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Mental health services for ‘experts by experience’? Vladan Starcevic University of Sydney, Sydney Medical School – Nepean, Discipline of Psychiatry, Sydney, Australia Corresponding author: Vladan Starcevic, Department of Psychiatry, Nepean Hospital, University of Sydney, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected] DOI: 10.1177/0004867414549965
To the Editor Many mental health clinicians in Australia may have come across recommendations about the desired terminology (Australian Health Ministers’ Advisory Council, 2013). Thus, we have learned that ‘patients’ and ‘clients’ are not appropriate and that we should adopt terms such as ‘experts by experience’ and ‘people with lived expertise’ (p.5). Likewise, we are told that these people do not suffer from ‘mental illness’, but, rather, that they have ‘mental health issues’, ‘challenges’ and/or ‘emotional distress’ (p.5). One way of reacting to this would be to ignore it as another bureaucratic nuisance. However, by doing so
Delayed diagnosis of multiple sclerosis in a patient with schizoaffective disorder: a case of ‘diagnostic overshadowing’ Brad Hayhow1,2, Frank Gaillard3, Dennis Velakoulis1,2 and Mark Walterfang1,2 Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia 2Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia 3Department of Radiology, Royal Melbourne Hospital, Parkville, Australia
ANZJP Correspondence we would turn a blind eye to a number of important issues. First, this terminology only reinforces the already rampant stigma about psychiatry by implying that terms like ‘patients’ and ‘clients’ are inherently stigmatizing. It is naïve to think that psychiatric patients will be less stigmatized if they are called ‘experts’. There is also a problem with logic. Experts usually seek no help for what they are experts on, and why would ‘experts by [psychiatric] experience’ seek help from the mental health staff who may not have the relevant ‘expertise’? Such logic ultimately makes mental health services redundant, although this is probably not the conclusion that was intended. Moreover, what are we to make of ‘experts’ who are hospitalized against their own will? It is hard to find another example where people with expertise may actually be punished for it. Is it a curse to be an expert – the more one knows, the more one is likely to get into trouble? Implicit in the reconceptualization of psychiatric patients as ‘experts’ is romanticizing of mental illness. There is nothing glamorous about psychiatric disorders and suggesting otherwise is hypocritical. Regardless of the debates about the definition of mental disorder, the
practical reality is that mental disorders do exist. If they did not exist, there would be no mental health services. Reducing mental disorders to ‘issues’, ‘challenges’ or ‘distress’ will not reduce the stigma, too; it trivializes patients’ suffering and further blurs the already hazy boundary between a disorder and non-disorder. Finally, these verbal, neo-Orwellian acrobatics show the absurdity of trying to be ‘politically correct’ beyond any reproach. That is impossible when it comes to the unpleasant facts of life, for example, a psychiatric admission due to illness. Such facts should not be hidden behind a preposterous and perilous terminology.
Corresponding author: Mark Walterfang, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Level 2, John Cade Building, Royal Melbourne Hospital, Parkville, VIC 3050, Australia. Email: [email protected]
associated with recurrent symptoms of peripheral paraesthesia, urinary incontinence, blurred vision, falls and heat-sensitivity. The symptoms had been present for several years, but had been attributed to BM’s schizoaffective disorder and the medications used to treat it. On examination of the patient’s mental state there was no evidence of thought disorder, delusions or hallucinations, but BM’s affect was apathetic and conversation impoverished. On bedside cognitive testing he demonstrated poor recall, impaired visual construction, decreased verbal
DOI: 10.1177/0004867414551067
To the Editor
1Melbourne
A 42-year-old gentleman (BM) with schizoaffective disorder diagnosed at age 27 was referred for neuropsychiatric assessment complaining of a decline in cognitive function
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
Reference Australian Health Ministers’ Advisory Council (2013) A national framework for recoveryoriented mental health services: Policy and theory. Available at: www.ahmac.gov.au/ cms_documents/National%20Mental%20 Health%20Recovery%20Framework%20 2013-Policy&theory.PDF (accessed 29 July 2014).
Australian & New Zealand Journal of Psychiatry, 49(2) Downloaded from anp.sagepub.com at University of Birmingham on June 7, 2015
Mental health services for ‘experts by experience’? Vladan Starcevic University of Sydney, Sydney Medical School – Nepean, Discipline of Psychiatry, Sydney, Australia Corresponding author: Vladan Starcevic, Department of Psychiatry, Nepean Hospital, University of Sydney, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected] DOI: 10.1177/0004867414549965
To the Editor Many mental health clinicians in Australia may have come across recommendations about the desired terminology (Australian Health Ministers’ Advisory Council, 2013). Thus, we have learned that ‘patients’ and ‘clients’ are not appropriate and that we should adopt terms such as ‘experts by experience’ and ‘people with lived expertise’ (p.5). Likewise, we are told that these people do not suffer from ‘mental illness’, but, rather, that they have ‘mental health issues’, ‘challenges’ and/or ‘emotional distress’ (p.5). One way of reacting to this would be to ignore it as another bureaucratic nuisance. However, by doing so
Delayed diagnosis of multiple sclerosis in a patient with schizoaffective disorder: a case of ‘diagnostic overshadowing’ Brad Hayhow1,2, Frank Gaillard3, Dennis Velakoulis1,2 and Mark Walterfang1,2 Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia 2Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia 3Department of Radiology, Royal Melbourne Hospital, Parkville, Australia
ANZJP Correspondence we would turn a blind eye to a number of important issues. First, this terminology only reinforces the already rampant stigma about psychiatry by implying that terms like ‘patients’ and ‘clients’ are inherently stigmatizing. It is naïve to think that psychiatric patients will be less stigmatized if they are called ‘experts’. There is also a problem with logic. Experts usually seek no help for what they are experts on, and why would ‘experts by [psychiatric] experience’ seek help from the mental health staff who may not have the relevant ‘expertise’? Such logic ultimately makes mental health services redundant, although this is probably not the conclusion that was intended. Moreover, what are we to make of ‘experts’ who are hospitalized against their own will? It is hard to find another example where people with expertise may actually be punished for it. Is it a curse to be an expert – the more one knows, the more one is likely to get into trouble? Implicit in the reconceptualization of psychiatric patients as ‘experts’ is romanticizing of mental illness. There is nothing glamorous about psychiatric disorders and suggesting otherwise is hypocritical. Regardless of the debates about the definition of mental disorder, the
practical reality is that mental disorders do exist. If they did not exist, there would be no mental health services. Reducing mental disorders to ‘issues’, ‘challenges’ or ‘distress’ will not reduce the stigma, too; it trivializes patients’ suffering and further blurs the already hazy boundary between a disorder and non-disorder. Finally, these verbal, neo-Orwellian acrobatics show the absurdity of trying to be ‘politically correct’ beyond any reproach. That is impossible when it comes to the unpleasant facts of life, for example, a psychiatric admission due to illness. Such facts should not be hidden behind a preposterous and perilous terminology.
Corresponding author: Mark Walterfang, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Level 2, John Cade Building, Royal Melbourne Hospital, Parkville, VIC 3050, Australia. Email: [email protected]
associated with recurrent symptoms of peripheral paraesthesia, urinary incontinence, blurred vision, falls and heat-sensitivity. The symptoms had been present for several years, but had been attributed to BM’s schizoaffective disorder and the medications used to treat it. On examination of the patient’s mental state there was no evidence of thought disorder, delusions or hallucinations, but BM’s affect was apathetic and conversation impoverished. On bedside cognitive testing he demonstrated poor recall, impaired visual construction, decreased verbal
DOI: 10.1177/0004867414551067
To the Editor
1Melbourne
A 42-year-old gentleman (BM) with schizoaffective disorder diagnosed at age 27 was referred for neuropsychiatric assessment complaining of a decline in cognitive function
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
Reference Australian Health Ministers’ Advisory Council (2013) A national framework for recoveryoriented mental health services: Policy and theory. Available at: www.ahmac.gov.au/ cms_documents/National%20Mental%20 Health%20Recovery%20Framework%20 2013-Policy&theory.PDF (accessed 29 July 2014).
Australian & New Zealand Journal of Psychiatry, 49(2) Downloaded from anp.sagepub.com at University of Birmingham on June 7, 2015
