The rise of counselling and the return of alienism.

Abstract:

:Current services for those with mental disorders show two trends. Psychiatric services are becoming concentrated on the care of those with "severe mental illness," largely (but unjustifiably) synonymous with chronic psychosis. The retreat of psychiatry from the care of those with non-psychotic mental disorders has helped the growth of counselling services for these patients. However, there is no evidence that non-directive counselling is effective for such disorders, in contrast to the evidence for the effectiveness of other treatments that are usually delivered by psychologists or community psychiatric nurses. By retreating from the concerns of general practice and general medicine, psychiatry is returning to the days of alienism: in Victorian terms, the care of "the mad." Possible consequences include increasing expectations of psychiatric services that cannot be met, a loss of skills within psychiatry, and increased demoralisation in the mental health services.

journal_name

BMJ

authors

Wessely S

doi

10.1136/bmj.313.7050.158

subject

Has Abstract

pub_date

1996-07-20 00:00:00

pages

158-60

issue

7050

eissn

0959-8138

issn

1756-1833

journal_volume

313

pub_type

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