Women in Psychiatric Training

Training in psychiatry involves a fascinating and rewarding journey, and is a wonderful career for women. This chapter explores what it means to be a female psychiatric trainee. The authors discuss the recruitment crisis within psychiatry and the way that stigma and financial pressures upon the NHS compound this. They discuss their own experiences as medical students interested in psychiatry, particularly with regard to overcoming prejudices within the wider medical profession. There are certain challenges that are particular to training in psychiatry that women trainees face, including everyday sexism and how it impacts on self-esteem, as well as exposure to violence and stalking, and the effect of social media on medical practice. The authors discuss their own experiences in facing these challenges, what more could be done to support trainees, and they consider the importance of self-care and the way in which training as a psychiatrist can give trainees particular skills of self-reflection and insights into group dynamics that can be invaluable in developing as medical leaders.

Whose Life is it Anyway? Life and Death in the Court of Protection

Psychiatrists are entering a brave new world. Following the introduction of the Mental Capacity Act, there has been an increase in the number of decisions regarding refusal of life sustaining treatment being heard in the Court of Protection. Many of these cases involve patients with mental health problems. Although in some cases, such as those with anorexia, treatment can be given against a patient’s will under the Mental Health Act, the question has become whether we should continue to give treatment to a patient who is actively refusing and who has not benefited from treatment for this condition over the last 10 to 15 years. In other cases, patients are refusing life-sustaining treatment for conditions unrelated to a mental disorder, who are deemed to lack capacity to make that decision. This essay will consider how the courts are interpreting the ‘best interests’ doctrine in these life or death cases.

Old Age, Women, and Dynamic Psychotherapy

Old age can be a challenging time for people. It brings with it changes which include losses as well as opportunities for shifting one’s focus. Societal perceptions of ageing and projections of negative values associated with being old can act as a further blow to peoples’ general resilience. This chapter explores some of these societal projections over the centuries, in public and political life and in the arts. It examines how these influences may impact on women personally as we get older, including how we become ill psychologically and how we react to illness. What the authors consider to be important is that in late life, opportunities for restoration of the self still exist. People can and do recover from mental illness and older women can and do contribute to the wider social world in ways other than as mothers and carers.

The Maternal Lap and the Mental Health Trust

This chapter describes how patients requiring care from psychiatric teams need a receptive and containing response in order to feel understood and as a basis for recovery. This mirrors the sensitive attunement that the infant depends upon when held on the maternal lap. It introduces the idea of the Mental Health Trust as having the potential to act as a concave receptacle, able to absorb and process all that is communicated by those in a disturbed state of mind. In this concave or receptive state of mind clinical management can be based upon a deeper understanding of the patient’s difficulties and needs. In contrast, if clinical teams behave in what is described as a more convex state of mind they are unable to absorb or think about their patients’ disturbance, which can lead to harmful re-enactments of inadequate nurture or rejection. Clinical examples are used to illustrate these ideas and the importance of teams being able to reflect about their work is emphasized.

A History of Women in British Medicine

This chapter, A history of women in British medicine, discusses the pioneering women who first trained and practised in medicine in the United Kingdom. It looks at the women who challenged and changed the medical establishment and those who helped to found the first medical school for women. It also looks at the role that a number of courageous women doctors played in both the First and Second World Wars at great risk to themselves, often without the support of their governments. Finally it explores the ongoing struggle that women doctors face in trying to achieve equality with their male colleagues.

Reducing the Risk of Dementia

This chapter looks at the impact of health and lifestyle factors on the risk of developing dementia in later life. It provides a brief overview of dementia and its most common causes, and an explanation of the degree to which genetics play a role. It reviews the available evidence regarding the extent to which potentially modifiable risk factors including smoking, obesity, physical activity, cognitive activity, diet, alcohol, depression, and diabetes may contribute to a likelihood of developing dementia in later life. Both general dietary patterns and the evidence related to vitamin B12, folate, antioxidants, and omega 3 fatty acids are reviewed. Possible approaches to the conversion of this knowledge into a reduction in the prevalence of dementia in the future are discussed. It is written for anyone with an interest in dementia and potential opportunities to mitigate the impact on individuals and society.

The Disappeared

This chapter presents a poem entitled ‘The Disappeared’.

Historical Child Sexual Abuse

The chapter covers three areas in relation to historical child sexual abuse (HCSA). It reviews the historical perspective in terms of the response of psychiatry and psychotherapy and its relation to HCSA. It also examines the role of the mother in HCSA and it addresses a particular clinical issue which is the request for a gender-specific therapist made by those with a history of HCSA who are seeking help from services. Using a psychoanalytic understanding of this form of developmental trauma elucidates the underlying dynamics that are brought into the therapeutic encounter, the family dynamics, and within society.

Jail Birds: Challenges for Prisoners and Professionals

This chapter considers the merits of different conceptual frameworks applied to women who offend and break the law, over time and between academic disciplines. It charts the increasing dominance of psychological and psychiatric models of disorder in the care of individual criminal women who, as a group, are widely recognized as socially and economically marginalized from birth. It analyses the relevance of this confused terrain for professionals currently working in women’s prisons, whether the patient in question has committed major or minor crimes. It argues that holistic thinking and the use of competing therapeutic discourses can be challenging but ultimately beneficial.

Psychiatry and Patienthood

This chapter describes some of the author’s experiences as a psychiatrist and, simultaneously, a patient with a diagnosis of bipolar affective disorder, and how each influenced the other. This personal story is used as a framework to inform on relevant topics: working in psychiatry; treatments for depression including electroconvulsive therapy, antidepressant medication, psychotherapies, and support groups; classification of affective disorders; doctors’ mental health; services for sick doctors; recovery; and retirement, at a level designed to inform those considering a possible career in the field of mental health. The current person-centred approach to formulation and management is compared favourably with the ‘medical model’ hitherto widely in use. The ‘recovery’ paradigm is outlined, including its application in the United Kingdom.