Letter from John Buchanan

Australasian Psychiatry • Vol 9, N

o 3• Septem

ber 2001

261

I encourage colleagues to join theauspsyc email list. You can subscribein one of two ways:

a) by sending a blank e-mail to

auspsyc-subscribe@yahoogroups.com

Note it is ‘auspsyc’, not ‘auspsych’.

b) by subscribing on the auspsycwebpage at

http://groups.yahoo.com/groups/auspsyc

Using either method, it would help if, at the same time, you send an email to the moderator at

jbuchanan@ozemail.com.au

to confirm that you are a psy-chiatrist, psychiatry registrar orpsychiatry medical officer, and bygiving your name and place of work(cryptic email addresses often do notindicate who the person is). Themoderator can then authorize yourmembership. Once you have joined,you can post messages to the list toauspsyc@yahoogroups.com A membercan simply unsubscribe by sending ablank email to:

auspsyc-unsubscribe@yahoogroups.com

Enjoy!

John BuchananMelbourne, VIC

A modest proposal in the fieldof practical ethics

DEAR SIR,

The decision of the RANZCP to levy a small sum of money with eachannual subscription in order to fundresearch into boundary violations is a welcome move. However, twentydollars seems a paltry amount whencompared to the feelings of betrayaland anger felt by many collegemembers when each of these casescomes to light. I propose that, inaddition to raising funds forresearch, the RANZCP institute adirect financial disincentive to deterimproper relationships. This couldtake the form of a one-off pay-ment at the time of completing theRANZCP exams of some thousandsof dollars and an additional annualpayment approximating the currentRANZCP subscription. This sumcould be refunded with someinterest to the psychiatrist, perhapsin the form of superannuation,

upon their death or retirementproviding that there have been noadverse findings with respect tosexual relationships or marriage to patients during their career.Female fellows could pay a reducedpremium. This measure woulddemonstrate that we are seriousabout the problem and it would be acontinuous reminder to potentialoffenders. I am advised that this sortof arrangement could be undertakenon the basis of a binding contract or preferably within a legislativeframework.

Matthew LargeSydney, NSW

Use of an ApprehendedViolence Order to avoidinvoluntary psychiatrichospitalisation

DEAR SIR,

Pakula and Brown’s case report, ‘Use of an Apprehended ViolenceOrder to avoid involuntary psy-chiatric hospitalisation’ in the March2001 issue1 highlights the troubledinterface between psychiatry and the law. After reading their report, I thought of an alternate strategywhich could have been used.

The patient’s fantastic, grandiose,and even bombastic accusationscould be reframed into anotherdiagnosis with a different treat-ment strategy. What are termed thepatient’s delusions also fit criteriafor pseudologia fantastica. They are plausible as they do not have the bizarre quality associated withpsychosis. They are generalisable in so far as anyone could be sovictimised, and they present theprotagonist as heroic and the centreof lofty attention.2

Since the diagnosis of pseudologiafantastica is more akin to a per-sonality disorder than to psychosis,there is no evidence to suggest thatenforced medical treatment isuseful. As the patient was so utterlyresistive to treatment at this stage,psychiatric staff may not have had arole to play at all until he was morereceptive.

Hence the community psychiatryteam could have honorably with-drawn from his care, leaving him to

Invitation to join ‘auspsyc’

DEAR SIR,

The ‘auspsyc’ email list was createdin 1997 by Angelo Ferraro, a psy-chiatry trainee, to provide anelectronic forum where psychiatristsand trainees in Australia and NewZealand can freely discuss issuesrelevant to the profession in theregion. Email is a very convenientand fast communication tool andthe list brings together cliniciansfrom many parts of Australasia.

The list is set up on a free email host. When a listmember posts to’auspsyc’, the message is automaticallysent to all members – 140 at present.Recent topics include the ethics ofpharmaceutical sponsorship, item 319restrictions, training experiences andissues, MOPS, inpatient psychiatricservices, WorkCover and TAC con-sults, prescribing of medications ‘offindication’, funding of psychiatricservices, processes in professionalorganizations, Clozapine side effects,and assorted clinical issues.

