Reporting Scotland’s at best outdated ‘expert opinion’ on NHS Tayside’s Mental Health Unit

carseviewnewheader

When I read the BBC Scotland online version of their coverage of the leaked internal report on the Carseview Unit which they have clearly passed around any academics willing to quickly tell them it is ‘shocking’ or ‘damning’, they found one. As is often the case, it’s one of those older ‘emeritus profs’ with time on their hand and perhaps missing the limelight. They got this one for the headline they wanted:

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I checked him out. I’m clearly not competent to judge his expertise myself but I know from personal experience that academics are not best placed to judge professional practice by themselves. BBC Scotland should have gathered opinion from people who have managed and worked at a senior level in centres comparable to Carseview to get a meaningful and useful assessment. An academic will know in theory what could be done and will have the highest expectations, but these may be unreasonable in the world of actual practice for staff working on a daily basis with extremely difficult patients, physically at risk themselves and limited by their humanity.

‘IF YOU CARE ABOUT YOUR (or someone you love) MENTAL HEALTH – DO NOT READ THIS BOOK’

On the academic side, I did find 26 mostly quite disturbing reader reviews of Tyrer’s 2018 Taming the Beast Within: Shredding the Stereotypes of Personality Disorder. That’s a lot of reviews and they’re not supportive until the last two or three which are a clear response by his supporters to hearing about the reviews. They’re pretty damning of a writer they nearly all see as outdated in his thinking and anecdotal in his use of evidence. As for the application of his ideas in therapy, many think them dangerous. There are, of course supportive reviews by other academics in academic journals, but I know from personal experience how cosy, back-scratching and uncritical these can be.

It’s a lot to read, but fascinating. Here’s the full set:

 

1.0 out of 5 starsIf you want to understand/develop empathy for personality disorder, buy a Masterson book instead.

9 June 2018

A ridiculous title, a ridiculous cover. If you’ve read any of the author’s articles you’ll learn nothing new. I think the Tyrer is touching on something by trying to move away from different PDs being separate, distinct entities but perhaps it should be left to an author who doesn’t make everything about themselves.

 

1.0 out of 5 starsThis is a profoundly damaging book

10 June 2018

This book serves to promote and increase the stigma experienced by those with a personality disorder diagnosis that it professes to reduce. It is a rambling self serving collection of biased ancidotal diatribes dressed up as science. It does nothing to increase the understanding of those who have little knowledge in this area and is profoundly damaging to those with a personality disorder diagnosis.

 

1.0 out of 5 starsDon’t bother !

8 June 2018

This book did nothing but anger me. It does nothing to destigmatise the diagnosis in fact it perpetuates it. I really wish i had not bothered to read this, a waste of time and energy.

 

1.0 out of 5 starsStigmatising

9 June 2018

This is a deeply stigmatising book, with extremely outdated views on ‘personality disorders’. The author does nothing to destigmstise ‘PDs’ but in fact adds to the negative connotations surrounding ‘PDs’. This is not a stand-alone view on the book when seeing other reviews. I just hope that people who read this do not believe the disaterous beliefs this author has regarding ‘PDs’.

 

1.0 out of 5 starsWill be interesting reading in the year 2150 of psychiatric abuse

10 June 2018

Historians and psych students can learn about the abuses of the system and professional attitudes of today, in 2018, by reading this book. When psychiatry finally wakes up that over-diagnosis will mean everyone will have a PD (yes, even them) it won’t hold for much longer.They have realised the Victorian notion of ‘wandering womb’ is nonsense but what will those of the future have to say of 2018?
Will they have finally realised re-traumatising the abused is not the answer? Will they have learned to listen? Peter Tyrer has now achieved leaving a legacy of being no actual help to anyone and monsterous.

 

1.0 out of 5 starsThe ostensible doctor-patient vignettes make for particularly painful reading. They are reminiscent of something that might …

9 June 2018

This is an extremely troubling book. The ostensible doctor-patient vignettes make for particularly painful reading. They are reminiscent of something that might have been written in the 1950s, with a ‘clever’ (male) psychiatrist talking down to a stupid, air-headed (female) patient. It’s shocking that this treatment of people suffering with genuine mental health difficulties is actually being advocated. Please do not read this book if you currently have any difficulties of this kind. It could be harmful.

 

1.0 out of 5 starsNOT VALID EMPATHETIC OR FACTUAL.

9 June 2018

I’m a qualified Clinical Psychologist. The content of this book is truly shocking, nothing but an outdated power trip. It implies people (especially women) with this (highly contested and scientifically invalid) label are manipulative, more “able” than they appear and “choosing” their “behaviour” deliberately. His wacky ideas are even to the extent of suggesting routine ‘personality testing’ for people with GPs?! His therapy transcripts match everything I have been told *not* to do including judgement, game playing, ignoring emerging evidence, perpetuating iatrogenic trauma, not workong collaboratively around diagnosis, assuming rightness against some kond of clever adversary, and believing his view to be the one right view. The fact that it is promoted by Stephen Fry who endorses the medical “brain chemical” model of distress – and crucially *does not have this diagnosis* (so why is he commenting on it?!) makes thos even worse. From a Psychologist to the reader. It is not you. It is not your personality. You’re not a beast. It’s about what’s happened to you, not what’s “wrong with you”. Ignore this book.

 

1.0 out of 5 starsSteer clear of this one.

10 June 2018

Gosh what a worrying book. I’d advise anyone who has been given a diagnosis of ‘personality disorders’ to steer clear of this one. It won’t help. It’ll probably make you feel worse. It will blame you and it won’t take account of your history or your strengths.
The author does not acknowledge or make use of the overwhelming evidence available about the impact of early trauma and adverse life events (and social conditions) on the development of a person’s ‘personality’. The author seems to have a bias in their thinking and excludes so much relevant research and ideas. This is victim-blaming literature and has a poor evidence base.

 

1.0 out of 5 starsNot a good insight into anything, let alone trauma disorders.

9 June 2018

Terrible book. Prejudiced and condescending.

 

1.0 out of 5 starsPerhaps the most stigmatising ‘destigmatising’ book that’s ever been. Awful.

9 June 2018

Perhaps the most stigmatising ‘destigmatising’ book that’s ever been. The author comes across as prejudiced and patronising and his perspective on ‘personality disorders’ is outdated and deeply troubling. Awful, all in all. Avoid.

 

1.0 out of 5 starsFit for the shredder

11 June 2018

This book makes no attempts to shred stereotypes. It gives some good examples of how not to talk to people and unscientific practice. Perhaps the title is fitting as it is in great need of shredding.

 

1.0 out of 5 starsShocking, horrifying, prejudice, sexist.

25 June 2018

I’m not sure what is more concerning.. the fact that the author believes these words that he writes, the fact that he sees no harm with these words that he writes, the fact that other people will read and believe the author’s words and opinions, or the fact that many people hold the same views and prejudice opinions. All of the above.
Not to mention the sexism. And overall feel of oppressiveness throughout.
Out-dated views. Some parts of this book are shocking and quite frankly, horrifying.

 

1.0 out of 5 starsIF YOU CARE ABOUT YOUR (or someone you love) MENTAL HEALTH – DO NOT READ THIS BOOK.

7 June 2018

IF YOU CARE ABOUT YOUR MENTAL HEALTH – DO NOT READ THIS BOOK.
“When it suits you…you can be as well as the rest of us” – this book claims to ‘shred stereotypes’ but is a driving force in stigmatising personality disorders, something myself & many other advocates for mental health are striving to eradicate. Not just for the sake of educating others, but for the sake of saving our lives. Societal stigma is a huge contributing factor to those who are fighting a mental illness. Peter may see himself as qualified to call these decisions, but to me that simply demonstrates the severely damaging picture of our mental health system – where those in professional power seem to, not only get away with, but be valued for their patronising, demonising & demoralising patients with their language, behaviour & manner. Imagine, a qualified surgeon informing a cancer patient with a tumour that “when it suits you… you can be as well as the rest of us”. It is unthinkable. So much so, you would hope the patient would speak out, be heard & that it would be unambiguous that the error lay with surgeon, & the patient would find a suitable replacement without internalising the ridiculous comment. The surgeon in question would likely lose his job, for his carless attitude & lack of knowledge. With mental health, it seems some professionals fail to adhere to their role of treating, instead causing more damage, often with no consequence. Because of the frequency of this occurrence, patients who are relying on professionals for support often can internalise this mis-treatment, their illness can be used against them as a means to neglect their voice being heard, & their health can deteriorate rather than improve. The need for change is mandatory, it is attitudes like Tyrer’s that are costing lives. Peter you are an individual with a voice & I urge you to be accountable for the stigma you’re compounding by using it. Most people suffering are desperate for help; they’re on waiting lists, they’re dismissed, they’re unheard. Let’s focus on compassion, on therapeutic environments & on treating, rather than preying on individuals who deserve support but are spoken to or about like an inconvenient, number.

 

1.0 out of 5 starsAn insulting ABOMINABLE book – please think twice before buying it.

11 June 2018

To discover this book was like a nightmare coming true. How dare the author honestly believe it’s OK to carry on categorising and labelling people, concluding for himself that there is something actually “wrong” with someone’s personality rather than that they are in fact reacting to past and/or present adversities?? People reacting in reasonable and resourceful ways to unreasonable situations in life – why does he think it’s anything different from that? (Oh yes I forgot – it’s because he wanted to bring out a book that would catch the attention of Stephen Fry, another medical-model disciple, amongst others who don’t seem to want to accept that there’s nothing going wrong in the brain, not some sort of a disease – and totally NOT a “beast”!)

At best this book title is a ridiculous analogy, void of evidence, common sense and anything ressembling empathy or respect…but at worst (and I feel this is the case unfortunately) it is insulting, deeply offensive, demeaning, patronzing, oppressive, dehumanizing and feels like such a typical capitalist collusion with the psychiatry model that so often ends up being about, basically, mass social control…

How would this author feel if he was lumped with a label and told he was broken, hopeless, obsolete, helpless, oppressed ?? – this is how SO many people feel who get tattooed with the label of “personality disorder”… nothing about the label or concept is respectful, kind, empowering, truthful, accurate or helpful. In any case, how does one differentiate between an apparently “normal” personality and an apparently “abnormal” one – who gets to ‘decide’ that exactly?! I guess the author plants himself on the “normal” side then – for him and his pathologising peers it seems like a very evident “them and us” narrative underpins the messages in his writing..

This book = An utter dystopian nightmare.

 

1.0 out of 5 starsThe idea that women who speak out or act in a manner that the psychiatric system doesn’t like is truly repulsive and perpetuates all that is wrong …

7 June 2018

Irresponsible and deeply stigmatising book about a diagnosis given to women by a patriarchal misogynist mental health system. The idea that women who speak out or act in a manner that the psychiatric system doesn’t like is truly repulsive and perpetuates all that is wrong with the MH system. It is noted that the author chairs the ICD 11 – the system that is currently recatogorising persomality disorders so as to include any and all women who reprt trauma histories or may be a tad too angry for the authors; liking. The title in itself is as denigrating as it gets. The construct of personality disorder versus complex ptsd is a cash cow for mental health professionals like the author as it attracts hefty NHS funding whereby ptsd doesn’t. Self interest then to promote the idea that women must be disordered if they object to some of societys’ injustices. The author needs to take a good hard long look in the mirror and ask himself who he thinks he is qualified to judge other human beings in this manner. DONT buy this. It is highly offensive to all women who have experienced trauma

 

3.0 out of 5 starsHmmmm.

11 June 2018

Hmm, I haven’t read it yet but I probably will. I was diagnosed with BPD in 2013-2014. No longer meet criteria because I received MBT. However, I can see why some people are not happy. The use of the word beast and the image does nothing to de-stigmatise personality disorders -particularly BPD which I can speak on. Many a time, people who live with BPD are spoken of in negative terms e.g. ‘attention-seeking, manipulative etc.’ Mental health professionals speak in this way too. I was looking at my diagnosis letter recently and noticed that the psychiatrist used the word ‘manipulate.’ If you do a quick google search, you will find many men saying not to under any circumstances get involved with a woman who has been diagnosed with BPD as she will basically ruin your life. Frankly, we don’t need a so-called professor adding to all of this. It’s a shame. He could have done better.

 

1.0 out of 5 starsStigmatising

7 June 2018

This book is full outdated and stigmatising view points. “You can be as well as the rest of us when you want to be”. I was labelled with personality disorder in 2016 and since then all areas of the NHS have seen me as a monster and this book reinforces this. Because of the personality disorder label I’ve been denied access to healthcare and called names a liar and a cutter by doctors. I was told never to go to A&E and advised that the next time i went to A&E I would be sent home and the police called. The label personality disorder was going to be dropped until Dr Tyrer decided it was a “valid” concept but instead now more people are going to be excluded from healthcare services and this includes physical healthcare

 

2.0 out of 5 starsHmmm.

9 June 2018

I found this a difficult and problematic read. For a book intended to be destigmatising about the diagnosis of personality disorder, that title really isn’t helpful. To put it mildly.

