2 results
Treating Through “The Sopranos”: A Biopsychosocial Approach
- Omer Hamour, Akeem Sule
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S24
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Television is a medium through which an audience can gain insight into the nuances of psychiatric practice. Nonetheless, the psychoeducational benefits are dependent on accurate portrayals. “The Sopranos” has received critical acclaim from various professional psychiatric bodies for its artistic depiction of psychoanalysis and the psychotherapeutic relationship. The series follows Tony Soprano, a middle-aged Italian-American male engaged in organized crime. He is referred to his psychiatrist, Dr Melfi, by his family physician after suffering debilitating panic attacks. Melfi accepts the referral despite Tony's chequered past, employing a holistic approach to his care. We aimed to analyse the psychotherapeutic relationship between Tony Soprano and his psychiatrist, using a biopsychosocial approach.
MethodsSeason 1 of “The Sopranos” was identified by a facilitator and utilized for discussion. The season was viewed individually and virtual case-based dialogues took place between the author and facilitator examining the psychotherapeutic relationship using the biopsychosocial model.
ResultsThe Sopranos coincided with the popularity of the serotonin theory of depression in the US, promoted by the pharmaceutical industry. Tony Soprano is pharmacologically treated for panic attacks, anxiety and depression. This sparked thematic discussion around symptom control, medication efficacy and adverse effects. Melfi balances the application of medication alongside understanding the psychological roots of symptoms, deprescribing when necessary.
Themes pertaining to conflict between Freud's id, ego and superego persisted, manifesting cognitive dissonance most prominently in relation to Tony's line of work. Symbolism of ducks guided understanding of Tony's biggest fear – losing his family. Projective testing was explored, alluding to the Rorschach test. Scenes depicting transference and countertransference were present, the former representing Tony's unmet needs from female figures in his life. Eventually, Tony's distress induces internally generated pseudohallucinations.
Tony's tender treatment of his children offsets his volatile relationship with his parents, particularly his mother who habitually antagonizes her son. His personal and professional life are intertwined, with mental health stigma evident in both realms as Tony seeks help surreptitiously to maintain his credibility.
Conclusion“The Sopranos” depicts the psychotherapeutic relationship between a man suffering from mental illness and his therapist. This layered and accurate portrayal can provide a case-based reference for psychoeducational discussion, and give rise to further discussions of psychiatric themes within film and television.
A Quality Improvement Project to Improve Audio Quality for Remote Attendees of a Ward Round at a London Older Adult Psychiatric Ward
- Omer Hamour, Hamilton Morrin
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S94
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Our aim was to investigate the extent and impact of poor audio quality during remote ward rounds using Microsoft Teams. We intended to compare attendees' audio quality experience with our expectation that a cardioid polar microphone would make it difficult for attendees to hear all members of the multidisciplinary team. We also hypothesized that switching to an omnidirectional recording system would improve perceived audio quality, communication, and patient care.
MethodsThis study is a continuation of a previous quality improvement project carried out on a general adult ward within the same Trust. This iteration involved individuals who participated remotely in ward rounds at a dementia specialist ward over a four-month period in 2022/2023. Participants of the study included staff from the ward team, community care coordinators and patient family members, who completed a digital feedback questionnaire about the audio quality. Due to the nature of their illness, no patients completed the questionnaire.
There were no exclusion criteria. Data from Likert scale questions were analysed. Little demographic data were collected, and qualitative data were analysed by identifying themes and grouping responses based on thematic frequency.
ResultsIn the pre-implementation survey, 12 responses were received from patient family members, 9 ward team members and 2 community mental health workers. Before the intervention, 3/12 participants rated the sound quality as "bad" and the same number were "dissatisfied" with the sound quality during ward rounds (modal response "neutral" for both, 6/10). Only 3/12 attendees reported being able to hear and understand everyone present in the ward round all the time, and one person reported only rarely hearing and understanding a single person in the room when they spoke.
All respondents agreed that the sound quality impacted their experience of the ward round. The three most common issues reported were people speaking too far from the microphone, voices sounding muffled, and poor internet connection causing gaps in speech.
Common themes identified in the qualitative data included: frustration, disengagement, and damage to patient care.
ConclusionIn summary, our findings indicate that when using a built-in laptop microphone with unidirectional pick-up, remote ward round attendees were not satisfied with the audio quality. However, this may be improved through the use of an omnidirectional system. Potential benefits from this technology may be optimised through the use of automatic transcription for individuals who may be hearing impaired, and ensuring optimal positioning for adequate sound detection.