Citation

Brown P. Australas. Psychiatry 2018; 26(1): 106-107.

Affiliation

Melbourne, VIC.

Copyright

(Copyright © 2018, Royal Australian and New Zealand College of Psychiatrists, Publisher SAGE Publishing)

DOI

10.1177/1039856217737883

PMID

29384008

Abstract

Bullying of patients is endemic in public psychiatry. I repeatedly encountered it in my locum travels. Aggression of staff members, not infrequently unconscious, based in personal and system dynamics (managerialism) as much as patient dynamics, not only oppresses the patient but also reinforces the patient’s defences: most notably splitting, projection and denial. The result is vicious cycles of patient and staff aggression, and patient acting out, in which the latter is the most obvious loser.

The pivot of all solutions in psychiatric treatment, and treatment service delivery, can be summed up in one word, but it is a word that I hardly heard on my locum travels. I did not hear it in the handovers or ward rounds. I did not hear it in debriefing, and it was not raised in training sessions. That word is countertransference. It represents the core of dynamic patient management. It departed the psychiatric lexicon with the demise of Freudianism with its erstwhile focus on the doctor–patient relationship. In short, the baby was thrown out with the bathwater...

Language: en