I read with great interest the article "Doctors accessing mental-
health services: an exploratory study" by Josephine Stanton and Patte
Randal and the response posted by Andrew K Ntanda and I would agree that
this group of doctors should consider accessing individual psychotherapy.
My training region also offers support to doctors with Mental Health and
other problems I would like to direct any reade...
I read with great interest the article "Doctors accessing mental-
health services: an exploratory study" by Josephine Stanton and Patte
Randal and the response posted by Andrew K Ntanda and I would agree that
this group of doctors should consider accessing individual psychotherapy.
My training region also offers support to doctors with Mental Health and
other problems I would like to direct any readers to their deanery website
to find out about availability of any similar services in their region.
From a very personal perspective I suffered from moderate post natal
depression following a c-section which coincided with the
completion of my CCST. I accessed the relevant service and found it most
helpful. However I also sought help and advice from my consultant
supervisor, a decision I now deeply regret. Since disclosing my
difficulties I have been unable to gain any consultant post. While this
may seem to the reader to be a case of sour grapes or perhaps slightly
over-sensitive on my part it has been difficult to shake the feeling that,
perhaps, by disclosing my difficulties I have made myself unemployable.
For this reason I would very much like to see further studies that
consider the longitudenal impact on doctors who access help for their
mental health difficulties and further to this their subsequent career
trajectories. Such a study may help allay the fears described by
participants in Stanton and Randal's paper and enable them to adopt
appropriate health seeking behaviours. Moreover I hope such studies will
enable the profession to be more self reflective and cease out-grouping
those of our peers with conditions that traditionally attract stigma.
Yours faithfully
Anon
Conflict of Interest:
None declared
The author of this e-letter has identified herself to the journal but requested to remain anonymous.
The fact that a high percentage of patients with locked-in syndrome
(LIS) shows an unexpected well-being does not surprise us, but we are very
interested in this. The first part of the work carried out by Bruno and
colleagues provides a basis for researchers to formulate new working
hypotheses in patients who have a lesion that is so localised and yet
leads to such a complex mosaic of consequences on a functional level. I...
The fact that a high percentage of patients with locked-in syndrome
(LIS) shows an unexpected well-being does not surprise us, but we are very
interested in this. The first part of the work carried out by Bruno and
colleagues provides a basis for researchers to formulate new working
hypotheses in patients who have a lesion that is so localised and yet
leads to such a complex mosaic of consequences on a functional level. In
the conclusions authors raise some additional ethical questions about this
challenging group of patients. We have identified a series of 'syndromes
within the syndrome' in patients with LIS due to ventral pontine damage
(pathological laughter and crying, motor imagery impairment and a
selective impairment in the recognition of facial expressions).1-3 At the
same time we found, albeit in a much smaller group of subjects, values
almost comparable to those of the general population in self-reported
Quality of Life.4 This is neurology; this is science and science must stop
here.
Prof. Savulescu attacks the work of Bruno et al., saying that this is the
classic research approach of those opposing euthanasia. In other words the
'ethical' conclusions would invalidate empirical data on the grounds that
these tendentially favour a certain ethical or political vision of the
world (and therefore are prejudiced). In our opinion, an alternative
approach, based not on scientific findings but rather on moral and/or
political motivations, would be prejudiced too. We find ourselves asking
"Who is invading whom?" Is politics invading science, or is science
invading politics? This would be a rhetorical question had we not arrived
at this point of convergence. Either Prof. Savulescu denies that the data
presented by Bruno et al. have scientific value on the basis that they go
against common sense (and asks Bruno and colleagues to 'abjure') or he
claims that the data are false. Yet in our opinion there is a third way to
proceed: separating science from politics and ethics. A disconnection that
must be clean and definitive.
1. Pistoia F, Conson M, Trojano L, Grossi D, Ponari M, Colonnese C,
Pistoia ML, Carducci F, Sara' M. Impaired conscious recognition of
negative facial expressions in patients with locked-in syndrome. J
Neurosci 2010;30:7838-7844.
2. Conson M, Sacco S, Sara' M, Pistoia F, Grossi D, Trojano L.
Selective motor imagery defect in patients with locked-in syndrome.
Neuropsychologia 2008;46:2622-2628.
3. Sacco S, Sara' M, Pistoia F, Conson M, Albertini G, Carolei A.
Management of pathologic laughter and crying in patients with locked-in
syndrome: a report of 4 cases. Arch Phys Med Rehabil 2008;89:775-778.
4. Pistoia F, Conson M, Sara' M. Opsoclonus-myoclonus syndrome in
patients with locked-in syndrome: a therapeutic porthole with gabapentin.
Mayo Clin Proc 2010;85:527-531.
I read with interest the authors' qualitative study assessing
potential barriers of doctors assessing mental health facilities.
In particular it was striking that 6/8 of the participants interviewed
worked in psychiatry, and as the author alluded to in the beginning, were
most likely to either treat themselves or trust their own council.
I think a way forward for this particular group of patients is for them to
consider in...
I read with interest the authors' qualitative study assessing
potential barriers of doctors assessing mental health facilities.
In particular it was striking that 6/8 of the participants interviewed
worked in psychiatry, and as the author alluded to in the beginning, were
most likely to either treat themselves or trust their own council.
I think a way forward for this particular group of patients is for them to
consider individual psychotherapy, and in our particular region, there
exits House concern within the department of psychotherapy, which deals
specifically with doctors who do have mental, behavioural or emotional
problems.
