Author:Khaldoon Ahmed (East London NHS Foundation Trust)
Paper short abstract:
I respond to the mismatch between clinical language and patient experience drawing on my work as an inpatient consultant psychiatrist, and ethnographic research in psychosis. I present the findings of the ReCreate psychiatry project that seeks to address these imbalances through dialogue.
Paper long abstract:
My paper discusses the gap between mental health services and patients as an inpatient consultant psychiatrist, my ethnographic research, and the 'Re:Create Psychiatry' experiment.
In my clinical work there is daily conflict with patients - most are detained in hospital and treated against their will. There is a disjuncture between clinical language and the experience of mental illness. One of the commonest problems presenting to hospital is self cutting and suicidal overdoses, psychiatrists name this is emotionally unstable or borderline personality disorder. But only a small number of patients feel the diagnosis fits them. Many find it objectionable because it condemns, or has stigma attached.
In contrast, when I conducted ethnographic interviews with British Bangladeshis with psychosis I found a striking hope in psychiatric diagnosis and treatment. At the same time diverse beliefs were held about the cause of the illness from jinn possession to bereavement. I venture that in both borderline personality and psychosis, stories about the illness episode are co-created as a result of the interaction between health services, and the patient. Within this, both resistance and concordance is seen.
In recent years I developed the ReCreate Psychiatry project with the Mental Fight Club, a service user charity. This is to address conflict between service users and psychiatrists through open-hearted dialogue. It has revealed how damaging and counterproductive the encounter often is, but also how constructive progress can be made when discussion is taken out of institutionalised power settings.
Hermeneutical injustice, clinical imagination and patient discontent in mental healthcare