Can Channel 4's Bedlam do for psychiatry what Educating Yorkshire did for teaching?

While an under-performing school holds ample opportunities for teachers to turn lives around, inpatient psychiatric units are where lives get put on hold.

There can be few professions more in need of a boost of good PR than psychiatry. The least popular of all medical specialties, we’ve been struggling to recruit young doctors to our ranks for years. In 2012, there were more training posts available in psychiatry than doctors applying for them. So as a psychiatrist, I’m keeping everything crossed, hoping that Bedlam, a new series airing Thursday 31st October on Channel 4 is going to change all that. Set in one of the country’s best-known psychiatric hospitals, it promises to give unrivalled insights into the lives of patients and staff over 4 episodes. With access to actual NHS consultations and treatment, the programme hopes to challenge the ‘myths and taboos’ around mental illness and psychiatry.

We know TV can do wonders for a profession down on their luck. It was with more than a little envy that I witnessed teachers getting a much-needed lift from the final episode of Educating Yorkshire last week. Who could have failed to be moved by Musharaf’s dogged determination to overcome his stammer for his English speaking exam, and the efforts of his teacher Mr Burton to help him? Though the profession has been in for a battering over their recent strike action in hard times, it reminded all of us how magical good teaching can be, the difference it can make to the lives of young people, and the benefits it brings to society as a whole. The inherent value of teaching shone from our screens. Up and down the country, thousands of sparks of inspiration were stuck, and people, perhaps unknowingly, started on a journey to a new career in education. As the credits rolled, I thought, ‘My lot could do with a bit of that.’

While other doctors have positive aspirational role models from glamorous American TV series, psychiatrists are linked in the popular imagination to serial killers like Dr Hannibal Lecter. And if we’re not characterised as evil or flawed, then the ‘go to’ image is comic. I was amused and saddened to learn at a recent psychiatry conference that if you do a Google image search for the word ‘surgeon’, you reveal countless images of attractive men and women in blue scrubs looking important and performing heroic acts, whereas typing ‘psychiatrist’ returns a tranche of barely humorous cartoons, and photographs of couches. In terms of inspiring tomorrow’s doctors and firing up passions, there’s no doubt that we’re up against it.

Am I nervous about Bedlam’s impact? You bet. While an under-performing school holds ample opportunities for teachers to turn lives around, inpatient psychiatric units are where lives get put on hold. Nothing can prepare you for the sheer strangeness of a psychiatric ward, a place that can seem untouched by hope, a temporary refuge for people at their lowest ebb.

I distinctly remember the first time I visited one fifteen years ago, not as a naïve medical student, but as a carer, visiting my friend hospitalised with depression after a serious suicide attempt. Having already seen the inside of many hospital wards, I felt well prepared for the experience, confident I would be unflustered by the surroundings. This left me plenty of emotional room to focus on coming across as sympathetic and patient, rather than showing that I was actually angry with her for what she had done, and petrified that we nearly lost her.

But no sooner had I stepped onto the ward than I was on the back foot. Where were the nurses? And who was in charge? Nobody had uniforms on and people just seemed to be milling about. There was no medical equipment of any type that I recognised. A stranger approached me, a young woman who made no eye contact and started to tell me something I no longer remember, then began to cry. My confidence had left me. I was totally out of my depth. Where was my friend? Was she going to be safe here?

It hardly seemed like the kind of place miracles happen. But the reality is that they do. I try to hold on to that first experience and how it affected me when meeting patients and families for the first time. It is easy to forget that they may not know what I know - that odds on, things are going to get better.

Mental illness can be shocking, devastating, harrowing. It can wreck lives in countless ways, and be harder to come to terms with than heart disease, diabetes or cancer. As mental health professionals, it is our job to do what we can to help turn these lives around. When people are at their most desperate and can’t see light at the end of the tunnel, we must not only be a shoulder to cry on, but help them find a way out.

Despite poor first impressions, psychiatric hospitals can play host to thousands of acts of kindness every bit as moving as Mr Burton’s. Look beyond the peculiarity of its wards, routines and functions, and you will see dedicated professionals doing what they can to make a difference, helping people overcome symptoms, move on, and recover. For too long there has been too much attention on the negative aspects of psychiatry. Yes, some of the medications we prescribe can have horrible side effects. Yes, sometimes we detain people in hospital against their will. But in making these difficult decisions, our intentions are invariably good. The factors and outcomes we need to consider are arguably more complex and life-changing than those faced by other doctors. We don’t shy away from making tough decisions. It’s hard to help people in profound distress, but we’re proud of what we do.

So here’s hoping Bedlam will reveal miracles. Here’s hoping we’ll glimpse some moments of magic. We need to find the next generation of doctors who want to become psychiatrists. People who experience mental illness deserve highly trained, highly motivated professionals who want to relieve suffering and hold their head up high. Here’s hoping sparks of inspiration are struck.

