Coming to terms with existential despair is a tough task. I find it quite worrying that many of my domestic appliances, even some of the ones made in China, are going to outlive me.
Some while back I caught the beady eye of my old Toshiba television. The little red standby light, the same one that had ruined the climate, seemed to be indicating: I’ll be here after you’ve gone. I took it to the Sense shop for recycling and I happen to know it went to a good home. They wouldn’t sell me any Sense though.
Similarly the Ivy all around my house waits patiently to make its big push. It can wait a hundred years or a million. In the meantime, Ivy has one great weakness, which is failing to armour plate its giant arterial stems. Possibly an even greater weakness has been its failure to develop a political wing. No-one is out campaigning to save the Ivy. Unlike its colleagues, Holly and Mistletoe, Ivy has refused to cash in on the Christmas market. I’ve a feeling it will never sell out.
For as long as I can remember, people have told me that the Psychiatric profession is about to go out of business. Psychiatry is a creation of the 20th Century and has probably been dying since the closure of the large asylums. Many reasons are put forward for this. On the one hand it is expected that Neuroscience will eventually explain what goes wrong with the brain when mental illness happens, so that problems like bipolar disorder and schizophrenia – the meat and drink of general psychiatry – will properly belong to the neurologist, along with dementia. The rest of it can be left to social workers and psychologists, if their time machine ever gets back from the seventies.
Another factor has been the massive reduction in the psychiatrist’s favourite habitat, hospital inpatient units (I nearly said hedgerows). And a third influence has been the rise of general practice based mental health care. So on the one hand more and more people are being diagnosed with mental health problems, yet on the other hand, very few of those people will ever see a psychiatrist.
I’ve tended to believe that these prophecies of doom have been overly pessimistic. After all the same has been said about the Liberal Democrat party, which is now part of the government. And similar predictions were made about some of the High Street chains, like WH Smith, which still seems to be doing very nicely, having occupied all the stations and airports.
So maybe I have become a little over-complacent. Woolworths’s demise should perhaps have sent us a wake-up call. And now the Royal Mail sell off is sending a message that nothing is sacred. And what about the public library? Are you a bit uneasy about the coffee machines and internet terminals, and the reduced number of books? When all books are e-books (next year?), why will we need a physical library building?
Uncannily, just after I wrote that sentence, we’re in Stephen King territory here, Look North just reported that 33 libraries are going to close in the county of Lincolnshire. I’m worrying that everything I write might come true. No-one likes I told you so.
Then there was MFI. Everyone joked that their sale had been going on since 1976. Until suddenly, like Marvin Gaye, it wasn’t going on any more.
Psychiatry is perhaps no more precarious than other venerable institutions. Recruitment has been very poor for many years – we have gone from being the Cinderella profession to the Ugly Sisters (no sexist remark is intended here). We are not yet in post-apocalyptic mode, like Mr Spock, or Dr Who, whose planets were destroyed, but it may be time to start wearing big leather maxi coats and stashing shotguns.
On so many occasions I’ve thought; this place is going out of business soon. This has occurred to me in pubs, restaurants, churches, shops of various kinds, launderettes, art galleries, zoos, theatres, even cinemas. In fact, especially cinemas. People said cinemas would close when TV became affordable. Many of them did, but more recently multiplex cinemas have opened in many new locations. They seem to operate with only one member of staff, the guy with night vision goggles who stops people filming the films and guards access to the Pullman seats.
So perhaps mental health will go the same way, returning in a new form, with VIP seating. In fact, premium products have done well in retail. Even Lidl have brought out a luxury range. Premium car brands like Audi and BMW seem to be gaining market share. Royal Mail will still be called Royal, which sounds better than Royal Yodel or Royal DHL.
What would a premium quality mental health service be like? Despite protestations by NHS Trusts and Private Hospitals that they offer such a thing, mental health services are often blue stripe basic. This is perhaps because the impact of mental health problems is often to reduce patients’ earning potential. In other words, most of our patients are skint. But if we can’t do premium, we can do Primark.
Along these lines, proper psychiatrists know that older mental health medications, which are incredibly inexpensive, are probably better in many ways than the expensive new ones. This is not something that GPs have discovered yet.
I have seen so many Psychiatric units close down. Including some that I saw open, with great fanfare and optimism. I remember one that even had its own carpet designer. Some fine new ones have opened recently, although nothing to compare with Victorian asylums, which had ballrooms, cricket pitches and farms.
Predicting their longevity is like a long range weather forecast. The main climatic system is social attitude. It feels like we are just starting a closing down sale. But I’m not certain yet that Everything Must Go. The outlook is probably somewhere between Royal Mail and FM radio. It’s still going but don’t bet your (Primark) shirt on it. Psychiatry is a bit like Toshiba, but it’s not all Tosh.
Everything Must Go was a Steely Dan album. Did they do another one? Like psychiatric medication, their earlier stuff was better.