Earlier this year the Royal College of Psychiatrists published Mindreadings: Literature and Psychiatry. Several of the book's chapters began life as articles in Advances, having in common ‘their reliance on language in all its communicative aspects, in particular in the form of literary texts, as sources and tools for furthering our understanding of our patients and their conditions’ (Oyebode, 2009: p. viii). I am grateful to the book's editor Femi Oyebode for allowing us to use his neologism for a new type of article in Advances.
‘Mindreadings’ will be short pieces on works of literature, art, perhaps music or cinema, exploring themes of relevance to contemporary psychiatry. The content and meaning of the work will be considered along with its background – who its creator was, what was going on in their personal life at the time and the sociopolitical context. Details of the structure appear in our Instructions for authors on the Advances website, and suggestions for topics would be welcome. The aim of this series will be the same as that of the book – to further our understanding of our patients and their conditions.
In the first of the Mindreadings series (pp. 459–461), Beveridge explores Kafka's Metamorphosis. He reflects on the theme of alienation, seeing the experiences of the protagonist as parallel to those of people who have severe mental illnesses. In 1817, the poet Samuel Taylor Coleridge coined the term ‘willing suspension of disbelief’, a formula which has found application in medical education, where it has been likened to the process of engagement (Herrington 2003). Indeed, once the absurd central premise of a man awakening having metamorphosed into a giant cockroach has been accepted by the psychiatrist reading the story, what follows is only too recognisable. The story might even be thought of as a ‘case study’ illustrating the articles by Adshead (pp. 470–478) and my Editor's Pick, Reiss & Kirtchuk (pp. 462–469). Adshead highlights how severe mental illness fundamentally alters personal identity. Stigma equates with ‘spoiled identity’. The impact is systemic. Anxiety commonly affects the patient, their family and the treatment team, and the perspectives of all involved need to be understood. Society's values influence and direct practice too; as Adshead remarks, in the current zeitgeist of risk avoidance, people with psychiatric disorders are again seen primarily as a source of unpredictable threat. These themes strongly resonate with Metamorphosis.
Interpersonal dynamics and multidisciplinary teamwork
Reiss & Kirtchuk (pp. 462–469) give an accessible and practical framework for considering how, as clinicians, we experience our patients emotionally and ourselves in relation to them. And correspondingly how our patients experience us and themselves in the therapeutic relationship. The differing responses are discussed in the team setting and used to aid formulation and plan treatment. It would be a fascinating exercise to draw on their approach to consider the multiple perspectives in Metamorphosis: ‘Like every other skill, our moral imagination, that is, our empathy, needs to be exercised and tested and literature provides a safe way of doing this’ (Oyebode 2009: p. viii).