People's ideas about psychiatry are more often than not related to patients lying on couches and inkblot tests. Image: Getty
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What happens when a president refuses to step down?

An approaching constitutional crisis has triggered deep political unrest in the Congo.

Franck Diongo reached his party’s headquarters shortly after 10am and stepped out of a Range Rover. Staff and hangers-on rose from plastic chairs to greet the president of the Mouvement Lumumbiste Progressiste (MLP), named after the first elected leader of the Democratic Republic of Congo.

Diongo, a compact and powerfully built man, was so tightly wound that his teeth ground as he talked. When agitated, he slammed his palms on the table and his speech became shrill. “We live under a dictatorial regime, so it used the security forces to kill us with live rounds to prevent our demonstration,” he said.

The MLP is part of a coalition of opposition parties known as the Rassemblement. Its aim is to ensure that the Congolese president, Joseph Kabila, who has been president since 2001, leaves office on 19 December, at the end of his second and supposedly final term.

Yet the elections that were meant to take place late last month have not been organised. The government has blamed logistical and financial difficulties, but Kabila’s opponents claim that the president has hamstrung the electoral commission in the hope that he can use his extended mandate to change the rules. “Mr Kabila doesn’t want to quit power,” said Diongo, expressing a widespread belief here.

On 19 September, the Rassemblement planned a march in Kinshasa, the capital, to protest the failure to deliver elections and to remind the president that his departure from office was imminent. But the demonstration never took place. At sunrise, clashes broke out between police and protesters in opposition strongholds. The military was deployed. By the time peace was restored 36 hours later, dozens had died. Kabila’s interior minister, claiming that the government had faced down an insurrection, acknowledged the deaths of 32 people but said that they were killed by criminals during looting.

Subsequent inquiries by the United Nations and Human Rights Watch (HRW) told a different story. They recorded more fatalities – at least 53 and 56, respectively – and said that the state had been responsible for most of the deaths. They claimed that the Congolese authorities had obstructed the investigators, and the true number of casualties was likely higher. According to HRW, security forces had seized and removed bodies “in an apparent effort to hide the evidence”.

The UN found that the lethal response was directed from a “central command centre. . . jointly managed” by officials from the police, army, presidential bodyguard and intelligence agency that “authorised the use of force, including firearms”.

The reports validated claims made by the Rassemblement that it was soldiers who had set fire to several opposition parties’ headquarters on 20 September. Six men were killed when the compound of the UDPS party was attacked.

On 1 November, their funerals took place where they fell. White coffins, each draped in a UDPS flag, were shielded from the midday sun by a gazebo, while mourners found shade inside the charred building. Pierrot Tshibangu lost his younger sibling, Evariste, in the attack. “When we arrived, we found my brother’s body covered in stab marks and bullet wounds,” he recalled.

Once the government had suppressed the demonstration, the attorney general compiled a list of influential figures in the Rassemblement – including Diongo – and forbade them from leaving the capital. Kinshasa’s governor then outlawed all political protest.

It was easy to understand why Diongo felt embattled, even paranoid. Midway through our conversation, his staff apprehended a man loitering in the courtyard. Several minutes of mayhem ensued before he was restrained and confined under suspicion of spying for the government.

Kabila is seldom seen in public and almost never addresses the nation. His long-term intentions are unclear, but the president’s chief diplomatic adviser maintains that his boss has no designs on altering the constitution or securing a third term. He insists that Kabila will happily step down once the country is ready for the polls.

Most refuse to believe such assurances. On 18 October, Kabila’s ruling alliance struck a deal with a different, smaller opposition faction. It allows Kabila to stay in office until the next election, which has been postponed until April 2018. A rickety government of national unity is being put in place but discord is already rife.

Jean-Lucien Bussa of the CDER party helped to negotiate the deal and is now a front-runner for a ministerial portfolio. At a corner table in the national assembly’s restaurant, he told me that the Rassemblement was guilty of “a lack of realism”, and that its fears were misplaced because Kabila won’t be able to prolong his presidency any further.

“On 29 April 2018, the Congolese will go to the ballot box to vote for their next president,” he said. “There is no other alternative for democrats than to find a negotiated solution, and this accord has given us one.”

Diongo was scathing of the pact (he called it “a farce intended to deceive”) and he excommunicated its adherents from his faction. “They are Mr Kabila’s collaborators, who came to divide the opposition,” he told me. “What kind of oppositionist can give Mr Kabila the power to violate the constitution beyond 19 December?”

Diongo is convinced that the president has no intention of walking away from power in April 2018. “Kabila will never organise elections if he cannot change the constitution,” he warned.

Diongo’s anger peaked at the suggestion that it will be an uphill struggle to dislodge a head of state who has control of the security forces. “What you need to consider,” he said, “is that no army can defy a people determined to take control of their destiny . . . The Congolese people will have the last word!”

A recent poll suggested that the president would win less than 8 per cent of the vote if an election were held this year. One can only assume that Kabila is hoping that the population will have no say at all.

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage