Monday, August 3, 2020

Comments by Sir Robin Murray, MD

Showing 1 of 1 comments.

  • First, I would like to thank those who have read my article, and for the kind words from some (though not all!). I will try to respond to a few of the points made.

    Several commentators assume that I am defender of the status quo of psychiatric treatment. Not so, I was the Chairman of the UK Schizophrenia Commission which listened to views of patients and carers the length of the UK, and produced a Report that was extremely critical of standards of care; our 42 recommendations for change can read at .To give one simple example, we pointed out that one of the reasons why compulsory treatment was rising was because the conditions in many in-patients units had declined to a point that few would voluntarily agree to be admitted to such places.

    Sadly, what knowledge I have of the standards of mental health care for the poor in the USA suggests that it is worse than in most European countries, and that more ill people languish in prisons or on the streets. It is perhaps worth again making the point that the idea that there exists a deteriorating disorder termed schizophrenia is much more prevalent in the USA than in Europe where models emphysizing the role of social and psychological factors are much more prevalent. Perhaps this is a consequence of a health care system based on the profit motive since social and psychological therapies are necessarily costly.

    Matt wonders whether I have been involved in clinical care or have I sat in a university classroom “studying” people from afar. For 40 years I have worked in one of the most deprived areas of south London where poverty, unemployment, social disintegration and crime are rife. One cannot work in such an environment without being aware of the corrosive effects this has on people, ill or well.

    The trouble for a psychiatrist is that no matter how concerned one is about the living conditions of one’s patients, it is difficult to persuade politicians to care about them. Ellen raises the question of the African-Caribbean community and whether they have been discriminated against. I have no doubt that they have been. Indeed, much of our work has emphasised the role which discrimination has played in the high rates of breakdown among migrants and ethnic minority populations in the UK.

    BC Harris asks if I am aware of 19th century Moral Treatment. Of course I am since the origins of moral therapy were in France and the English Quakers played a major role in its development with the famous Retreat in York.

    Yes, I do know of the Open Dialogue approach. I look forward to this model being tested in the same scientific way that any novel treatment approach should be. Currently we are waiting tor the results of a randomized trial of another innovative treatment – avatar therapy

    Others question if I am aware of the views of patients. Fortunately, the Institute of Psychiatry where I work has for the last 15 years had a thriving “service users” department “SURE” which has carried out much important research . So I am lucky to have ready access to new insights from user groups including the Hearing Voices movement.

    In my view, societies can be judged by the extent to which they care for their less fortunate members. I sympathise with those who have been hurt by bad psychiatry, and look forward to better and more holistic care. We, psychiatrists and anti-psychiatrists alike, have much to learn about how to improve care, and we should not to be ashamed to change our minds when new information comes to light: that is the way progress is made.