How does your approach differ from regular psychiatry?
Now, I don’t generalise all psychiatrists. But based on observation - the idea of psychiatry sounds to me like a pseudoscience held by those not really interested in what they do in terms of the care of the patient. It’s largely a draconian viewpoint similar to what the Nazis were doing back in WW2.
However, I’ve read many of your posts - forgive me when I say this - and I say this in a complimentary tone. But if you were a patient and you showed your posts to a registered NHS psychiatrist - that would see you incarcerated for a lifetime and drugged up to the eyeballs. It would not register with them at all. So, I find your comments refreshing and surprising. It doesn’t follow suit. Is there a particular reason why that is? Why did you get into psychiatry or forensic psychiatry? What was your career goal when you decided to take the road you did?
That’s right! Hence ‘Guilty by Reason of Sanity’. Some know what that is about, clarifications by PM only. The ‘rules’ do not allow me to say more in open forum. You’ll have to wait a while for the latter to answer most of your questions. You asked. Your ‘punishment’ follows!
I never planned to specialise in psychiatry. A psychiatrist was the last thing I ever wanted to become. I still do not see myself as ‘a psychiatrist’. I’m just me. A Ouija Board I was fooling on with my cousin, foretold that I would become “a psychiatrist” when I was just 17, and at which point I did not even know what ‘psychiatry’ or ‘psychiatrist’ really meant. So as ‘PSYCHIATRIST’ was being spelled out we were like ‘What the hell is that, is it spelling?’ All I knew back then in my uninformed youth, was some vague thing psychiatrists attend to ‘mad people.’ Why would I want to be that!? My cousin and I cracked up laughing, in stitches on a bed.
My only true interest from my mid-teens was in philosophy and human nature. That has remained true to this day. As I write these words, I have no burning interest in psychiatry as a medical sub-speciality. Psychiatry feeds my original fires but that is about it.
I wanted to see life with different sets of lenses. So – I pushed myself hard – too hard my close associates have said – to gain qualifications in law, social science, and business. I saw too many patients suffering violations of their Human Rights. That led me to become an Amnesty International recognised Human Rights Defender.
For someone with no true enthusiasm about psychiatry, I micro-specialised in forensic psychiatry then into women’s mental disorders. I did not stop there. In the last 10 years I acquired much sound experience and knowledge in learning disabilities, attention deficit disorders, autistic spectrum disorders, and late adolescent psychiatry, psychiatry of older persons.
None is the short answer. My entry into medicine was forced by clan expectations (a family of doctors). My true passions were in philosophy, IT, and law. Those resurfaced years later and more so in the last 10 years.
I ended up in psychiatry only because in a foreign land 5,500 miles away, in 1986/87 I was given forced options arising from a post-scholarship contract (one more year of service to do): a job venereal diseases or a job in psychiatry at the single asylum in a small country of about 1.1 million people at the time. [It was a true ‘Asylum’ left by our English colonial masters. Hence by pure accident I ended up visiting almost identical architecture and cultures at Friern Barnet Hospital (1990-ish) and Rampton Hospital [early1997 to late1999] - and back to Rampton about 5 years ago x 1 year.
So - being displaced in medicine and in psychiatry - after about 2 years in the Asylum, some key events knocked this ‘gyrating fragment of geological strata’ over to England:
An intense philosophical interest in psychopathology via Jaspers and others.
A patient at the Asylum: Mr F. He was quite affable in his manner. He suffered with schizophrenia and epilepsy (the latter is not a mental illness). He was stable in his behaviours. He had beliefs that he was the son of the Queen and heir to great property in England. He ‘denied’ the existence of his true biological mother. He remembered as a child sitting on his mother’s lap in Buckingham Palace and she telling him bedtime stories in the Palace. He recalled playing with the Corgis and going for walks out on sprawling palace grounds. I spent hours exploring his beliefs - being totally baffled. Mr F could never believe that he was mentally ill. I often wondered “How come the chemicals (pills we prescribed) are unable to untwist his beliefs?” As the years passed and my knowledge and experience grew, I understood it like this: pills can untwist some brain-chemical imbalances, but they cannot untangle structural brain pathways (the wires in the brain). Some types of schizophrenia are probably due just to imbalances of brain chemicals, whilst other types may be due to a micro-structural chaos of tangled ‘wires in the brain’. A good question would be ‘Why would he take your pills?’ Another, “Why would he travel miles to a psychiatric clinic to get pills for an illness he does not believe he has?”. The answer is that he believed all the pillswere for his epilepsy – and we (nurses and doctors) never had the courage to educate him differently. Okay – that was rather deceptive, relative to today’s standards of practice. Terrible!
A psychologist: Around late 1989, in the Asylum a senior female psychologist said to me in passing conversation “Doctor, it is coming up on 2 years, you’re working here. I’ve noticed that you stopped complaining of the smell of the place.” I struggled to respond for a couple seconds. I could not find words. Then I responded with some brief words to brush it off and deny what she was saying. I was slightly angry inside – how dare she say such a thing? Later that night, I realised that she was entirely correct. Something ‘philosophical’ awakened in me, ‘How could my behaviour and awareness be changed by ‘the Institution’?’ [Back then I knew little about ‘Institutionalisation’]
Existential psychiatry: Nobody (I mean 99% of people I’ve met) seems to be interested in this ‘airy fairy’ sidebar of psychiatry. But of course it gripped me - having read loads of stuff on existentialism and then coming across the several books by Viktor Frankl. ‘Mans Search for Meaning’ was the most powerful for me.
So - I have no current career goals today and I say that at every appraisal. I am nobody on any national stage. I write too much I’ve been told because words fly from my fingers at about 100wpm, and I speak in strange ways (relative to most of my professional colleagues) My goals are elsewhere. For me it’s about the ‘human condition’. My aims and objectives in life are to fight for what is right. Work is just there to pay the bills.
Too many thoughts flew when you dropped that lovely ‘stone’ in my psychological pond. So - I didn’t get to the part on ‘why forensic psychiatry?’
Key way points:
North London: I’m a fledgling around 1991-1992 in general psychiatry - struggling to cope with a new culture and systems, when a forensic psychiatrist came to assess one of our patients who was quite disruptive on the ward. Everybody was like “OMG! OMG!! Forensic Psychiatrist!!” Everybody was flying around to ensure that a proper room was found for Dr X to see the patient. Those were the days when forensic psychiatrists were given some respect .[Don’t start me up - in the last 10 years we are nobody amongst all the other ‘experts’ who went on their ‘courses’.] Naturally I wanted to sit in on his assessment of the patient. We could not get much out of the patient beyond a few short phrases. Dr X permitted me and a nurse to sit in on his assessment. No laptops in those days. He sat there with an A4 pad and fountain pen, spectacles two-thirds down on his nose bridge, legs crossed - and just made a few statements (not really questions to the patient). Right - so all this stuff begins to come from the patient. Nurse and I are in school now! Full sentences but fragmented thinking, delusions and other stuff he elicited. Dr X was only occasionally looking at the patient from the corner of his eye. P did not become agitated or attempt to attack. It was quite obvious by the end of the hour that P was being commanded by various hallucinations and afflicted by delusions to dish out violence. So that was a a “WOW!” experience. ‘How could I become like Dr X?’ - was my thought.
The late Dr John Bradley - a true English gent and one of my supervising consultants - once a head of MPS defence services - was influential on my legal thinking in medicine. Legal issues in medical practice excited me because of my natural interest in law from my teens.
The late Prof Nigel EastmanProfessor Nigel Eastman (1945–2022) - PMC: I attended a lecture he gave in Southampton probably around 1995 if memory serves. At the time he was a ‘Senior Registrar’ in ‘forensic’. I’m like, “Wow! This guy is amazing. How can I learn to think as clearly as him?” Over the years Nigel’s career shot off like a rocket. He was a sort of ‘marmite figure’ like him or hate him among forensic colleagues. I sat at his feet in many an audience lapping up the logic of what he was talking about. He strained my brain on occasions. No bad thing. No pain no gain. Enter Rampton Hospital (early 1997 to late 1999), consent capacity issues became important. I drew on all his work. Nobody else back then knew what I was talking about and even when I provided them with well written works by Nigel - it all went flying over their heads. But sadly a few years ago, I realised that Nigel’s health was failing when he failed to attend and give a couple lectures. The last time I saw him was at a massive conference about about 18 months before he passed away. When I saw how weak he had grown, I had a sixth sense that time was short for him. At the foot of an escalator, I pat him on the back for a quick conversation. I said, “Nigel - I want to thank you for being an inspiration and motivation for me in forensic psychiatry from your days back in Southampton.” He smiled and said "Thank you Russell. Much appreciated." he remembered me - my name not on a lanyard - from my brief interactions over the years. Simply phenomenal. We shook hands and off he went up the escalator. That was my last contact.Nigel was not just ‘a lawyer in psychiatry’ he fought fiercely for ethics in psychiatry. None of this means that I want to be ‘son of Nigel’. I could never fit into such big shoes. I just continue in the same vein to fight for what is right.
Well there is a lot more - but I don’t want to be guilty of hogging a whole thread with my autobiographical accounts. All that I have said is either in the public domain already, now thrust into the public domain and there’s more coming later on (in other spaces). I am of capacity - thank you very much!
The thread is now ‘Psychiatry’.
I want to encourage other psychiatrists out there to share their motivations for:
Becoming a doctor.
Becoming a psychiatrist.
Choosing their speciality or sub-speciality in psychiatry.
Just hit the reply button and give something of yourself that you feel comfortable sharing in the public domain. Many thanks to @Jonathan for allowing the thread to continue.
Interesting that the post started with a comment about psychiatry being akin to Nazi methods, and Russell mentions his interest in Victor Frankl’s experience with that period. It explains a lot, Russell, about why your approach is so different. It gives hope that there is an alternative to trampling on humans and what should be, their certain rights.
This is an amazingly astute observation, that coheres with mine. Your word was ‘similar’ - and I can tell you now that a majority of psychiatrists won’t want to tarred with Nazism. 'Pseudoscience’ has stained psychiatry in its history. And today I have serious concerns about that on the issue of diagnostics.
The historical stains on psychiatry are undeniable, but they must be understood within the broader context of the field’s evolution. Psychiatry was coined as a recognised discipline in 1808 by German physician Johann Christian Reil. Psychiatry began as a fledgling discipline grappling with profound ignorance about mental illness, relying heavily on trial-and-error approaches and societal biases. Over time, it matured into a sophisticated medical specialty, claiming to be grounded in science and ethics.
Looking back
Imagine stepping into an asylum in the 18th or 19th century. What greets you is far from a sanctuary for healing. Instead, you encounter overcrowded wards filled with individuals chained to walls or confined in cages. These institutions, originally conceived as places of refuge, often devolved into sites of neglect and dehumanisation. Patients were treated as less than human, their dignity stripped away by societal attitudes that viewed mental illness as shameful or dangerous.
The lack of effective treatments meant that early psychiatrists resorted to crude interventions like bloodletting, purging, and induced vomiting. Historical evidence—including writings by figures like Benjamin Rush and Philippe Pinel, asylum records, and medical journals—supports the claim that early psychiatrists used those crude interventions. These practices were grounded in superstition and pseudoscientific theories rather than rigorous evidence, highlighting the challenges faced by early efforts to treat mental illness.
Pseudoscientific roots
Fast forward to the late 19th and early 20th centuries, when psychiatry found itself entangled with pseudoscience. Take phrenology, though discredited today, it was once hailed as cutting-edge and used to justify discrimination against marginalised groups, including people of colour and women.
Then psychiatry in its rudimentary phases was lucky to not be stained by the diagnosis of hysteria. The latter became a catch-all label for women who defied societal norms. Thanks to Freud (a doctor but not a psychiatrist) masturbation fell out of vogue as one of the favoured treatments. But psychiatry had a strange evolution out of its chimeric 18th and 19th century’s roots when it had not been well differentiated from other branches of medicine.
Nazi Psychiatry and Eugenics
Perhaps the darkest chapter in psychiatry’s history unfolded during the Nazi regime in Germany. Psychiatrists, entrusted with caring for the mentally ill, collaborated with the state to identify and execute individuals deemed “unworthy of life.” Under the Aktion T4 program, approximately 200,000 people with mental illnesses, disabilities, or chronic conditions were murdered in gas chambers disguised as medical facilities.
