Hector Warnes’ comment on Leonardo Tondo’s interview of Michael Shepherd (1923-1995) in
Michael Shepherd has set himself apart from psychoanalysis, from American praxis of psychiatry at least in the decade of the 1980s and from Kraepelin’s divorce of social issues in the psychiatric population. His one-sidedness has gone so far as to place the general practitioner as the doctor responsible for the care of the emotionally disturbed patient. More than 50% of patients consulting general practitioners were for non-organic or functional disorders. But like most of us, he had another side which we hardly knew. He wrote not only on Social causes of Mental Disorders but on psychohistory, mythology, neuropsychopharmacology and psychopathology, in particular Jaspers.
His interest was fueled with the full support of Aubrey Lewis at the Maudsley Institute of Psychiatry. Professor Shepherd wrote 30 books and 200 articles. One I read with delight was “Clinical Psychopharmacology” published in 1968 in collaboration with M. Lader and R. Rodnight (Shepherd, Lader and Rodnight 1968). His humanistic bent led him to study Jean Starobinski, a prolific writer including on the topic of the history of Melancholia and Body-consciousness.
I shall cite on his approach from the individual patient seen in outpatient or psychiatric hospitals as compared with the one found at the community at large:
“…how many patients and illnesses you find in the whole population… affective illnesses is the largest group of disorders in the general population… the concept of depression is quite scattered, appearing as it does in the categories of psychosis, neurosis, personality disorders, alcoholism…” Two populations were studied one “is subject to a lot of stress and the other is not, one is urban and the other is rural… a comparison of the prevalence rates of affective disorders in these different settings can be carried out in order to outline the environment component.”
I would go further and compared the patients who are cared for (or in psychiatric treatment) versus the patients who are not cared for; the comparison between the patients with low income (or poverty stricken) and the patients with middle or high income, the immigrant population versus the non-immigrant population (as is happening in Europe) and the ethnic and cultural factors of families and the way they manage the ill member.
There are also differences regarding criteria for normality and abnormality (pathogenic and pathoplastic factors). Some types of behaviour are better handled in some cultures than others. Nevertheless, a psychosis is a psychosis in every country although its causes may be interpreted from different perspectives.
February 22, 2018