This is part of the consumer views section of forallthat. Dave Lowson wrote this for a magazine called Asylum who published it in 1994. I hope he and they do not mind me publishing it here, since I got it indirectly and don't know where to contact them. Dave is a member of Wales Mind Cymru. The article is based on ideas from Louise R Pembroke or Survivors Speak Out. It is a neat satirical reflection onto those professionals themselves of professional ways of seeing and talking about their patients.

In my training as a psychiatrist - and remember I was especially trying to be human and psychotherapeutic - I now look back on how I was trained to listen to patients but only within a framework of scanning what they were saying and doing for symptoms and signs of psychiatric disorders or psychological complexes and patterns. In effect, this was not listening but invalidating. It is no wonder that those who were longterm patients in a 24 hour a day similar invalidating framework, feel much freer when they are able to return to more ordinary supportive settings in the community.

The problem is that psychiatrists do have to listen within this extra-ordinary professional framework or they would not be doing their job. They need to keep an eye open for stories and evidence of disorders like dementia and (debatably, for sure) for physiologically based serious disorders with mainly mental presentations. These disorders may need medical investigation and types of treatment.

In psychotherapy it may indeed be really helpful to recognise patterns that link with published or individual experience of similar cases. For example, we now are much more aware of the way undisclosed sexual abuse can lie behind psychological and somatic patterns of presentation, so we know how to open our minds rather than repeat the invalidation again.

In child and adolescent mental health services, we are facing an unprecedented demand from the public for us to label and medically treat children for ADHD etc. Many of my articles (choose from my Home Page), and forallthat as a whole, argue in line with Dave Lowson's implied argument in his PTD article. For my response to a book that tells professionals a related but also different view of what it is like to be their client (where special labels and help were wanted by the client), see Dear Jennie Roberts, a review of Jennie's book 'Dear Psychiatrist'.

I think it is a really difficult task to do both kinds of listening at the same time. It's like asking a surgeon to do the job of cutting human beings up in life and death situations, and also to remain always aware of the feelings and pain and life and death human situation around them. But it's certainly true that professionals are overwhelmingly trained in the one and not the other important way to listen. So Dave Lowson's piece is on the mark.

PTD (Professional Thought Disorder)

By Dave Lowson

PTD is a condition which affects many professionals but it seems to be
particularly prevalent within the mental health field. The major
characteristic is an assumption of intellectual or moral correctness or
superiority frequently held in spite of the presence evidence to the
contrary. Signs and symptoms of PTD include:

* sufferers often have major difficulties when it comes to dealing with
their own and others' emotions
* they have a pathological inability to acknowledge their own distress and a
denial of vulnerability
* they have an inability to display empathy with others in distress
* they have a compulsion to analyse and compartimentalise the experiences of
others
* they show impaired social and interpersonal functioning
* communication with others is frequently characterised by an unusual
rigidity. In particular the acknowledgement of the other is frequently
missing and often manifests itself in lack of common courtesy and impaired
listening
* they have rigidly held beliefs (which they often present as 'facts'). Such
beliefs are not affected by empirical evidence from the real world
* they ask strange questions which seem to have no relevance to the context
within which they are asked
* they tend to see themselves as important, gifted and beneficent. A
particularly frequent delusion is that the sufferer deserves to be trusted
by others prior to exhibiting any behaviour which would make trust
appropriate. These delusions are maintained by hostile labelling of anyone
who challenges these self concepts. One consequence of this is that the
worth and abilities of the other are frequently unacknowledged.
* the sufferer is unable to distinguish their own wishes and impulses from
those of the people they believe themselves to be helping. This is assumed
to be the reason why they so often 'act out' this confusion by behaving in
ways which provoke anger in other people and then punitively label this
anger as a sign of pathology in that other.
* sufferers do not, or are unable to recognise that they have a problem
* much of the sufferer's disturbed behaviour is positively reinforced by the
surroundings they develop for themselves
* the main harm caused by PTD is not experienced by the sufferer but by
those they are meant to help. This limits the motivation for change.

nick.child@virgin.net