitality
https://en.wikipedia.org/wiki/Hospital

Oxford Philosophy and Psychiatry Summer School and launch of new Oxford Handbook of Philosophy and Psychiatry

University of Oxford Philosophy and Psychiatry Summer School to host book launch of the new Oxford Handbook of Philosophy and Psychiatry. 

The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published and we are delighted to announce the launch as part of the Summer School. Sponsored by Oxford University Press, the launch will open with a short address from Dr Anita Avramides (Reader in Philosophy of Mind, University of Oxford). The book is written and edited by an international team comprising world-leading philosophers and psychiatrists, resulting in an authoritative volume. We are very happy to welcome several of these team members to the Summer School where they will be delivering key sessions:

• Values in Mental Health Practice - Professor Bill Fulford (Emeritus Professor of Philosophy and Mental Health, University of Warwick, and Member of the Philosophy Faculty, University of Oxford)
• Ordering Disorder: Mental Disorder, Brain Disorder and Therapeutic Intervention - Professor George Graham (Professor of Philosophy and Neuroscience, Georgia State University)
• Karl Jaspers and the Ethics of Incomprehensibility - Professor Giovanni Stanghellini (Professor of Dynamic Psychology and Psychopathology, University of Chieti)

These sessions form part of an intensive programme delivered through keynote lectures and seminars offering opportunities for substantial dialogue between philosophers, scientists and mental health practitioners.

The Summer School will take place at St Catherine’s College, Oxford (14 – 19 July 2013) and includes opportunities to network and socialise with fellow delegates, faculty members and invited speakers. Residential and non-residential options are available.

Further details available: www.conted.ox.ac.uk/ppss2

My source: NURSE-PHILOSOPHY at JISCMAIL.AC.UK (IPONS)