These actions were justified by pseudoscientific theories of racial superiority, with psychiatrists playing a central role in legitimising persecution and genocide. The betrayal of trust was profound, irreparably damaging the credibility of psychiatry in certain contexts. It serves as a stark reminder of how easily professional expertise can be co-opted for ideological purposes. One ought to consider present-day psychiatry and how it may be influenced by political ideologies and megabucks coursing through unseen channels from Big Pharma.
We are where we are
There is substantial evidence in the public domain to support a view that UK psychiatry from 2008, has faced significant workforce shortages, funding cuts, rising demand, and systemic pressures. The combination of effects has created precarious situations for both practitioners and patients. The gradual degradation of psychiatry under the weight of systemic neglect and overwhelming demand means that psychiatry as been forced into pseudoscience especially in the last 5 years, from my observations.
Individual self-respecting psychiatrists won’t like that sort of comment. No one likes being put into a basket. But strangely they like to say, “We’re all in this together.”
The future
Psychiatry stands at a crossroads. Its history gives it unique insight into the dangers of pseudoscience. We now have a profound opportunity to lead by example. We need to learn from our past. We need to say yes to rigorous, compassionate care, and evidence-based care. And we need to say NO to political and financial bullying of our profession.
Conversely, failing to heed history’s lessons risks sliding backward into practices that undermine our very evolutionary purposes for existence. Psychiatry’s dark history underscores the need for eternal vigilance. The field’s legacy of abuses serves as a warning and a moral imperative to prioritise evidence-based care. We must uphold ethico-legal standards, and resist shortcuts driven by systemic pressures. The stakes are high, the margin for error is slim, and the cost of complacency is too great to bear.
If we do not adapt and reclaim our profession, we risk facing extinction as the dinosaurs did.
I suddenly left two separate jobs consecutively on the grounds that I was being forced into illegality or expected to act in illegal ways, which obviously would have been unethical if I had continued. [Don’t ask - because I cannot provide details that would identify Trusts, without severe consequences.] Of course, I will never get a reasonably good recommendation from either because I ‘told um like it is’ and left. I’m notching up as a psychiatrist to avoid all over the country. In other words I’ll soon be ‘starved out’ - as word travels ‘down the wire’ (or WhatsApp or whateverrr). They’ll win.
But my substantive colleagues (with few exceptions) have to stay and be part of the ‘game’. How? When you have spouse/partner, children, home/house, commute times and job insecurity to face - you’re going nowhere! You’re basically anchored. If seen logic being twisted to justify the status quo. The Golden Rule is: ‘Never bite the hand that feeds’.
In the last 2 years I’ve observed:
Nobody checking the quality of psychiatric practice [GMC sits there waiting on complaints because it is not an inspectorate of its own standards. CQC wouldn’t know what to look for - their instruments are very blunt and meant to assess service, not individual groups of heath workers.]
Nobody checking capacity/consent issues.
Nobody checking appropriateness of diagnoses and how they are matched to treatments with medications (as per ‘appropriate treatment’).
Nobody doing much about ridiculous polypharmacy; most seen in LD and so-called EUPD groups of patients.
Nobody looking into the quality of documentations that psychiatrists make or are responsible for. In my estimate 75% of all documentation by psychiatrists will fail GMC standards, and are medicolegally useless. [Caution: I work in all the wrong places so my observations are not to be generalised nationally].
Disregard and disrespect for nearest relatives by MDTs.
Widespread burnout of psychiatrists and constituent MDT members.
Disregard for older people with mental health disorders.
… I’ve stopped myself there else I could be here all day.
But lets say I’m seeing the worse parts of psychiatry - then I have to wonder where is it wonderful - in what necks of woods are lovely things happening with durable regularity.
So far I’m not hearing about ‘lovely things’ happening in psychiatry nationally, when I put my ear to the ground.
We are a ‘profession divided’ and ruled by powerful political and economic forces. The future is not orange in my outlook - but it may well be for everybody else.
I have a poll that I can share later if @Jonathan gives permission. It doesn’t have to be completed. The questions dig deep and serve a reflective practice purpose.
Nigel was not just ‘a lawyer in psychiatry’ he fought fiercely for ethics in psychiatry. None of this means that I want to be ‘son of Nigel’. I could never fit into such big shoes. I just continue in the same vein to fight for what is right.