Dr Emma Brandish is a foundation year two doctor 

Single best decision

I entered medical school in 2006 as a graduate, having previously read International Business with French at Loughborough University. My first degree included an industrial placement year which I spent working in London at the head office of a high street fashion retailer. Working in fashion was exciting and I planned to return as a graduate, but I changed my mind during my final year and applied for medicine instead; this was the single best decision I have ever made.

As a second year medical student I became increasingly aware of the role of research in clinical practice. I knew absolutely nothing about research but wanted to learn more so I emailed my personal tutor for advice. He was a psychiatrist and he invited me to spend the summer vacation doing research with him. I successfully applied to the Wellcome Trust for a Vacation Scholarship which funded 8 weeks of basic research training and the opportunity to contribute to a number of different studies. During that summer I had my first taste of both clinical and academic psychiatry and I loved it. It was as if a light switched on - I knew what I wanted to do.

Award

Further experience gained during my psychiatry clinical attachments increased its appeal. I enjoyed spending time with patients, talking to them, entering into their world and exploring. I became fascinated by the interaction between mental illness and the unique human experience of individual patients.

In 2010 I was awarded an Undergraduate Fellowship in Psychiatry. The Fellowship scheme is a Southampton initiative where clinical medical students with an expressed interest in psychiatry have the opportunity to compete for a monetary prize (to support educational development in psychiatry) and are assigned a psychiatrist mentor.  They are also encouraged to assume an active role in further development of the local student psychiatry society.

It was the combination of these academic and clinical experiences which prompted me to apply for an Academic Foundation Programme in Psychiatry to further explore my interest in the specialty.

Cement my career choice

Post qualification I have frequently encountered significant psychopathology within the general hospital setting. I often considered how this contributes to the presentation of physical illness and it has served to remind me how important mental well-being is to overall health.  

Despite enjoying aspects of medical and surgical jobs I continue to be drawn to psychiatry and my four months as an academic FY2 in psychiatry has cemented my career choice. I have recently been appointed as an Academic Clinical Fellow in General Adult Psychiatry in the Wessex Deanery. I start in August 2012 and I am very much looking forward to the next stage of fmy psychiatric career.

I cannot deny that I have been lucky and mentorship has been a key factor in my progress to date. In particular, that of Professor David Baldwin and Dr Julia Sinclair who have supported me and guided me whilst introducing me to a world of clinical and academic possibilities. However, despite the convenience of having a receptive and supportive academic psychiatrist as a personal tutor I have met many psychiatrists who are extremely receptive to opportunistic emails from keen medical students and junior doctors looking for further clinical or academic experience. Therefore I would always encourage colleagues who express an interest in psychiatry to take that first step.

Psychiatry is still evolving, there is still so much to discover and learn, so much we don't understand and that is incredibly exciting. I want to be a part of its future. I shamelessly promote the virtues of psychiatry as a specialty wherever I go, both to medical students and to other doctors. I also encourage medical students and other junior doctors to consider academic medicine as I don't feel it is sufficiently well promoted to them yet it presents diverse, stimulating and exciting career opportunities.

Dr Alan Spratt is a foundation year two doctor 

Four months

Old age Psychiatry is akin to an Addenbrooke’s cognitive assessment.

1. The general populace of medics tend to avoid it (we’ll ignore the surgeons altogether).
2. It seems it will take a while to get through it.
3. Although it can seem simple to highlight a problem, the management and repercussions are far from simple.

Few FY2 rotations are available in psychiatry. Although I sought the rotation out, many do not. For a specialty that is essential in many other specialties including Emergency Medicine, GP and General Medicine, people do not have an opportunity at foundation level to experience it. 

Four months isn’t a long time unfortunately to fully submerse into a specialty or indeed a sub-specialty. 

Cross your path

However, in a four month rotation I have seen the division of care between community and hospital and the importance of the community psychiatric team and the communication skills to keep it linked together (meeting upon meeting followed by phone calls and then referral letters). 

Caffeine-laced on call duties where no two referrals were ever the same provided exposure to acute admissions across all sub-specialties. These were by far the most challenging aspect of the rotation. In these situations although help was never far away, when you’re on your own the most prominent and lasting lessons are learnt. These situations are meant to be stressful in medicine, it just so happens in psychiatry you carry an alarm and the door opens both ways in the assessment room.

Now a humbling realisation is that care of the elderly was the highlight of the rotation. Organic illness will be an increasing problem in the future of the NHS. Regardless of what specialty people end up in, dementia and Alzheimer’s will cross your path and I guarantee you will have no idea how to manage it as successfully as is done in psychiatry. It will affect you, your patients or your family. 

It is therefore worth spending four months finding out about it and the challenges it brings. 

Josie Phizacklea is a 4^th Year Medical Student at Cardiff University

Larger than life

For Cardiff University Psychiatry Society’s first event, Professor Dinesh Bhugra, President of the Royal College of Psychiatrists, spent an evening exploring the portrayal of mental illness in Bollywood through the decades. After enjoying a buffet of Indian food, 60 students and trainees settled down to enjoy a fascinating insight into another culture's perception of psychiatry.

