The arts and humanities concerning psychiatric practice

The arts and humanities are what we usually think of when ‘culture’ is discussed. However, while a vibrant psychiatric literature on these topics continues, a historical perspective suggests that mutual engagement and understanding between these worlds has declined. The famous painting of Pinel unchaining the inmates of the Salpêtrière, painted in 1895, illustrates not a consequence of the French Revolution but the benefits of an empirical psychiatry based on observation that prioritises patient benefit without presuming prior theory.^{Reference Fee and Brown2,Reference Woods and Carlson3} This active, empirical approach still characterises psychiatry.^{Reference Green4} Nevertheless, psychiatrists are now represented as theorisers, more interested in investigation than benefiting our patients,^{Reference Byrne5} and sometimes entirely indifferent to them.

As the humanities’ awareness and understanding of psychiatrists has diminished, so has our involvement with them. The conjunction of psychiatric, surrealist and philosophical thought between the 1920s and 1960s contributed to the development of both postmodernist thinking and antipsychiatry.^{Reference Khalfa6} Yet, even the memory of those connections now seems lost to us, and we are invited to consider them as if they are alien to our tradition and we had never responded.^{Reference Bracken7,Reference Lewis8}

To encourage a rapprochement and interchange that takes into account the progress made since the middle of last century, we will seek to publish not only cultural thinking by psychiatrists but also work by practitioners of other methodologies. It is often forgotten that the visual arts, music, poetry and literature are also methods for exploring the world, especially our subjectivities. For psychiatry, the subjectivity of our patients is part of our core business, and we are no longer so restricted by the limits of paper and physical printing. We therefore do not necessarily require that a submission to the culture section is in the form of a conventional academic paper, provided that it addresses a cultural issue that has an impact on psychiatric practice and meets our quality standards.

Regulatory culture

The arts and humanities are often seen as a counterpoise to excessive regulation. However, there is also regulatory culture, which operates to deliver the intentions of a regulatory regime when circumstances are indeterminate and discretion is essential.^{Reference Meidinger9} It can be thought of as the set of explicit or implicit attitudes and intentions expressed through norms, routine policy and everyday practice. It has become an explicit part of financial regulation, and firms are reviewed to ensure that their management structures deliver it.^{Reference Burdon and Sorour10} Within the National Health Service (NHS), regulatory culture is much more variably instituted^{Reference Dixon-Woods, Baker, Charles, Dawson, Jerzembek and Martin11} and an audit model may not capture many of its necessary components.^{Reference Liberati, Tarrant, Willars, Draycott, Winter and Chew12} We therefore wish to publish articles relevant to improving the regulatory culture of psychiatric care, as the level of variation found suggests an ongoing and urgent need.

The cultured practitioner

The mission of BJPsych Bulletin focuses on topics that affect what we do in our daily practice. The norms and values that our culture instils do precisely this. For example, social constructs such as masculinity and societal power gradients predict the balance between a response style of decisiveness versus accommodation.^{Reference Johnson, Kulesa, Cho and Shavitt13} The concept of specifying moral principles in practical, situational terms is well-established in biomedical ethics.^{Reference Beauchamp and Childress14} The same is needed for cultural influences, as professional practice cannot be detached from its cultural environment.^{Reference Cocks15} Patient (service user) groups have begun developing this from an antipsychiatry perspective.^{Reference Beresford16} We believe that practitioners need explicit accounts of how psychiatrists should express our discipline's best culture in daily practice. We will seek articles that relate the practice of psychiatrists to aspects of culture, applied to the benefit of their patients.

Culture and society

Psychiatrists are taught their discipline as applied science. However, it is also one of society's institutions, tasked with performing an essential role. The Parthenon can be described entirely in engineering and aesthetic terms, but those perspectives do not explain how the Parthenon functioned. We also need to know that it was a Greek temple to Athena, the tutelary goddess of ancient Athens. To properly understand what our discipline delivers, and why, we need to be aware of how it is situated in our culture, how it maintains itself and the drivers that shape the services it delivers. Science is but one of these, and funding not only limits policy but also follows it. We are therefore interested in publishing articles that will let us map psychiatry's ‘cultural geography’, for example patterns of influence with other institutions, such as the law and politics, cultural drivers of research or service prioritisation, or the role of the relationship between psychiatrists and patients in shaping our clinical culture. We believe that having a clearer account of these will enable our profession to develop and deliver more effective services.