Chaplin (Reference Chaplin2000) could have made an interesting read but unfortunately seemed to miss making any particular point. The effects of medication and Mental Health Act assessments can and do have powerful effects on both the ill person and his or her family. Alas, Chaplin failed to expand on a major issue — the attitudes some psychiatrists hold have far more devastating effects on their patients than either medication or the Mental Health Act.

I have written elsewhere (Reference CorkerCorker, 2001) about the deeply harming effects that stigmatisation and discrimination by psychiatrists can have on people who may have suffered mental illness and may or may not have been their patients. While many articles have been written about the stigma of mental illness, too little has been said about the effect that the attitude of mental health professionals may have on patients.

For the patient the mental health professional must maintain a position of trust and also remember that they provide the building blocks for modelling at a point of extreme vulnerability in the life of the patient. As a mental health professional for 20 years, both in the National Health Service and private practice, I have also experienced the discrimination and stigma of being a patient during and following two major depressive illnesses. The experience of being ill has certainly changed my life and resulted in major losses; worse is the way in which the illnesses have been used by fellow professionals, both medical and non-medical, to stigmatise and discriminate. I do admit to making mistakes as a result of illness but would have expected that this would be seen as the result of illness, where poor decision-making is acknowledged as one of the key signs.

I agree with Chaplin that psychiatrists “must be prepared to identify and challenge our own prejudices and attempt to modify our clinical practice”. First and foremost, this requires a sense of humility to examine a personal approach. Second, attitudes and practices that need to be changed must be identified. Third, the responsibility needed to make the change must be accepted.