Psychiatry, power and the person

Abstract

Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one’s own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.