I’ve just been to a three day conference organised by the World Psychiatric Association to attempt to come up with practical ideas for their Institutional Program on Psychiatry for the Person.
Juan Mezzich, President of the WPA has been pushing both the idea of comprehensive diagnosis and the idea of an ‘Idiographic (Personalised) Diagnostic Formulation’ for the last couple of years and wants there to have been progress made during his term of office. But I had some sense of the difficulty from the way that preliminary discussion of basic ideas expanded to leave very little time for actually trying to draft some kind of guidance or protocol or whatever.
One interesting sign of the difficulty was this. Robert Cloninger presented a scientific model of factors which both promote positive mental health and also protect against mental illness (although one of his more interesting general points was that these do not simply stand in a reciprocal relationship). But he got considerable criticism from part of the audience, especially Richard Williams, for somehow ignoring the person.
Over coffee he (Cloninger) expressed indignation over the fact that, surely, he was putting the person at the heart of things. It seemed to me that the underlying contrary worry was that a ‘psychiatry for the person’ should concentrate on placing patient or service user voices at the heart of things and thus adding even a scientifically well grounded theory of personality – couched obviously in analysts’ rather than agents’ categories – didn’t address that issue.
There were a couple of other themes: much disagreement on the value of making formal diagnoses at all for a high proportion of mental health care; and also at least some suggestion that the real challenge the service user movement was offering to psychiatry was to take the pathology out of conceptions psychopathological experience. Who knows what will actually come of the work, though.