The Current Role of Empathy in Psychiatric Education

ABSTRACT WE5-4

MICHEL BOTBOL
University of Western Brittany and Brest University Hospital, Brest, France

ABSTRACT DESCRIPTION

Psychiatric Education has currently two main roles:

1. The dissemination of the Evidence Based knowledge and of researches concerning the physiopathology of mental disorders and the mental health practices to treat them accordingly.
2. The promotion and development of person centered perspective and integrated cares in mental health and related topics, to take into account the patient’s personal subjective perception and needs respecting his rights and values.

These two roles are converging in their intention to improve mental health care for the patients and bring better support to professional and non professional care-givers to increase their efficiency and reduce their exposure to burn out or to unemotional handling of their therapeutic tasks. However, to integrate and balance these two roles can be quite challenging, at least from a methodological point of view:

• Whereas a disorder centered approach, is generally required for the research studies to get the most objective Evidence Based data we want to be disseminate,
• A person-centered approach is crucial to attend the patient and take care of his needs rights and values in their subjective, cultural and spiritual dimensions.

The integration of these two conflicting aspects can be seen as the most challenging issue in current psychiatric education, because, may be more than other medical disciplines, Psychiatry and Mental Health are exposed to the negative effects of disorder centered approach. Because of the uncertainty about the very nature of psychiatric disorders, and of the competing theory to approach their etiology and physiopathology, mental health classifications on which are based the psychiatric disorders categories, have to neglect key aspects of the person’s mental health status (such as subjectivity for instance), in order to catch up the paradigm on which are based the medical classifications in other medical disciplines. The first stake of a person-centered psychiatric education is to tackle this issue, to integrate disorder centered EB knowledge dissemination with a struggle to avoid that an abusive reductionism leaves us “with half a science” (Strauss) and nosographical references too artificial to be well adapted to clinical practices with clinical patients.

After briefly presenting the first task of psychiatric education (dissemination of EB knowledge and research) this intervention will discuss how the Person-centered Integrative Diagnosis (PID) model has been constructed to deal with this stake. It is based on the previous International Guidelines for Diagnostic Assessment (IGDA) constructed on the results of a series of focus groups (involving psychiatrists, health professionals and other health stakeholders as patients, families and advocates) and of a survey realized by a global network of national classification [12]. One of the main findings of this systematic work is that the patients’ perception, values and experiences of illness and health are key components of their health status and can be provided only if dimensions and narratives (idiosyncratic formulations) are added to traditional descriptive procedures. Through narratives, the physician has to access the patient’s conscious and unconscious feelings and representations. He does not lean only on what he observes of the patient’s behavior or physical condition, but has to use his empathy to go behind the screen of the visible. The intervention will discuss the nature and the steps of the empathic process involved in this effort to access the patient’s subjectivity, in various clinical situations.

References:

Botbol M, Banzato C and Salvador-Carulla L: Categories, Dimensions and Narratives for Person-centered Diagnostic Assessment. International Journal for Person-Centered Medicine, 2 (2), pp 196-200.
Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press.
Kleinman, A. (1989). Illness narratives: suffering, healing and the human condition. New York: Basic Books.
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Roberts, G.A. (2000). Narrative and severe mental illness: what place do stories have in an evidence-based world? Advances in Psychiatric Treatment 6, 432-441.