Professor Bhugra began by emphasising the role cinema plays in the understanding of any culture, with social themes influencing film and film, in turn, influencing society’s thinking.

As the world’s largest producer of films, Bollywood is an important window to a global perspective of mental health and has a powerful role in shaping the views of a vast audience. Bollywood movies are unique in being very fantastical, colourful affairs, with larger than life sets and often unrealistic storylines. Ubiquitous across India, from small, shared TVs to glossy multiplexes, they are a huge part of the lives of ordinary Indians, often providing sanctuary from the trials and tribulations of everyday life in a developing country. Bollywood movies often do not reflect reality but are vital, instilling hope and giving something towards which to aspire.

Clichéd boxes

The Wellcome Trust has funded Professor Bhugra to study more than 50 films that include a protagonist with mental illness. This enabled him to examine the evolving attitudes towards psychiatric illness in Indian culture during periods of massive political, social and economic changes.

Professor Bhugra points out that the three main periods in Hindi cinema were each defined by turning points in the social norms. The films of the 1960s were influenced by the idealism of a newly independent republic, and reflected this confidence in a period of ‘Romanticism’, where a mood of optimism was coupled with a gentle representation of the mentally ill.  

Film clips illustrating this included Khamoshi (The Silence, 1969) which describes the story of a young nurse who migrates to the West and saves a psychiatric patient from misery by falling in love with him. Working alongside her was a caricature Freudian psychiatrist, sporting a fine beard, who ticked all the clichéd boxes you could hope for.

However, “growth of government corruption and an unstable political climate” during the 1980s led to a national feeling of discontent and spawned the period of ‘Villainy’ in the Hindi film industry, resulting in a plethora of ominous psychopaths appearing on Bollywood screens.

A ‘New Romanticism’ appeared with the economic liberalisation of the 1990s. Professor Bhugra described how, "women were seen as possessions in both society and the cinema, and the portrayals of stalking and morbid jealousy increased”. This point was illustrated by characters demonstrating signs of paranoia in clips of this era.

Inspired

It was a privilege for the students and trainees who attended to be guided so thoughtfully through the captivating periods of India’s history in relation to mental health; we are enormously grateful to both Professor Bhugra and all those who organised the event.

It was fascinating to learn how the societal and political climate in India effected change in Bollywood Cinema and to consider how the portrayal of psychiatric patients reflects society’s treatment of the mentally ill at the time. An understanding of these cultural themes will help us to appreciate the perspective of patients we encounter as medical students and foundation trainees. Many of us left the event with a refreshed enthusiasm for pursuing our interest in the speciality.

Sonia Sangha is a foundation year two doctor.

Risky business

I recently attended Psychiatry as a career: Everything you wanted to know but were afraid to ask at the Royal Society of Medicine.

Some of the lectures not only allayed concerns and myths about psychiatry, but challenged some of my own pre-conceived ideas. In particular, the section, Is psychiatry a risky profession? presented by Dr Mark Salter and Dr Victoria Cohen, was undeniably controversial, with 70% of the audience agreeing that it was. 

Two studies

Dr Salter compared two studies to debate the question he had set out for discussion.

The first (Wyatt and Watt) looked at 100 junior doctors working in Accident and Emergency departments in the U.K. The study found that 18% of doctors, not including duty on-call psychiatrists assessing patients in A&E,  had been assaulted by patients on a total of 23 occasions and that 32% had said that patients had tried to assault them. None of those assaulted received any counselling. Only 11% had received any training on how to manage aggressive patients, although 88% had believed that it would be useful.

The second study (S. Davies) set out to determine the annual rates of assaults and threats to psychiatrists. Over a year, 17% reported one or more assaults and 32% reported one or more threats (see table 1). In this case, 48% had attended a course on dealing with aggressive patients, which 87% had found useful.

Dr Salter concluded that the evidence from these studies illustrated that violence in the mental health population is no greater than that in the general population and the cause of it is likely to be related to the same factors in the two populations. Thus, psychiatry is no more ‘risky’ a profession than other specialities.

Further research presented, showed that substance misuse and psychopathy are often useful predictors of violence in the mentally ill. Often substance abuse and mental illness co-exist. These useful predictors, along with supervision, greater opportunity to attend appropriate courses and supportive colleagues, place psychiatrists in a ‘safer’ position.

Not deterred

In conclusion, mental illness and violence are often considered intrinsically linked by doctors and lay people alike, often due to skewed media coverage. For example, the misunderstanding of schizophrenia as an illness, demonstrated in Alfred Hitchcock’s film Psycho and schizophrenic patients being portrayed as violent. 

This is being addressed currently by the campaign, Time to Change, after a YouGov poll of 2,010 people found that more than a third held the belief that all sufferers of schizophrenia are violent!

Overall, the meeting was a great success and it fulfilled my expectations. I left feeling that psychiatry is a speciality that has a great deal of uncertainty and complexity about it, but then that is what makes it unique and is the very reason why I am committed to pursuing psychiatry as a career.