The BMJ Today: From mental asylums to cognitive behavioural therapy

“The mental asylum belongs to a vanished era,” begins the obituary of psychiatrist Henry Rollin in The BMJ. Despite working in asylums until their closure, there is no implication that Rollin himself belonged to that vanished era.

After Enoch Powell’s Hospital Plan of 1962 brought about the closure of mental hospitals and moved care into the community, Rollin continued to work in mental health. On his retirement he was appointed consultant forensic psychiatrist to the Home Office, a position he held for the next 10 years.

Rollins fitted in a great deal in his 102 years. He went to medical school aged 16, he served in the Royal Air Force Volunteer Reserve in the second world war and worked on the transformation of the Royal Medico-Psychological Association into the Royal College of Psychiatrists. He also married at the age of 62 and had two children.

Today’s head to head follows the psychiatry theme. Peter McKenna, a research psychiatrist, and David Kingdon, professor of mental healthcare delivery, discuss whether cognitive behavioural therapy (CBT) for psychosis has been oversold.

Arguing in the affirmative, McKenna cites 50 trials into CBT as the basis of his argument against the efficacy of the treatment. It is his view that “behind all the fanfare” CBT is “kept afloat only by efforts to play up weak or equivocal findings and to discredit the increasingly ominous results from meta-analysis.”

Not so, argues Kingdon. “Would we be having this argument if cognitive behavioural therapy was a drug?” he asks. The treatment has a similar effect size to clozapine, which is universally accepted as an important additional treatment in psychosis. “Psychological approaches do not hold all the answers,” Kingdon says, “but the evidence suggests that they can have an important and acceptable role in helping people cope with very distressing and disabling experiences.”

Finally, from good psychiatrists to a bad one. A news story in The BMJ today reports that a locum psychiatrist has been struck off the medical register for failing to inform a 2012 fitness to practise hearing about an incident that had led to her suspension from work.

Elizabeth Jasiak, allegedly thrust a “knitted representation of female genitalia” into a male colleague’s face, which he had found “highly offensive.” The 2012 hearing also heard that she had given colleagues nicknames such as “Douche Bag,” “Jugs,” and “Sausage Tits,” and that she had referred to patients by various unflattering names, although not to their faces.

Abi Rimmer is BMJ Careers news reporter.