BJPsych Kaleidoscope column September 2017

Derek K. Tracy, Dan W. Joyce, Sukhwinder S. Shergill

Full text: The British Journal of Psychiatry Sep 2017, 211 (3) 186-187; DOI: 10.1192/bjp.211.3.186


Going smoke-free on psychiatric wards was a hugely debated and contentious issue. Whilst we recognise the obvious health benefits, and see that broader societal trends are moving this way (remember when you could smoke on an airplane?), it was argued by some that psychiatric wards should be exempted from legislation. Some of this was well-intentioned, if possibly patronising: at a low and enormously challenging time in someone’s life, why force them to stop smoking too? It does undermine somewhat our frequent call for parity-of-esteem with physical healthcare. However, there was a deeper but less openly spoken concern: smoking was ‘therapeutic’ and ‘calming people down’ on our wards – stop that and there would be greater rates of violence. The anxiety was perhaps understandable – the anecdote is easy to envisage – but we need to be grown up and have such conversations more openly. In any case, the law moved quicker than our in-house deliberations in mental health, and it came to pass that all units are now smoke-free. So what happened next? The first large study to explore the effects has just been published, following up an entire NHS Trust for 30 months before, and 12 months after, the smoking ban. The outcome? A 40% reduction in violence. Now there is a lot to unpack and debate within that, to which I can’t do justice here, but it’s a strong challenge to our preconceptions.

Finally, I made a graph showing my past relationships: it had an ex axis and a why axis. No doubt many of us have looked back on a previous relationship and wondered if we were deluded. This month’s Kaleidoscope found a wonderful piece from the journal Medical Humanities that explores love and delusions. It focuses on ‘erotomania’, which may sound like a wild and fun festival, but is actually a rare but serious delusion where an individual believes someone powerful, usually a celebrity, is in love with them, and it can lead to dangerous stalking behaviour. This also proved an irresistible opportunity for me to get the phrase “Love Island” into the British Journal of Psychiatry to win a bet. Moving to non-pathological variants, the piece argues that a degree of delusion is normal and healthy in all relationships; it helps keep one’s other half important and less flawed, and of course, the same about us in their eyes. The paper finishes on a more melancholic note: the author concluding that the only difference between love and delusions is that “delusions persist; love dies”.