I go to a lot of conferences these days, most often as a speaker. This is a function of age and job description. It is unfortunate that I hate travelling. It might have been wise to take this into account before I changed from a relatively static NHS role to more mobile academic one, about five years ago. I dislike business hotels, especially cramped budget chains where the flat screen TV is almost in the bed with you and the toilet is a pod room-within-a-room arrangement. Walking around city centres alone has little appeal, and I have eaten Big Macs in Illinois, East Finland and South India (actually, the one in India was a Macdonald’s masala veggie burger). Hot weather is horrible, as is cold weather.
More than 20 years ago, I went to a fantastic conference sponsored by Boots. It wasn’t that they felt a need to market toiletries to psychiatrists; in those days Boots had a pharmaceutical manufacturing division. The conference was about cults and new religions. However, that was an exceptionally interesting meeting. I haven’t been to a meeting sponsored by a pharmaceutical company in many years, and for a long time I didn’t attend many other conferences either, because they all tended to have too much on psychopharmacology. I used to get very bored and I didn’t believe that the 1990s would be the ‘Decade of The CNS’ (I mention this because I was right). Also, I got too old for conference fever, a succession of late nights and hangovers and worries over what you said or did the night before.
Either conferences have improved, or my expectations have declined. It’s more likely the former, although my preference for performing over being in the audience has something to do with it too. Whatever the reason, I seem to have been to a lot of interesting conferences in recent years, with content that almost makes up for the irritation of being forced to use those little bars of soap wrapped in packaging you can’t open.
In the olden days, the Royal College of Psychiatrists Annual Meeting wasn’t actually dire, but it wasn’t really desperately inspiring either. That has completely changed. It is now the International Congress and it is a huge, well-organised conference with a really high standard of content. The Congress is in progress right now, Wednesday, 1st July. I’ve been in Birmingham since Monday and there’s another day to go.
I don’t know what people think psychiatrists talk to each other about: how to invent new diagnoses or the pharmacokinetics of new medications I expect. To be fair, these things do sometimes crop up, but the programme is hugely varied. Today we’ve had Professor Richard Bentall, a clinical psychologist who is sharply critical of psychiatry, talking about delusions and Professor Tom Burns, who has conducted a Randomised Controlled Trial of Community Treatment Orders that showed that they don’t work. He used to be a strong advocate for their use, but, being a good scientist, he has completely changed his mind and now says they shouldn’t be used at all. We’ve had sessions on human rights and an address by Simon Stevens, the Chief Executive of NHS England (or ‘of the NHS’ as the Anglo-centric programme would have it). I’m not sure that he told us anything new, but the fact that he came seemed important to me. There was loads more.
It’s a rich mix, with lots to think and argue about. Psychiatry is a controversial profession, but it is by far the most interesting field in medicine. Our strength is our thoughtfulness and our diversity. As a profession we are willing to acknowledge shameful episodes in our history and to learn from them. Psychiatry is far from perfect and there are lots of theories and practices that I am very uncomfortable about, but we do engage with our critics and sometimes we decide that they are right.
Twenty-five years ago I was one of seven British and two West Indian psychiatrists involved in a conference related incident that I later labelled ‘Shoot Out On Bourbon Street’. It happened in New Orleans at 2 am on a Monday morning and nothing bad actually happened, but it was a bit frightening at one point. I have often heard the story retold second hand with heroic embellishments. The true outcome on the night was that we all ran away, having briefly considered leaving one of our number behind, as he was the only one at any real risk of being shot. Anyway, my life is much more sedate these days, but I do meet lots of old friends at the Royal College International Congress. I often learn things that I remember, at least for a while. I am actually proud to be a psychiatrist, despite some aspects of the profession’s history and some of the ambiguities intrinsic to clinical practice. Occasions like this week in Birmingham demonstrate why that is.
I haven’t mentioned the workshop that Professor Catherine Robinson and I ran on religion and professional boundaries. I’ll come back to that in another blog.