If you work in mental health, you could do much worse than reading the editorial in today’s Lancet Psychiatry about unpleasant debates and how to avoid them.
Unfortunately, debates in mental health tend to get nasty quite quickly – but I’ve seen no part of the debate spectrum which has a monopoly on bigotry or a blessed surplus of consideration.
But instead of throwing up their hands in despair, the editorial team wrote some sensible guidance on bringing some respect to moving mental health forward.
The first is to assume the best of one’s opponent: that their argument proceeds not from self-interest, financial interest, or wilful ignorance, but from genuine curiosity and a desire to improve the lives of people with mental health problems. There is a view that so-called punching up to perceived figures of authority is justifiable and necessary, but punching up is still punching someone. There is always potential in the discussion of mental health issues to trigger distress, as everyone, patient or professional, has an unseen personal history and sensitivity.
Second, it is worth questioning whether one line of investigation or treatment necessarily diminishes the other. Although a holistic medical perspective on mental distress is useful, alternative types of assistance might also be of value. Such services need to be taken seriously, evaluated thoroughly, and, when appropriate, considered for public funding. Perhaps some arguments about which model of research or practice should be prioritised would be better resolved by a united campaign for better funding across the board.
Third, as Sun Tzu advised, know your enemy. Do not dismiss biological data as an irrelevant folly, nor philosophical and sociological analysis as a form of obscurantism. Take some time to consider your opponent’s intellectual discipline, and how his or her work might be criticized on its own terms. This might be a long, difficult, and tedious process, but it is what patients, and the public, deserve.
The final point is to ensure that those whose voices are not listened to enough are given the space and opportunity to be heard. Their numbers include individuals such as mental health nurses and social workers, who provide a large amount of care but who are given little time compared with psychologists and psychiatrists. Most important, the voices of patients must be “airtime” respected in all their diversity. If a new form of mental health care is to be built, all involved would do well to remember the three principles of James Madison, President of the USA and father of its constitution: compromise, compromise, compromise.
A tip of the hat to you.
Link to Lancet Editorial ‘Duel diagnosis’ (via @PsychiatrySHO)
