Skip to main content
The BMJ logoLink to The BMJ
. 1996 Jul 20;313(7050):158–160. doi: 10.1136/bmj.313.7050.158

The rise of counselling and the return of alienism.

S Wessely 1
PMCID: PMC2351562  PMID: 8688780

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.

Full text

PDF
158

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boot D., Gillies P., Fenelon J., Reubin R., Wilkins M., Gray P. Evaluation of the short-term impact of counseling in general practice. Patient Educ Couns. 1994 Aug;24(1):79–89. doi: 10.1016/0738-3991(94)90028-0. [DOI] [PubMed] [Google Scholar]
  2. Corney R. Developing mental health services in the community: current evidence of the role of general practice teams. J R Soc Med. 1994 Jul;87(7):408–410. doi: 10.1177/014107689408700712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med. 1992 Feb;22(1):173–180. doi: 10.1017/s0033291700032827. [DOI] [PubMed] [Google Scholar]
  4. Fletcher J., Fahey T., McWilliam J. Relationship between the provision of counselling and the prescribing of antidepressants, hypnotics and anxiolytics in general practice. Br J Gen Pract. 1995 Sep;45(398):467–469. [PMC free article] [PubMed] [Google Scholar]
  5. King M., Broster G., Lloyd M., Horder J. Controlled trials in the evaluation of counselling in general practice. Br J Gen Pract. 1994 May;44(382):229–232. [PMC free article] [PubMed] [Google Scholar]
  6. Pringle M., Churchill R. Randomised controlled trials in general practice. BMJ. 1995 Nov 25;311(7017):1382–1383. doi: 10.1136/bmj.311.7017.1382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Pringle M., Laverty J. A counsellor in every practice? BMJ. 1993 Jan 2;306(6869):2–3. doi: 10.1136/bmj.306.6869.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Scott A. I., Freeman C. P. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ. 1992 Apr 4;304(6831):883–887. doi: 10.1136/bmj.304.6831.883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Sharpe M., Hawton K., Simkin S., Surawy C., Hackmann A., Klimes I., Peto T., Warrell D., Seagroatt V. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996 Jan 6;312(7022):22–26. doi: 10.1136/bmj.312.7022.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Sibbald B., Addington-Hall J., Brenneman D., Freeling P. Counsellors in English and Welsh general practices: their nature and distribution. BMJ. 1993 Jan 2;306(6869):29–33. doi: 10.1136/bmj.306.6869.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Sibbald B., Addington-Hall J., Brenneman D., Freeling P. Investigation of whether on-site general practice counsellors have an impact on psychotropic drug prescribing rates and costs. Br J Gen Pract. 1996 Feb;46(403):63–67. [PMC free article] [PubMed] [Google Scholar]
  12. Strathdee G., Williams P. A survey of psychiatrists in primary care: the silent growth of a new service. J R Coll Gen Pract. 1984 Nov;34(268):615–618. [PMC free article] [PubMed] [Google Scholar]
  13. Weisz J. R., Donenberg G. R., Han S. S., Weiss B. Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. J Consult Clin Psychol. 1995 Oct;63(5):688–701. doi: 10.1037//0022-006x.63.5.688. [DOI] [PubMed] [Google Scholar]
  14. Wessely S. C., Castle D., Douglas A. J., Taylor P. J. The criminal careers of incident cases of schizophrenia. Psychol Med. 1994 May;24(2):483–502. doi: 10.1017/s0033291700027458. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES