Exploring Training Approaches and Variations in Psychiatry

 This week, we interview Professor Jim van Os.

Professor van Os is Chairman of the Department of Psychiatry and Psychology at Maastricht University Medical Centre, Maastricht, The Netherlands, and Visiting Professor of Psychiatric Epidemiology at King’s College, Institute of Psychiatry, London. 

He trained in Psychiatry in Casablanca, Bordeaux and the Institute of Psychiatry and the Maudsley Royal Hospital in London.

In 2011, he was elected member of the Royal Netherlands Academy of Arts and Sciences (KNAW); he appears on the 2014 Thomson-Reuter Web of Science list of the world’s most influential scientific minds of our time.

He is Director of Psychiatric Services at Maastricht University Medical Centre and runs a service for treatment-resistant depression and first episode psychosis.

I was keen to ask professor van Os about his views on biological psychiatry, why we should sometimes challenge schizophrenia, psychosis and other diagnostic terminology and how he sees the future of mental healthcare.

In this episode, we discuss:

How Jim became interested in Psychology and Psychiatry, partly because of the experiences of family members

That Jim felt that training in many parts of the world allowed him to see variations in psychiatric models and this led to him questioning the biological model

That Jim also saw how dominant the prescribing of medication but noticed the wide variation in practices

How Jim observed in France a willingness by the treating doctors to accept that they didn’t know what the root cause of a mental health difficulty

That some of the diagnoses that psychiatrists rely on are actually cultural agreements between professionals and that if a patient accepts the idea that they have a diseased brain, it can be limiting for that patient

That we should be able to admit that we don’t know causes but we can still help and support people who struggle with their mental health

That there is a 25% yearly prevalence of mental disorders, but many nations have a capacity for only 4% to 6% of the general population

That selection criteria to get help and support with their mental health just don’t work because we cannot precept outcomes for people

That there are interesting developments in eCommunities where people can participate in online communities to share experiences, for example ‘Proud to be Me’ in the Netherlands.

That diagnoses are starting to function as an economic measurement of mental illness and treatment and some cannot access treatment without a diagnosis, which perpetuate the diagnostic paradigm

That there were attempts in the most recent Diagnostic and Statistical Manual (DSM V) discussions to adopt ranges or dimensions of disorders, but the proposal was shot down

That it would have been historic if dimensions were adopted in the DSM because then the discussion between the clinician and the patient would have had to change

That there is some dimensionality in DSM V, represented as ‘spectrum disorders’ which are the first step towards acknowledging the variations inherent in human experiences

That Jim saw in his own family that the initial ‘relief’ of receiving a diagnosis was undone when more and more diagnoses were added

That a label of Schizophrenia can mean that other people do not know what to expect and find it difficult to relate psychologically to that person and their experiences

That the Maastricht User Research Centre has been discussing the language used in psychiatry, in particular the terms psychosis and schizophrenia and trying to find more helpful terms, for example hyper-meaning

That sometimes terms such as ‘susceptibility’ and ‘syndrome’ are far more helpful than giving someone the message that they have a brain disease  

That biological psychiatry has been trying to reverse engineer and validate the concept of schizophrenia by investigating case control differences

That there is more awareness developing about the critical appraisal of diagnostic terminology

That the mental health sector should not be viewed as a separate entity, but should reinvent itself as an inclusive local community that is there to connect with people and their range of experiences

That patients often indicate that what got them better was community and connection and meaning and empowerment

That the User Research Centre, led by Dr. Peter Groot, have developed a solution to help patients withdraw slowly and gradually from their psychiatric medications

That when prescribing medication, we should encourage people to monitor their experiences to allow a better discussion about treatment continuing or stopping based on evidence

That if we suppress difficulties with medication, it can make it more difficult for the person to build up coping mechanisms

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