There is a message here I can appreciate – that of not casually using diagnostic labels to attack or smear or even amateur diagnose others. I think the importance of how traumatic events impact people is also highlighted.

Where I run into some real issues is in the belief that 65% of us have some sort of ‘personality difficulty’ or ‘personality disorder’ versus 35% of us who do not. In that scenario, what is ‘normal’? Can this even be a diagnosis of any scientific reliability and validity? Tyrer seems aware of the paradox to this but pushes on ahead. It’s a little disturbing to think that almost everyone who goes to mental health services could be diagnosed with a personality difficulty or disorder using his diagnostic criteria. Especially given his acknowledgement that the only treatment he’s sure works reasonably well is time and changed circumstances.

Some of the transcripts of conversations with patients I also found a little disturbing. One in particular made me very cross where a lady is presented as lying about her mental health symptoms even as Tyrer acknowledges that professionals will class her as delusional when telling the objectively verifiable truth.

If you’re looking for a book which will explain how the ICD diagnosis of personality disorder will work in the near future, then this perhaps will give some of the foundations for that. Whether it will be of any practical value to anyone with such a diagnosis, I know I personally found it a struggle to read.

 

5.0 out of 5 starsA happy consequence of his work is a far reaching destigmatisation …

6 July 2018

Those familiar with the science and politics of the classification of psychiatric disorder will understand how monumental an achievement has been Professor Tyrer’s magnum opus,the simultaneous publication of the issue of his research and theorising in its section of which he was the Chairon Personality Disorder in the WHO’s ICD11,and in his new explanatory book.The walls of precedent and usage have finally been breached letting in reason and lucidity to a jealously guarded scattershop realm of inconsistent thought.In a pellucid prose that befits an editor of the British Journal of Psychiatry under whose tenure the journal rose to pre-eminence,Tyrer explains the findings of a professional lifetime of research from which his theorising derives including startling findings that challenge everyday notions of normality.A happy consequence of his work is a far reaching destigmatisation of former diagnostic types which have so cruelly closed the portals to treatment to those who are now shown to be treatable.
How ironic that a group of reviewers have collectively acted in a manner unprecedented in this reviewer’s experience to hurl abuse at the author to a degree little short of character assassination and in a crude way to stymie the sales of the book.The Group at the outset risked disqualification in tackling a book written for the intelligent and inquiring reader but the nature of there accusations are such that it appears doubtful that a majority has read the book at all,as one reviewer had the candour to admit.But given that the accusations are not merely untrue but represent the converse of the truth leading to the conclusion that even if read the book was not understood.The Group has not grasped that scientific theories of cause are ethically neutral but has shown the self-blinding character of ideology elevating beliefs about cause to the level of a creed releasing an intellectual destructiveness that justifies Tyrer’s selection of a title that might otherwise have appeared too strident.Tyrer’s proposition that by courage,honesty and,perhaps,some sense of humour a person,any of us,can convert the “Beast Within” into a pussy-cat seemed to enrage the Group particularly,but what else is being described than the conversion of the paranoid to the depressive position and a confirmation of the classical analytic notion that we can be the authors of our own unhappiness.Tyrer hasn’t dismissed the Group’s theorising but has merely pressed on it a seemly sense of proportion.
Ultimately,to best appreciate Tyrer’s book the reader should understand it as a resplendent valediction he now being nearer to 80 than 70 and in the twilight of his career.It is widely known that he has devoted his best professional energies to the care of those regarded by professionals and other as lost causes for whom the most beneficent option has been an invocation to their patron saint,Jude.Tyrer has shown that those previously diagnosed with alleged personality disorder can be trated with DBT,CBT,the newer nidotherapy as well as classical therapies.He has shown that few of our personalities can evade a degree of embarrassment under types of duress and has also demonstrated remarkable virtuosities in those severely afflicted.His work has produced growing respect and treatment possibilities in those truly afflicted with personality disorder.In his book he has broken the embargo on self-disclosure by psychiatrists in illustrative autobiographical sketches professional strictures demanding neutrality,anonymity and even the sometime functioning as part-object.This self-revelation can be regarded as a parting gift to patient in gratitude for the support they themselves give,the respect that is not always fully merited and the opportunity to partake of the joy in a patient’s recovery.Professor Tyrer’s is some legacy and his work will be judged by the respective fates of the relevant sections of ICD11 and DSM5.
Last a declaration of interest.Tyrer and this reviewer played together on our medical school’s football team,Tyrer on the left wing.We both went into Psychiatry but our paths diverged when I moved to North America to pursue psychoanalytical study.The paths re-converged over shared interests in nidotherapy.

