Extracted from The Newsletter, NSW Branch
The Royal Australian & New Zealand College of Psychiatrists
February-March 2016, p.15
I had the pleasure over the recent Christmas and New Year break to read Dr David Bell’s somewhat provocatively titled book “Welcome to the Loony Bin. 55 years in Psychiatry and the Law”. Part autobiography and part personal critique about the tendency of psychiatry to follow the fashion of the times in terms of diagnosis, I found his book to be both entertaining and stimulating.
Dr Bell begins his book in an autobiographical fashion describing his entry into the profession of psychiatry when, “in January 1956, I first drove through them in my tiny Fiat 600” referring to his driving through the gates of the then Callan Park Mental Hospital. One only has to read a further few sentences before the name of Harry Bailey is mentioned and we know then that here is someone with a living memory of what some say was an infamous period of psychiatry in New South Wales.
After briefly describing his family of origin and particularly his admiration for his father who had grown up in Poland in the late 19th and early 20th century, where anti-Semitism was already taking root, he goes on to describe his initial appointment to the Cerebral Surgery and Research Unit at Callan Park. Indeed I was surprised to read that at the time of this appointment Dr Bell believed that he had started on a career in neurosurgery at Callan Park. Dr Bell goes on to describe the events that led to the Royal commission into Callan Park following allegations of corruption made by Dr Bailey the then medical superintendent.
We are then led through a historical exposition of what might be deemed the golden era of psychiatry during which large asylums were emptied of their patients largely through the development of neuroleptic medication, whilst the previously chronic misery of the patients with psychotic depression was being treated by the newly developed electro-convulsive therapy.
However it is when Dr Bell moves on in time that we come to experience the tone of the whole volume namely a man whose long experience enables him to cut through the political correctness that tends to infect psychiatry in particular. For example, of community psychiatry he says, “deserves the label of fashion, having recurred in similar for many times back to the Dark Ages.” Furthermore, “the mental health teams in the community, equipped with insufficient staff and facilities, become hardly more than the means to keep on turning the revolving doors.”
However it is when Dr Bell begins writing about his experiences in the medico legal arena that he is at his most strident in criticising both psychiatry and the law. The malingerer and the hysteric are particularly singled out at this point with psychiatry being accused of being complicit not only in fostering an environment in which epidemic illnesses such as repetitive strain injury are allowed to foster, but also by legitimising these conditions in ripping off the Australian taxpayer through the abuse of the workers compensation schemes.
Even the condition of post-traumatic stress disorder comes in for criticism because the lack of objective criteria for the diagnosis opens up the opportunity for malingering to occur. It is here that I would view the situation differently. Whilst Dr Bell’s call to objectivity is admirable, this is not possible currently. Dr Bell’s close work with legal practitioners also leads to what I would say is a different version of psychiatry to that which I practice. This highlights the dialectic in psychiatry which I believe contribute to the way it has been marginalized and sidelined in the eyes of the public.
The question is who are we treating. I have never been too concerned about getting the objective truth in my patient’s complaints (because I believe that requires more of a legalistic approach – even though they don’t do it very well) as I see my role is to understand my patient’s subjective experience where it is causing distress. It is this aspect of Dr Bell’s book that is likely to cause vigorous debate.
In keeping with the tenor of the book there is little discussion of the role of psychotherapy in psychiatry. However overall I found Dr Bell’s book entertaining and informative. It is well written. Perhaps more photographs could have been incorporated into the volume particularly to illustrate the earlier autobiographical chapters. However the ones that are in the book are adequate. So to borrow from a personality currently in the public’s attention – “do yourself a favour!”
Dr Andrew Frukacz
Guest Editor, Member
NSW Branch Committee
The Royal Australian & New Zealand
College of Psychiatrists