Thursday, 18 October 2012

More than 17 (just)

Arriving for breakfast at 0632, I was surprised (and very pleased) to see I was the last one there. We ate rather silently and nervously, and got the metro to arrive in our presentation room just after 7am. We put up our display posters either side of the stage, and leaflets on all the seats; we adjusted Yousuf’s powerpoints a few more times, and finally handed it over to the technicians. Then we waited…
Emma and Olivia - with the tree of hope

Nearly 17 by now...
Although there were only 3 attendees there on the dot of 0800 (our official starting time), somebody did say that lots more were outside the congress centre, just arriving – so we waited a few minutes before starting. Soon there were 17 and by the end we had about 30, though there was some coming and going. The talks went pretty well exactly to time and to plan, and are available on the LLE website  .  Afterwards, we breathed a sigh of relief and had the freedom to enjoy the rest of the congress.

C B Nemeroff (USA) gave the first plenary lecture – on Neurobiology of Child Abuse and Neglect – and gave a dazzling exposition of the genetic, neuroimaging and pharmacological bases of adult consequences of childhood trauma and abuse, and how the people with histories of maltreatment had different brains. Although he seemed to deliberately avoid the PD label, it was almost a return to the days of ‘endogenous v reactive’ depression – except over a life course, rather than weeks or months. Quite reassuring to those of us who fear being eclipsed by the biomedical juggernaut driven by the economics of the pharmaceutical industry.

Then to the posters – hundred of them from all over the world; interestingly all of those from latin countries bearing a prominent ‘no conflict of interest’ declaration, none of which would have suggested any such suspicions. Is this an international version of the UK ‘health and safety’ culture, used to destroy trust and spread persecutory anxiety? And next to the poster, a display of restraint cages through the years, and straitjackets exhibited like a fashion display. Was this deliberate irony?

Bed shortage?


straitjacket couture?

Next to a heart-warmingly reassuring session by Czech psychiatrists and therapists from The International Centre for Integrated Psychotherapy (Knobloch). Heart-warming because it was human-scale and clinical, reassuring because it is a TC by any other name. Although they only briefly referred to TCs, I asked if they recognised the British TC tradition, with Maxwell Jones and all, as their work seemed so familiar: and indeed they did. Somehow, we should be making friends with groups like this.

Towards the end of the afternoon, were workshops. The title of ‘Innovation in Psychotherapy Education’ was catchy enough to attract me, but for some reason, my heckles were soon raised once there. It was a sharply commercial presentation of an elegant and well constructed Moodle website for training in basic psychotherapy – not unlike KUF in its design, but lacking the radical ‘relational’ edge that I think is essential in any therapeutic engagement. A sales pitch, I suppose, when I was looking for realttitude change, I suppose – tackling ‘us & them-ness’ – ever seeking that dear old ‘quality of relationship’ again.  After an initial altercation which Yousuf and I had with the presenter – about the viability of hard evidence-based rules for all psychotherapies – I meekly shut up and watched nigh on a dozen video clips of very self-assured therapists teaching how to do CBT…

The final session was much more cheering, though. Professor R S Murthy was being presented with a special prize. The purpose, structure and committee for this prize was explained at great length before the ceremonial  exchange of gifts and flowers and the lecture could begin. Professor Murthy is recently retired Dean of the NIMHANS – ‘the Maudsley of the Subcontinent’ in Bangalore – and I explained to him before the talk about our link with ASV and the intention to do an LLE there in the next year or two. Maybe we should do a second one for NIMANHS residents! But he was great – talking our language like few others did here. 

Here’s the points from two of my favourite slides of his. This one gave seven criticisms of the current ways of psychiatric thinking and practice:
  1. 1.       Medicalisation of suffering
  2. 2.       Vague diagnosis
  3. 3.       Mainly pharmacological interventions
  4. 4.       Doubtful outcomes
  5. 5.       Insensitivity to local customs and practices
  6. 6.       Loss of personal context
  7. 7.       Psychiatric imperialism

And this one gave three points for the ‘paradigm change’ that’s needed for world mental health to improve:
  • ·         Recognition of the central role of people and families
  • ·         Information and interventions for them
  • ·         Professional development to share this

Back for a celebratory meal of stroganoff with dumplings and Czech beer at a cosy little restaurant just near the hotel. But rock on Professor Murthy – you’re my main man!

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