Photo: Cover artwork of 'Head First: A psychiatrist's stories of mind and body'.
Head First: A psychiatrist’s stories of mind and body
By Alastair Santhouse
My interest in medicine came from my mother. She qualified as a doctor in the 1940s. In the 1960s she trained as a psychiatrist, specialising in hypnosis. At that time there was a pill for everything, so she was out of step with her colleagues. She believed most mental illness was a rational response to intolerable situations, and that listening to people was often more useful than giving them drugs.
Alastair Santhouse has worked as a consultant psychiatrist for the last twenty years, at Guy’s Hospital and The Maudsley Hospital. He gives a shocking account of starting as a new junior doctor, in 1992. But ‘Even now’, he says ‘decades later, there is the same institutional indifference to doctors, and… you cannot run two cultures in one organisation… If the health and well-being of staff is not looked after, then the health of those patients they are meant to be treating suffers too’.
Santhouse describes how and why he became a doctor, and what led him to move into psychiatry. Using stories, he demonstrates how the mind, shaped by culture, can control our physical reality. For example, after a heart attack, the heart works less efficiently, as measured by the amount of blood expelled from the pumping chamber, expressed as an ejection fraction. It is possible to have an ejection fraction of forty-five per cent and be crippled by it, or an ejection fraction of thirty-five per cent and lead a fulfilling life, even though both these states indicate significant heart damage.
‘Warmth and empathy shine through.’
Santhouse also considers how religious and Cartesian dualism, the theoretical separation of mind and body, led to a medical model of the body as a machine, with organs behaving in a predictable way, and an almost absolute belief in science. ‘This body-as-machine medical model is also maintained by an increasingly risk-averse culture’, leading to over-investigation, with tests sometimes used to make the patient feel better (by knowing they are being taken seriously, and that something is being done) in the absence of any obvious physical cause. Things are not helped by having physical health records and psychiatric notes on two separate, unlinked, electronic systems.
This is a readable and enjoyable book, covering a variety of aspects of health/ill-health, from ‘Melancholia’ to ‘Agency’, via ‘Exhaustion’, ‘Suicide’, ‘Meaning’, ‘Pain’ and ‘Covid-19’, all told through individual stories and all rigorously referenced. Santhouse’s warmth and empathy shine through, as does his desire to help people and to understand them better. He is frank about the failings of our healthcare system, but without being judgemental or censorious. Using a wealth of evidence, he offers hope for the future.
‘Over time… I have come to realise that while the underpinning of medicine is a science, the practice of medicine is an art.’ I think my mother would have approved.
