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Psychiatry for the person
John L. Cox
a,b,c
and Alison J. Gray
d
Introduction: questions but few answers
Searching questions are being asked by psychiatrists at
the present time about the future of the specialty and the
identity of the psychiatrist. Forty leading psychiatrists
have issued a ‘Wake-up call for British Psychiatry’ [1
].
They were concerned that the diagnostic approach to
patient care (the medical model), the ability to treat
comorbid physical illnesses, and the provision of medical
treatments based on clear and accurate diagnosis, were
each at risk of serious atrophy, and that patient care was
being jeopardized. In reply Tyrer [2] considered reaching
for a ‘snooze alarm’, but instead recalled the effectiveness
of placebos, the improved multiprofessional community
services and the prospect of increased access to
psychological therapy.
‘What is the heartland of psychiatry?’ asked Goodwin and
Geddes [3], who questioned the pre-eminence of schizo-
phrenia as the paradigmatic illness of modern psychiatry,
because of its association with the antipsychiatry move-
ment and the asylum era. They suggested that the com-
plexity of pharmacological treatments for bipolar disorder,
and the common comorbidity with other disorders,
required not only the special skills of a psychiatrist but
also closer links with other specialists, and that bipolar
disorder was therefore the preferred heartland.
Koenig [4
], from a psychosocial perspective, asked how
psychiatrists should work with patients from multifaith
communities, and suggested that they take a ‘spiritual
history’, consult with clergy and consider (under certain
limited circumstances) praying with a patient. This latter
suggestion provoked a strong response from Poole et al.
[5], who insisted that psychiatrists were bio-psychosocial
scientists and not generic healers, and that prayer was the
task of the clergy. Hollins [6], on the contrary, gave a
cautious endorsement to the article.
The review of ‘Psychiatry for the Person’ – a term
popularized by the World Psychiatric Association – is
relevant therefore to understanding the reason for these
pressing questions about the nature of psychiatry and the
role of psychiatrists. It considers the meaning of these
questions within the conceptual framework of person-
centred psychiatry and the overdue search for answers.
Person-centred psychiatry and a medicine of
the person
Person-centred approaches to healthcare are consistently
advocated by user and carer groups and promoted in
several policy papers in the UK. The most recent report
‘Shared Decision Making’ [7], for example, has focused
on the partnership between doctor and patient.
a
University of Keele,
b
Institute of Psychiatry, London,
c
University of Gloucestershire and
d
Consultant
Psychiatrist, Research Associate, University of
Birmingham, Birmingham, UK
Correspondence to Professor John L. Cox, 58 St
Stephen’s Rd, Cheltenham GL51 3AE, UK
E-mail: john1.cox@virgin.net
Current Opinion in Psychiatry 2009, 22:587–593
Purpose of review
This review considers much recent work focused around the Psychiatry for the Person
Programme of the World Psychiatric Association. Yet we have also considered the
wider medical context, based on recent publications familiar to us in the fields of ethics,
religion, spirituality and person-centred medicine as well as ‘medicine of the person’ as
developed by Tournier.
Recent findings
There is an urgent need for evaluative outcome studies of person-centred care,
including the narratives of service users, rigorous scientific methods and new
conceptual models; and for a reformulation of the bio-psychosocial model to incorporate
new knowledge in the neurosciences, philosophy, anthropology, ethics and theology.
Summary
We suggest that a biosocial/psychospiritual (BSPS) approach to relationship-based
healthcare should be more actively considered.
Keywords
bio-psychosocial model, ethics, faith, mental health, person-centred, philosophy,
psychiatry, religion, spirituality
Curr Opin Psychiatry 22:587–593
ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
0951-7367
0951-7367 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/YCO.0b013e3283318e49