The highlights for me were Michael Linden’s talk on embitterement, Kimberly Dean’s talk on violence and mental illness, the discussions about developing a curriculum with regard to forensic psychiatry, especially in the civil area, and of course my talk on “bizarro world II“, nobody asked me what was bizarro world I, I had a ready reply – DSM5.
I was especially interested in Michael’s talk because he spoke about a group of people who seem to have been ignored both by DSM in its various iterations and by ICD 10 and 11. That is people who seem to have been coping well and for a variety of reasons experience a breakdown in their capacity for coping that may never significantly improve and who not do well with the usual treatments including psychotherapy, CBT, and medication. Michael had done impressive research and had focused on an aspect that I have seen as insignificant but I now recognise the importance of embitterment. I spoke to Michael about a book I wrote in 1989 called “Falling Apart, Living with Stress Breakdown” (7,257,841 on the list of Amazon bestsellers). Much of my clinical work has been with people in this group.
Kimberly Dean’s lecture was a delight. It was a deeply academic talk exploring large data sets and examining how different ways of looking at these datasets can produce totally different results. For example one study showed that when the confounding influence of alcohol were removed there is no difference in the level of violence between the general population and those with mental illness. Some years later exactly the same data was reanalysed with the opposite outcome!
It made me conscious, yet again, how seduced we are by numbers.
The other piece of research she spoke about was seeing what happened if intensive interventions were done with people with psychosis who were at risk of violence. The surprising thing was that it made no difference long-term. Perhaps that is a good thing for mental health services.
It was particularly interesting to have a frank and full discussion with the subcommittee developing criteria for forensic trainees. I thought they had done an impressive job, despite my previous quibbles and handled the adverse comments about the lack of any civil training effectively. In essence, the complaints were that there was insufficient emphasis on doing civil forensic work and that most of the people doing civil forensic work did not necessarily come from the criminal forensic stream and there was no training envisaged for them. These matters are being considered.
Apart from that the weather was great, the food, though expensive, was good and I spent a week travelling to a small aboriginal community at Kalkaringi, 750 km south-west of Darwin, that was a real eye-opener. A terrific indigenous community but plagued by the usual problems, lack of employment, lack of school attendance and lack of purposefulness.