 

1.0 out of 5 starsThe most stigmatising preposterous book that should never have been published.

7 June 2018

It is 2018 and I was shocked, appalled and disgusted that such a book has been written and published. I sincerely hope the author’s power in the upcoming icd11 is overruled with his ridiculous beliefs about the

 

1.0 out of 5 starspainful and offensive

27 June 2018

Just horrendous.. a book lacking compassion and with a huge power difference in professional/’patient’. Tyrer is of a generation that needs to grow out frankly, the arguments are outdated, painful and offensive.

 

1.0 out of 5 starsTerrible, awful and nasty book

9 June 2018

This is an awful, awful book written by someone who is clearly unfit to be in medicine.

Nasty beyond belief

 

1.0 out of 5 starsTrigger Warning – there are themes in this book which may distress some people in my opinion.

9 June 2018

Patronising and very depressing.

 

5.0 out of 5 starsCompassionate, Knowledgeable and Humourous

7 June 2018

This is a very kind book written with great empathy and humour. Professor Peter Tyrer’s knowledge and understanding of personality disorder stems from years of working with patients in addition to a hugely respected research career.

I would advise anyone to read this book. It breaks down stigma and shows a great understanding of the pain and turmoil people with a diagnosis of personality disorder can go through. There is a specific chapter on borderline personality disorder which really nails the condition and the pain it causes sufferers (best I have read on the subject with Tyrer describing the symptoms as ‘devastatingly awful’ for people with the condition).

The book ends with hope with a chapter on nidotherapy, a relatively new treatment that helps you make changes to your environment so it better suits you (so you are no longer feel a square peg in a round hole!)

The book is very engagingly written, laugh-out-loud funny, and brimming with understanding and kindness. You really get the impression that Professor Tyrer cares about you feeling better and flourishing in your life. A must for patients, families, friends and medical professionals.

 

5.0 out of 5 starsA clear, human and helpful guide to the mysteries of Personality Disorders

4 July 2018

As someone working in mental health (non-psychiatrist) with occasional interactions with people described as having Personality Disorder, I found this a very compassionate account of these human difficulties. The author explores some of the associated medical jargon and then explains it in clear language, using very accessible examples to illustrate the different types of personality difficulties. Personality itself is a notoriously slippery concept and I found that the explanation / definition given in Chapter 1 was very helpful.
In contrast to some of the negative reviews that have been posted which seem to accuse the author of ignoring the effects of childhood neglect and abuse, this is clearly stated as significant contributory factor in Chapter 5, alongside other environmental factors, genetics and innate differences. Again, Chapter 6 provides an invaluable explanation of the intended new classification system. The explanation of the continuum of personality from normal personality at one end to severe personality disorder at the other is very helpful in demystifying and destigmatising the disorder. It challenges the reader to question their own personality and notions of normality. However, it doesn’t shy away from the problems experienced in day-to-day life of people at the more extreme end of the continuum.
Although it is unusual to read autobiographical material in learned books about mental health conditions, I found Professor Tyrer’s analysis of his own personality, as well as the other vignettes, both humanising and explanatory.
I think this is an important book which will be very helpful to mental health professionals, people struggling with personailty difficulties and the general reader.

5.0 out of 5 starsNaff cover,great book.

14 June 2018

Very interesting,little book about personality disorders. Covers a lot and packs in alot of information. The discussion on diagnosis and possible therapies was really clear. It could be read by anyone and they would find something of value. Surprised by the number of negative reviews from people who did not purchase the book. I even thought the preface from Stephen Fry was very good and out of the hundreds of books on mental health I have read,this is one of the best for clarity and jargon free information.

 

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One thought on “Reporting Scotland’s at best outdated ‘expert opinion’ on NHS Tayside’s Mental Health Unit

  1. johnrobertson834 April 19, 2019 / 9:48 am

    The acting medical director for NHS Tayside, Professor Peter Stonebridge said the reports findings were being acted on and added that there would be an “unrelenting focus” on improving mental health services.

    However he added: “We report our rates of violence and restraint to the Scottish Patient Safety Programme for Mental Health and it is clear that our median rates of violence and restraint do not make us an outlier with other mental health services in Scotland.”

    Like

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