Captain's Log, Stardate January 2020 - Dr John Mitchell, outgoing PMO Psychiatry, Mental Health Directorate, Scottish Government

We kick off 2020 with a guest blog from Dr John Mitchell, outgoing Principal Medical Officer & Psychiatric Adviser to the Mental Health Directorate at the Scottish Government who boldly goes where no man has gone before...

Mental Health and Star Trek – seeking out new worlds and new civilisations

As a child I grew up with Captain James T Kirk swaggering, often topless, across the universe in episodes of Star Trek. We would gather around the Saturday night television marvelling at the special effects and the crew of the Starship Enterprise conquering adversity after adversity with phasers set to stun. Men were real men and women real women. I had my heart set on being a doctor so Dr McCoy acted as role model. Known as ‘Bones’ he set an unsympathetic and cynical tone in his application of the tricorder. No one on the Starship Enterprise had ‘mental health’ and certainly any crew member coming forward in distress after alien interference or mass extermination would have been given short-shift by ‘Bones’. Only Spock was allowed an emotional breakdown when he entered the Vulcan mating cycle and that could be explained away without embarrassment as he was an alien.

The years passed and Jean-Luc Picard took over with a new, more politically correct crew, mirroring the society watching. His senior medic was a lady doctor but intriguingly Deanna Troi appeared as ship’s counsellor – an appropriately senior member of the top team. For me, by now a budding psychiatrist, this was a great leap forward. Through a modern lens we see the separation of physical and mental health into the embodiment of two different people as archaic. It also should be noted that the doctor of physical medicine was a hearty family woman, single but with an adolescent son on board; whereas the counsellor of mental health was a half breed alien. Mental health remained the business of ‘the other’.

The spin off series of Deep Space Nine never really worked for me. I am not sufficiently informed about its interpersonal dynamics to make comment.

In 1995, as I started my Senior Registrar training in Psychiatry, Star Trek Voyager hit the screens. Captain Janeway set a feisty and determined tone as captain of the beleaguered Starship. She set a good example for public health with her holodeck sport contests and her earl gray tea. Her no nonsense style had a counterpoint of caring and nurturing, emotion and behaviours. She set firm limits on the released cyborg drone under her command whilst encouraging them to be a person and explore their humanity. However as ever, I was intrigued by the doctor. He had no name and as hologram and artificial intelligence set a new example of how we might envisage health care in the future. The world had moved on. He combined the weary cynicism of Bones of old with comfortable if somewhat unsympathetic pronouncements about mental ill-health as well as physical. He often commented on imbalances of brain chemicals and micro-cellular scan abnormalities as explanation of people’s troubled thoughts or behaviours. Neurological organic explanations of mental illness were tempered with advice to Seven of Nine the cyborg drone about psychological processes and social behaviour.

The attitudes towards the role of doctors and the relationship of physical and mental health in the sequence of these programmes gives us pause for reflection. It illustrates several things. Society is rapidly changing in its attitudes. The stiff upper lip has been replaced with concern about our mental health and wellbeing. Some realisation of the critical interdependence of mental and physical health is happening. The mental health doctor is however still portrayed as ‘the other’ whether half breed alien or computer programmed hologram.

Over the last few years we have seen a public opening up around the issue of mental health. Encouragement to people to be aware of their emotional lives and their wellbeing has unfortunately been mirrored by misconceptions of the difference between mental health and ill-health and the confusion of distress with mental illness.

Sci-fi can be a good predictor of future trends and also a good mirror of changes in society. It is programmes like the Star Trek series that help to mould societies attitudes – equal status of women, ethnic minorities and LGBTI people are modelled by the evolution of these stories. However, we still have a way to go in reducing the stigma of mental illness and the perception of the role of doctors in it and in good mental health.

I am now following Star Trek Discovery where the black female lead is called Michael and the ship’s doctor and chief engineer are in a warm openly gay relationship. I was sorry to see the doctor Hugh Culber die and be resurrected from the mycelium plane – again as an example of combined mental and physical emotional sensibility he has not been permitted to remain simply human. Society has moved on in relation to mental health – it would be good to see Star Trek reflect that. I look forward to the day when the ship’s doctor is fully human, and fully able to represent the synthesis and interdependence of mental and physical health. A sort of intergalactic, pan-dimensional liaison psychiatrist.

Perhaps I should apply?