The service is confidential, and is unique in a sense that
it is a novel way of accessing some help. It is run by a consultant
psychotherapist(and practicing psychiatrist)who can then signpost the
doctors to other services, if they consent for this to happen.
As the other points out, a lot more qualitative work about the attitudes and
heath seeking behaviour of doctors needs to be done, and this study is a
step in the right direction.
This sort of research demonstrating remarkable adaptation is often
used by anti-euthanasia lobbyists to argue that assisted suicide and
euthanasia should not be offered to such people because they come to value
their life. They find meaning. However, that conclusion is not warranted.
Some do want to die and should be allowed to die. The lesson that should
be learnt is the one authors draw: you should wait to see how you a...
This sort of research demonstrating remarkable adaptation is often
used by anti-euthanasia lobbyists to argue that assisted suicide and
euthanasia should not be offered to such people because they come to value
their life. They find meaning. However, that conclusion is not warranted.
Some do want to die and should be allowed to die. The lesson that should
be learnt is the one authors draw: you should wait to see how you adapt.
But, if after waiting a suitable time, you want to die, you should be
allowed or helped to die. The authors adopt a similar moderate view. " In
our view, shortening-of-life requests by LIS patients are valid only when
the patients have been given a chance to attain a steady state of SWB."
But this is too paternalistic. If a competent person does not want to
wait, and has been advised of this kind of research and the possibility of
adaptation, but still wants to die, he should be allowed to die. It is
hard paternalism to keep people alive when they competently and informedly
want to die.
This kind of research is also used to call into question the validity
of living wills or advance directives. However it provides no grounds for
questioning the validity of living wills. It provides reasons to make sure
people are aware of the phenomenon of adaptation before completing a
living will. Imagine that I know I will be happy some years after having
developed locked-in syndrome. Can I now validly ask doctors to allow me to
die at the time I have a massive stroke that will leave me locked-in? Yes.
I can refuse any medical treatment, even if I am having a perfectly good
life. Jehovah's Witnesses do this when they refuse life-saving blood
transfusion.
What makes each person's own living hell is a matter for that person.
It is subjective. And we can adapt to hell. That is important for all of
us to know. But it does not change the rights of individuals to make what
they will of their lives, including choosing the conditions under which
and the time to end them.
Conflict of Interest:
Stephen Laureys is a collaborator with our Oxford Centre for Neuroethics which I direct
I just wanted to add a few other dimensions to the topic on the
happiness of persons who are living with a disability in which they have a
limited ability to communicate: resources.
I work with participants at a cerebral palsy center. The persons I
find to be more content are those who are given access to equipment that
allows them to communicate with others and equipment in which their
mobili...
I just wanted to add a few other dimensions to the topic on the
happiness of persons who are living with a disability in which they have a
limited ability to communicate: resources.
I work with participants at a cerebral palsy center. The persons I
find to be more content are those who are given access to equipment that
allows them to communicate with others and equipment in which their
mobility is less restricted.
The people who use our program either have the luxury of private
insurance in which they can have excellent augmentative communication
devices, have state insurance that allows lower-end devices that take over
two years to replace or fix when they break down, or no insurance and
either use crappy equipment we have left over or none at all.
The same is true for the types of mobility equipment that
participants have. Those with resources have better autonomy due to their
wheelchairs' capabilities. Unfortunately for some, the use of any type of
wheelchair only happens at our center.
Our computer lab is stocked with mid-range devices and substandard
computers for this day in age. We do our best, but continued budget cuts
have left this area wanting as well. There are a few participants whose
augmentative devices access the internet, thus serving as their own
computer as well, but this is rare.
I just thought I'd tell you that the study should include the subject
of resources that allow people with severe disability to still be included
in society would surely make a difference in how content their lives are.
It is a terrible shock to most who become disabled later in life to
see how little value society puts on their inclusion when it comes down to
it! I know because I have had two children born with disability, one in
the state that your article is written about. Also, I majored in
Disability Studies at UC Berkeley after raising my children. I now am a
special educator working with adults who are living with a variety of
disabilities.
Dear Editor
I read with great interest the article "Doctors accessing mental- health services: an exploratory study" by Josephine Stanton and Patte Randal and the response posted by Andrew K Ntanda and I would agree that this group of doctors should consider accessing individual psychotherapy. My training region also offers support to doctors with Mental Health and other problems I would like to direct any reade...
The fact that a high percentage of patients with locked-in syndrome (LIS) shows an unexpected well-being does not surprise us, but we are very interested in this. The first part of the work carried out by Bruno and colleagues provides a basis for researchers to formulate new working hypotheses in patients who have a lesion that is so localised and yet leads to such a complex mosaic of consequences on a functional level. I...
I read with interest the authors' qualitative study assessing potential barriers of doctors assessing mental health facilities. In particular it was striking that 6/8 of the participants interviewed worked in psychiatry, and as the author alluded to in the beginning, were most likely to either treat themselves or trust their own council. I think a way forward for this particular group of patients is for them to consider in...
This sort of research demonstrating remarkable adaptation is often used by anti-euthanasia lobbyists to argue that assisted suicide and euthanasia should not be offered to such people because they come to value their life. They find meaning. However, that conclusion is not warranted. Some do want to die and should be allowed to die. The lesson that should be learnt is the one authors draw: you should wait to see how you a...
Hello,
I just wanted to add a few other dimensions to the topic on the happiness of persons who are living with a disability in which they have a limited ability to communicate: resources.
I work with participants at a cerebral palsy center. The persons I find to be more content are those who are given access to equipment that allows them to communicate with others and equipment in which their mobili...
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