The ethos of the list is free and opendebate on professional issues; thelist is open only to psychiatrists,psychiatry registrars and psychiatrymedical officers. ‘Flaming’ i.e. per-sonally attacking colleagues, is notacceptable behaviour on email lists;it is better to stick to discussion ofthe professional issues; flaming canresult in the correspondent(s) beingremoved from the list by the mod-erator. This is usual ‘netiquette’procedure for email discussion lists.

Till now, the auspsyc has been on‘listbot’. By the time this letter ispublished, it will have beentransferred to ‘yahoo’ because listbothas been taken over by Microsoft,and is going commercial. In order tokeep it free, we need a host whichdoes not charge.

Email is a wonderful tool for speedycommunication and discussionbetween professional colleagues. Todo so, it must be ‘closed’ to thepublic, the press, and anyone who isnot a member of that professionalgroup.

CORRESPONDENCE

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cope with the demands of the legal system. As a person with apersonality disorder, he wouldpresumably be able to learn andbenefit from this experience.Indeed, he may have learned thewisdom of voluntary compliancewith treatment as a result ofinteraction with the legal system.

REFERENCES

1. Pakula I, Brown P. Use of an ApprehendedViolence Order to avoid involuntarypsychiatric hospitalisation. AustralasianPsychiatry 2001; 9: 62–65.

2. Felman M, Ford C. Patient or Pretender.Chicago: John Wiley & Sons, 1994.

Albert LorbatiQueanbeyan, NSW

The College and democraticprocess

DEAR SIR,

The status and power of the CollegeExecutive Committee (CEC) sub-ject to recent correspondence is a recurring theme which, to mypersonal knowledge, goes back to theearly sixties when I was a member ofCouncil. There were then, as now,serious allegations that it was a cabalwhich like another profession hadpower but not responsibility.

It was wisely (and perhaps cynically)observed by a senior Fellow at thetime that if EAC (the name of the CEC at that time) did not exist,it would have to be invented. Inessence an imperfect de jure organi-sation open to scrutiny, it was much

to be preferred to the inevitable de facto system that would inevitablyevolve.

REFERENCE

1. Buchanan J. The College and democraticprocess. Australasian Psychiatry 2001; 9: 68.

Russell PargiterHobart, Tasmania

Training and further education

DEAR SIR,

Reading the final report of theProject Team1 reminded me of theMay 1967 council meeting at whichDavid Madison, then censor inchief, presented his proposals for arevised examination. I, for one, wasgreatly impressed by its common-sense, utility and clinical orienta-tion. However, it was designed foranother era and, although it wasflexible enough to evolve, therearose a point when no furtherevolution was practicable.

On reading the report, I am surethat in general David Madisonwould have strongly approved for hewas a man of vision who couldmove with the times.

REFERENCE

1. RANZCP Project Team. Preparing psy-chiatrists for a changing world: review of Training, Examinations and ContinuingEducation (Final Report) AustralasianPsychiatry 2001; 9: 5–18.

Russell PargiterHobart, Tasmania

Flannel flowers and ‘bestpractice’ psychiatry

DEAR SIR,

Only rarely are the pages ofAustralasian Psychiatry so richlyilluminated by irony as glittering asthat which so appositely (although Ifear inadvertently) adorned page 69of the March 2001 issue.

So the Flannel Flower has beenchosen as a symbol of mental healthawareness. So it should. My Collinsdictionary defines flannel as ‘8) to talk evasively, to flatter in orderto mislead’. Flower is, of course,defined as, amongst other things,‘the choice or finest product’.

Thus the Flannel Flower, at its bestindeed around the time of NationalMental Health Week, means ‘thefinest example of evasive talk, which is designed to flatter in orderto mislead’.

I recently sent a patient to hospitalunder the Compulsory AdmissionProcedures in South Australia. Thatmade three such voluntary patientswho spent the entire night in thelocal public hospital CasualtyDepartment, there being no bedsavailable in South Australia in eitherthe public or private sectors.

Mental health awareness? Flannelindeed! There is always room for onemore 9am–5pm bureaucrat or forone more platitudinous politician.

Richard ThompkinsBedford Park, SA