Psychiatrists across the world, when assessing mental states, have to consider “insight”.
Psychiatrists, like myself, are also taught the “subjective-objective divide”. This “divide” has always troubled me, as it would seem to imply that the description of symptoms by the patient (“subjective”) is less valid than the interpretation (“objective”) by the “expert” interviewer. I have always been in agreement with Dr Allan Beveridge that it is time to abandon this divide. Harry Stack Sullivan maintained that the most important therapeutic factor was the relationship between doctor and patient, and this led him to decry those clinicians who adopted a detached and supposedly ‘objective’ approach to the patient.
The Royal College of Psychiatrists, of which I am a member, publishes a magazine called “INSIGHT” and the first edition includes a cartoon of Prof Sir Simon Wessely handing over Presidency to Dr Wendy Burn with a high-five. This image, and the title of the College magazine, has returned my thoughts to the events of the last few weeks in relation to the publication and reporting of a Lancet meta-analysis on antidepressants.
What has struck me about the debate that has ensued is that those speaking for the Royal College of Psychiatrists do not seem to wish to make any comments about the evidence that the majority of those taking antidepressants (1 in 7 in Scotland) are taking them long term or indefinitely. Furthermore, the language used by some senior College members seems to dismiss the experience of those taking antidepressants, using terms such as “pill shaming”, “pretending” and “demonising”. I recently considered such use of language in this post: “Psychiatry, dependent on its authority, is finding withdrawal seriously difficult”. One of the points that I made was that we should listen to all voices, including the experts and also to those who have had experience of taking antidepressants.
It is my view that my College needs to develop the insight to recognise that it is time to abandon its imposed divide between “subjective” and “objective” understandings.
If you are interested to learn more of the backdrop to this, I would suggest you read this by James Moore and this by James Davies.
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