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Practice of Psychiatry
You cannot have a diagnosis by democratic means saying
let the majority decide- Dr. Quasim
Currently there is too much of input in psychiatry but
direction should come from professional bodies

COVENTRY (UK): Psychiatrists have got to be clearer and understand as to what they are talking about and what they are treating?  Currently there is too much of input in psychiatry. What I am talking about is nurses telling patients what to do, psychologists telling doctors what to do, social workers telling psychiatrists what to do? I personally feel that psychiatry is becoming a handmaiden to every body else. It is an honorable discipline which should be setting the directions and this direction should come from professional bodies like Royal College of Psychiatrist. This was stated by Dr. M. Quasim, a senior mental healthcare professional from UK while talking to “Pulse International” recently.  Dr. Quasim, it may be mentioned here was one of the five psychiatrists which the Midland Psychiatric Research Group had honoured by presenting them the Life Time Achievement Awards at their recent annual conference in recognition of their contributions in this field.

Explaining his viewpoint further Dr. Quasim said that while practicing psychiatry, you cannot have a diagnosis by democratic means saying let the majority decide. No. If there is correct diagnosis by one man, then that one man is right and all others are wrong. Psychiatrists must take a lead and make it scientific, technical and clinical but make it educational. You just cannot tell people come into psychiatry and then they are being ruled by social factors and economic factors. The whole psychiatry has lot of emphasis on social aspects. To me it looks as if there is very little difference between a social worker, a psychologist and a psychiatrist. That distinction must remain, he remarked.

Replying to another question regarding future of psychiatry as a discipline as a career for fresh medical graduates, Dr. Quasim said that  for me it is a bit difficult to answer because my background is predominantly medical. I did MRCP in Medicine before I came to psychiatry and then I did neurology. If psychiatry has to get an honourable place in Medicine, it should be among the equals and not at all less than others.

Answering another question Dr. Quasim said that the annual conference of Midland Psychiatric Research Group was superbly organized not only because  a large  number of people came from overseas  to participate but  also the fact that some heavyweights in the field of psychiatry with expertise in fields like schizophrenia, bipolar disorders, social issues were there. It was highly educative lectures even for most experienced psychiatrists. I think most of us who are part of it really enjoyed it educationally and I must confess socially as well. It was a very pleasant experience. People got to know each other. Every body I met wanted to come again. This meeting is becoming bigger and bigger every year. When it started six years ago it was a gathering of thirty forty people. Now you cannot accommodate. This time it was one hundred forty plus and it was difficult for the organizers. This time we had six top heavyweights in the field of psychiatry participating and speaking at the conference. You do not even get such people in a meeting in London.

Asked about the main scientific highlights of the meeting Dr. Quasim said that lecture by Dr. Norman Sartorius was very interesting and educational. Then we had very interesting lecture by President of American Psychiatric Association Prof. Pedro. That was very enlightening because he highlighted the fact that there is a cultural impact and people who migrate from one country to the other suffer from psychiatric problem. They develop substance abuse of all kind besides depression and anxiety. They are always comfortable if they have their own community but those who are isolated have much high suicide rate. He was saying that now in United States there are large areas where there is Hispanic population who are obviously far more psychiatrically disturbed than they are in their own native country. Even though they are quite affluent and have got much more money but they have more mental sickness. One of the funny things he said was that there are places where the Hispanics have settled in such a great number that the Native Americans are getting depressed and they have got higher suicide rate. In the next fifty years the Hispanics and Blacks might form the overall majority in United States. I personally have learnt a great deal in this meeting.

Continuing Dr. Quasim said that one of the most important things is that Dr. Afzal Javed the main organizer of the meeting discusses with almost every body. The whole Midland Psychiatric Research Group looks into the current trends in psychiatry. In future we need to look more not into defining schizophrenia but see what schizophrenia is besides understanding the spectrum of psychiatric disorders. Look at the bipolar disorders and the quality of life issues. Some of these issues are rarely looked into detail. Then there are certain aspects of depression and anxiety. The topics selected for the Midland Psychiatric Research Group conference are always of current significance and interest to the participants. At present there is a significant population who has got co-morbidity meaning that they have some other diseases and substance abuse is becoming a major issue particularly alcohol and cocaine. The patients are now coming with two diagnoses, one is original one and the other is sporadic one.

Speaking about the importance of spirituality which is gaining more importance in the management of psychiatric diseases, Dr. Quasim said that in the long run you will have to seriously consider that the man cannot live on bread lone.  We will have to look at the whole philosophy of catering to people’s needs. If they need car, they should get, they need good housing and good education. The fact is that there is not enough, hence there is a need for fellowship, there is a need for people understanding and living with each other. You cannot be an island in yourself thinking while I am alright; I do not care whether the man next door die or cries, it does not affect me. There is a spiritual dimension that unless you feel, you cannot care.   As a Muslim I can go back and recall the saying of Caliph Hazrat Omer that if your neighbor is hungry or distressed the food which you are eating is not good until you share it with others.

What is happening in the West is that most of the migrants are considered economic emigrants not necessitated by political pressures because they wish to meet their economic needs. The whole world is in a flux. The Britons are migrating to America; Americans are going to Australia and so on. Every body is on an onward move. I cannot see what is morally and ethically wrong with that. But the fact is that there is a cultural pattern which is being destroyed. People coming from our part of the world, India, Pakistan coming here has to learn and adjust here to live here. This leads to social isolation and disruption in their family. The children are no longer brought up here the way they would be in India or Pakistan. There is some kind of family bonding which is breaking. It has already broken in the West; it is breaking in our part of the world too, Dr. Quasim remarked.