Delenda est Carthago!

Blog Post by Robert Poole, North East Wales NHS Trust, UK

I imagine that all authors worry about reviews of their work. Only a very robust ego could survive the disappointment of a bad review after all of the effort and sacrifice required to get a book into print: finding a publisher; mustering the energy to write the damned thing; trying to maintain a civil relationship with your co-author(s); and rescuing the finely crafted prose from the ravages of the typesetter. However, it would be foolish to deny that I am more concerned than most about good notices. Indeed, I seem to exist at the far edge on the spectrum of needy review-sensitivity. My co-author, Robert Higgo, seems to feel no need to obsessively scour the internet late at night. Nor does he seem to feel any particular attachment to our exact ranking ‘in books’ (i.e. sales) on Amazon’s web site (from the dizzying heights of 60,000th in the UK to the nadir of 2,800,000th in the USA; the latter in the year that our royalties from North American sales were minus £3.00).

I’m not very good at humility (I can’t really see the point of it), so I am unembarrassed to report that reviews of our two books have been uniformly good. That is, until August, when our standing in authorial world became altogether more ambiguous. The month started well enough, with the news that ‘Clinical Skills in Psychiatric Treatment’ had been highly commended in the BMA book competition. I was pleased that the panel had liked the book, and I was even more pleased to finally see a return on 29 years of BMA subscriptions. My feelings were more mixed when I discovered my name in chapter 2 of ‘Spirituality and Psychiatry’, a book which has recently been published by the Royal College of Psychiatrists. It is always flattering to be cited, but I could smell the blood of payback time.

There is a rather large Spirituality and Psychiatry Special Interest Group in the College that is pressing hard to make spirituality a central concern in everyday practice, not to mention that they want to make it a core competency for all psychiatrists. Many of my colleagues, some of whom have a religious faith, think this is wrong, and so do I. We mentioned this in our books, and I was first author of a letter on the subject in the Psychiatric Bulletin last year.

Centuries of experience have allowed the religious to develop sophisticated torments for the unbeliever. The reference to our book was not disparaging, which would have allowed some righteous wrath and a good clean fight. No. Cruelly, it was sort of a bit indifferent. Our book on interviewing was okayish, according to the authors, but it would have been much better if had addressed spirituality properly.

Still trying to make sense of this tepid assault, my obsessive nocturnal investigations led me to the Critical Psychiatry Network blog, where there was a picture of ‘Clinical Skills’ and reference to me personally. Now, I have to admit that we’d asked for this one, having made distinctly unflattering reference to ‘post-psychiatry’ in our books and in another letter to the Psychiatric Bulletin (mainly because it is based on post-modernism which is, in our opinion, mostly incoherent, unhelpful tosh).

The blog opened in an encouragingly confrontational fashion, with the accusation that I am an old fashioned radical. This was a good start, all a bit ad hominem; what, so I adhere to an outmoded form of radicalism that comes in a teak box with Bakelite knobs and leather handles and you can only get spare parts from a factory in Romania? Or, more likely in a post-modern critique, is radicalism itself an outmoded encultured discourse with a quaintly old fashioned attachment to tangible change in the real world? (you see: I can do this confrontational stuff). Then there was what I took to be a bald piece of sarcastic snobbery regarding my university, which, as a former technical college, may be too proletarian for post modern purposes (I may have taken this the wrong way, but no old fashioned radical would get very far without a chip on his shoulder).

Having read this far I was ready for a good old fashioned ruck between philosophers, like the one involving a poker between Bertrand Russell and Ludwig Wittgenstein in Cambridge in 1946. Just as I was getting fired up, the whole attack went off the boil and it was said that our books were probably alrightish, though they were bound not to be as good as another book by some post-modern psychiatrists having, in probability, missed the essential component of ‘provisional scepticism’. The blog’s author stated his intention to read our books, but I’m not sure why, having found it possible to review them unencumbered by knowledge of the content.

It takes a versatile intellect to offend both the religious psychiatrists and the post-modern psychiatrists to the point where they have, quite independently of each other, viciously condemned our work as ‘alright if you like the kind of thing, but they’ve missed something essential’. I can see why neither party likes us much. However, I can’t for the life of me see what we have done to upset the Dutch.

It is possible that something was lost in the on-line Dutch to English translation, but the Dutch Journal of Psychiatry review of ‘Clinical Skills’ really contributes to the August cacophony of indifference in a big way. No saving grace of being accused of being old fashioned radicals here. The review said it was a nice idea for a book but we are kicking down doors that are open (obviously the reviewers don’t have strong feelings about post modernism or religion). Everybody knows this stuff after about two years in psychiatry, they said. Mind you, it’s got some good practical tips in it, even if you’re Dutch. And although it isn’t as good as you think it’s going to be, it’s only slightly disappointing really.

What’s going on? The first book was published in 2006 and now suddenly in August 2009 we are drenched in lukewarm water. Did Robert and I expend all those hours of creative energy (and even more hours of bickering over punctuation) just to be damned by faint praise at this late stage? Why couldn’t they bring themselves to really hate the books? Perhaps we could step outside and sort this out in the car park?

The trouble with writing books is that your narcissism kicks in after a while. Good intentions to fill a gap in the literature are replaced by an unhealthy sense of ownership of the ideas. Nearly all academic discourse is heavily infected by the clash of narcissisms, and the old fashioned radical in me thinks that this is a problem. However, in all truth I have little credibility as a radical, except perhaps for my obvious residual tendency to factionalism. Whilst my differences with the postmodernists and the spirituality lobby are real enough, perhaps I should acknowledge that they do have common cause with us in believing that there is more to helping people with mental illness than the simple application of the technologies of neuroscience. Perhaps I should try to stop being quite so pleased at our cleverness in writing a book that has been highly commended in a major book competition. Perhaps I should focus on the more encouraging point that, although there is a lot wrong with organised medicine, it can still find it in its heart to highly commend a book that is based on a scientifically grounded, humanitarian, patient centred style of practice that is at least as concerned with the social and the psychological as it is with the biological.

Rob Poole, Wrexham

Robert Poole is co-author of Clinical Skills in Psychiatric Treatment


One Response to Delenda est Carthago!

  1. I came across your piece as I was checking out the new Cambridge blog ( I have a recent edited book published by Cambridge Intervention & Resilence After Mass Trauma )I was interested in your point on the new emphasis by the Royal College on spirituality and psychiatry.I am sure you will agree any good therapist should understand the religious and spiritual beliefs of his or her patient no matter what their own might be. However if you want evidence based understanding one should look at the psychosomatic literature. For example depression being a risk factor for heart disease etc. ( see )Thanks for the opportunity to comment and put in a plug.

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