Episode 6 – Dr. Pratima Singh

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This week, we interview Dr. Pratima Singh. 

Dr. Singh did her medical degree in India, before moving to the UK to work at the Maudsley NHS Hospital in London as an adult psychiatrist. Dr. Singh has a deep interest in alternatives to biological approaches to psychiatry and the use of psychotropic medications.

 

I was keen to ask Dr. Singh about her background, what led her towards psychiatry as a medical speciality and what she feels about the future of psychiatric care.



In this episode, we discuss:

  • How Dr. Singh completed her medical degree in India and became interested in psychiatry 
  • That Dr. Singh felt uncomfortable with the predominantly biological approach to psychiatry including the use of medications and that her interest was in psychotherapy as a therapeutic intervention
  • That there is a recruitment and retention problem within psychiatry
  • That 15 years in psychiatry has given Dr. Singh a nuanced and humble attitude to helping people with their mental health
  • That Dr. Singh felt that her discontent with biological psychiatry continued during her training
  • That, in the UK, General Practitioners (family doctors) actually deal with 80% of mental health problems
  • Patients may then be referred by the GP to therapy teams in secondary care, commonly known as Community Mental Health Teams (CMHT)
  • These teams include psychiatrists, occupational health specialists to try and address a range of service user needs
  • That there is also acute care, or crisis teams, where support is given for psychiatric emergencies
  • Recently there has been diversification to include specialisms like eating disorders, learning disabilities or neuropsychiatry but provision differs across the UK
  • That Dr. Singh feels that we have too rapidly and too dramatically cut down the amount of in-patient beds, leaving a gap and increasing the pressure on the community teams
  • That in the UK we struggle to provide a brief intervention model because many service users often require more time
  • That Dr. Singh feels that the majority of people that she sees have already been put onto psychotropic medications by their GP and often this is too early in the process
  • That there are patients now that say they do to want to try medication
  • That the evidence for using so much medication for emotional distress is weak
  • That psychiatrists do not have tests to help predict how a medication will affect a patient or if they will struggle to withdraw
  • That Dr. Singh would like us to understand the medications better especially why some people struggle even if they try to withdraw slowly
  • That, as professionals we need to listen to patients experiences of adverse effects or withdrawal difficulties 
  • That Dr. Singh feels that it is a privilege to be able to engage with patients in this way but that we must be very carful not take advantage or to harm the patient despite our best intentions
  • That we need a completely different mindset to better manage mental health difficulties
  • That Dr. Singh prefers to look at the wider issues in a persons life to try and find the best way to support them including diet, exercise or other potential issues such as metabolic problems or nutritional deficiencies
  • How sometimes a therapeutic relationship can feel like an arranged marriage
  • That a new model would only work if the intervention is early enough in the process, if we engage with people too late, it can be more difficult to help
  • How Dr. Singh remembers her first interaction with a patient and uses this to guide her in listening to the patients own wisdom and experience 
  • That Dr. Singh took some time to undertake a Leadership and Management fellowship and that this really helped her to stand back and appreciate the issues and to listen to the customer
  • That full disclosure and informed consent is so important
  • Functional medicine and how it differs to mainstream psychiatric approaches 
  • That functional medicine is a holistic approach that considers the whole person
    and underlying root cause of chronic illness
  • In a functional approach there are no specialities
  • The place of recovery colleges in co-producing training in holistic ways of
    maintaining health
  • That we still tend to think about contemplative practices as something to try rather than a core skill necessary for good mental health
  • That there is not enough evidence to influence a closed mind
  • That many of the best discoveries in medicine come from observation rather than from a laboratory
  • Dr Singh’s hope that psychiatry can return to a place of creativity and openness 

Relevant Links:

The Institute for functional medicine

UK functional forum, January 2017

Dr. Rangan Chattejee

How to Listen:

To listen on Mad in America, click here

To discuss this episode on the MIA forums, click here

To listen in iTunes, click here

To listen on YouTube, click here

To get in touch with us email: podcasts@madinamerica.com

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2 thoughts on “Episode 6 – Dr. Pratima Singh

  1. Heard this numerous times from psychiatrists who have begun to face up to what is actually happening and it isn’t that they didn’t know, they do it! It’s that they have realised far more now know and in depth and detail. The initial response is that the patient should be informed of the drug affects and then to place responsibility on the patient to ‘look after themselves’ . When this psychiatrist and all the others know that psychiatry is based on coercion and force, it uses lies, psychiatric nurses, social workers and the police to coerce and force people onto these – antipsychotics..Olanzapine etc – drugs. They say ‘we can’t reliably predict how a patient will respond’ Not true, there is a genetics test, indeed as far as I know the first gene test was for psychiatric drugs. Thankfully this woman had it:

    The gene test was talked about as long ago as 2000 here on the BBC website:

    http://news.bbc.co.uk/1/hi/health/704577.stm

    “Approximately four million people in the UK have a defective form of this gene, which leaves them unable to break down drugs into an active form or to a form that can be eliminated from the body.

    This can either result in a lack of benefit or an adverse drug reaction – it is therefore pointless to give such drugs to these people.”

    Then.. ‘We don’t know enough about the drugs’…We know plenty about the harm these drugs do… read some toxicology books.

    And now it’s not just those who are deemed to have psychosis being given these neuroleptic drugs, it’s people with anxiety/insomnia and next, of course – as with the US – it will be children..this is a normalisation of drug abuse. we only see history through the filter of change over time and realise either something definitely good or very harmful was done, my view is that our own time will exceed the likes of Hermann Pfannmuller and Hans Heinze.

    Like

  2. Thanks for your comment Streetphotobeing. I am currently undertaking genomics training after studying the current literature but ironically know that the use is non existent in NHS practice other than in academic research. Why , you might ask? For the same reason that while we have known for years about specific genes that predict risk of psychosis in some cannabis users vs others, this has not translated in frontline use. Cost, resistance to change, failure of adaptation, resistance to biological models etc come to mind. My discussions with Swedish colleagues however tells me that its not as straightforward as the example above due to polys etc. Gene variants that code for drug metabolism enzyme aren’t the sole determinant of drug response as drug receptors, transporters, and targets also play a role.

    Genomics so far has over-promised and under-delivered but does have a vital role if medication has to be used. I agree that it deserves the seriousness that cancer drugs have (although even pharmacogenetics tests are not common place even for known and acknowledged toxic cancer drugs although are available) but unless the profession acknowledges a need, the solutions do not follow.
    I do hope to offer this advice and support to my own patients in future.

    Liked by 1 person

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