HOME

HELP

FEEDBACK

SUBSCRIPTIONS

ARCHIVE

SEARCH

TABLE OF
CONTENTS

British Journal of Psychiatry

Advances in Psychiatric Treatment

All
RCPsych Journals

QUICK SEARCH:

[advanced]

Author:

Keyword(s):

Year:

Vol:

Page:

Duncan Brian
Double | View/Change User Information | CiteTrack Personal
Alerts | Subscription HELP | Sign
Out

Psychiatric Bulletin (2008) 32:
240. doi: 10.1192/pb.bp.108.021105
© 2008 The Royal College of
Psychiatrists

This Article

Full
Text (PDF)

Submit an
eLetter

Alert
me when this article is cited

Alert
me when eLetters are posted

Alert
me if a correction is posted

Services

Email
this article to a friend

Similar
articles in this journal

Alert me to new issues
of the journal

Download
to citation manager

Google Scholar

Articles by Fannon, D.

PubMed

Articles by Fannon, D.

Pat Bracken
Dominic Fannon

Pat Bracken is a Consultant Psychiatrist and Clinical Director of
Mental Health Services in West Cork, Ireland. He is also Professor of
Philosophy, Diversity and Mental Health at the University of Central
Lancashire in the UK. He trained in psychiatry and philosophy in Cork
and in Birmingham. His interests include collaborating with
user/survivors, developing critical thinking in psychiatry and
working with asylum seekers and refugees.

If you were not a psychiatrist, what would you
do?

I would have loved to have been an artist but I didn’t have the
talent. A full-time career in philosophy would be my other
choice.

Do you feel stigmatised by your
profession?

Not stigmatised as such. I do pick up a sense of frustration from
medical colleagues in relation to psychiatry. Some of this could be
avoided if psychiatry was a bit more honest about what it could and
couldn’t do.

What are your interests outside of
work?

My family, astronomy, messing about with the local drama group.

Who was your most influential trainer, and
why?

I have been fortunate to work with some great trainers in Ireland
and the UK. I think David Dunne in Cork showed me that, in the
end, good mental health work had more to do with caring relationships
than anything else.

What job gave you the most useful training
experience?

Working in Uganda for the Medical Foundation for the Care of
Victims of Torture in the late 1980s. This challenged many of
the ideas I had accumulated during my early training, particularly
about the nature of therapy and healing. I also learned about
the crucial role played by social and cultural contexts both in
shaping our emotional reactions and our attempts to understand
them.

Which publication has influenced you
most?

Hubert Dreyfus’ Being-in-the-World. This is a commentary on
Heidegger’s Being and Time. The latter is notoriously
difficult, but together these works are a powerful antidote to
the Cartesian assumptions that underscore a great deal of psychiatric
theory. Heidegger wants us to think beyond the idea that we exist as
individual minds relating to an outside world. I think we are just
beginning to understand the full implications of this for our work.

View larger
version (134K):
[in this
window]
[in a new window]
[as
a PowerPoint slide]

What is the most promising opportunity facing the
profession?

The rise of the user/survivor movement. This has opened up fantastic
possibilities for dialogue, possibilities that were simply not
available when I started training 25 years ago.

What is the greatest threat?

Further corruption of the academic environment by the interests of
the pharmaceutical industry.

What single change would substantially improve quality
of care?

Work to promote a ‘community development’ approach to mental
health. So far, community psychiatry has been limited to clinics or
teams operating in the community. Alongside user/survivor and
carer organisations, we need to engage the whole community in a
democratic debate about mental health. Most of the disasters in our
history have been due to the social exclusion of people who
experience states of madness. A ‘community development’ approach
holds out the possibility of overcoming this.

What is the most important advice you could offer to a
new trainee?

To keep an open mind and a questioning spirit. I usually encourage
my trainees to actively explore the critical literature on
psychiatry as well as studying for their exams.

Do you think psychiatry is brainless or
mindless?

Neither. In fact, I think it has been too focused on both. What it
has lacked is an orientation towards contextual factors. How we
understand both the brain and the mind is shaped to a large extent by
background assumptions, frameworks and priorities. Philosophy,
anthropology, history and critical thought have tools that can help
us to understand these. Psychiatry needs to prioritise its
involvement with these disciplines.

What is the role of the psychiatrist in rebuilding
healthcare systems?

If psychiatry can escape from its current bioreductionist orientation
it has a lot to offer. We need to see that what makes psychiatry
special is its primary focus on the meaningful aspects of human
reality: beliefs, behaviours, emotion, relationships etc. Other
doctors (like neurologists for example) deal with these, but
they are generally of secondary importance to their concern
with what is happening in terms of anatomy and physiology. Our
challenge is to develop a form of medicine that is adequate to human
meaning. If we can do that, psychiatry could genuinely offer
leadership in healthcare.

What single area of psychiatric research should be
given priority?

I believe that we need to find ways of getting beyond the evidence-based
practice paradigm. This seeks to determine what technical parts
of our interventions are successful. It seeks to exclude what
are called ‘non-specific’ aspects of care. In doing this, it
underscores the predominance of the technical and systematically
relegates these non-specific issues to the sidelines. But these
issues have to do with personal relationships, contexts, values and
meanings, and these are the very things that users/survivors are
telling us are important. We know from years of psychotherapy
research that it is the non-specific aspects of therapy that
determine outcomes and recent meta-analyses of antidepressant
trials have served to underscore the importance of the placebo
effect in psychopharmacology. Our job in the next 20 years is
to find ways to work collaboratively with users/survivors, carers and
the wider community to research and explore these aspects of care as
our central concern.

This Article

Full
Text (PDF)

Submit an
eLetter

Alert
me when this article is cited

Alert
me when eLetters are posted

Alert
me if a correction is posted

Services

Email
this article to a friend

Similar
articles in this journal

Alert me to new issues
of the journal

Download
to citation manager

Google Scholar

Articles by Fannon, D.

PubMed

Articles by Fannon, D.

HOME

HELP

FEEDBACK

SUBSCRIPTIONS

ARCHIVE

SEARCH

TABLE OF
CONTENTS

British
Journal of Psychiatry

Advances
in Psychiatric Treatment

All
RCPsych Journals