Raj Persaud who, since the death of Anthony Clare, is probably the UK’s most prominent psychiatrist, has spent the day batting on rather sticky wicket.  Many news sources, including the guardian and BBC report that in a Manchester GMC hearing today Persaud admitted to having plagiarised material in a book and several newspaper articles and medical journals.

He did admit that this plagiarism was inappropriate and misleading, but denied that his actions were dishonest or were liable to bring the medical profession into disrepute.  This latter claim may need some justification. 

(this next bit has parts pinched from Persaud’s wikipedia page, but that’s okay isn’t it?  I’ve substantially rewritten also added some new bits.  Anyway I’m anonymous!)

Persaud’s troubles started in 2005 and concern claims, now substantiated by Persaud, that he passed off the work of other academics as his own in several publications and books. 

Thomas Blass, professor of psychology at the University of Maryland, complained that a large proportion of Persaud’s article in Progress in Neurology and Psychiatry (Volume 9, Issue 2) had been taken verbatim from Blass’s work on Milgram’s experiments, as had an earlier article of Persaud’s in the Times Educational Supplement. Persaud claimed this had been due to an error, and offered to apologise for not crediting Blass.

In the BMJ Persaud appeared to have reviewed a book of Blass’s by simply quoting large chunks of it, but without using quotation marks.  The BMJ subsequently withdrew the piece. Persaud blamed the BMJ’s editing of his original article, a claim that the BMJ refuted.  This Guardian article has further details and a comparision of the relevant texts.

A June 2005 article about Scientology in The Independent is said to have used parts of a publication of the Canadian Professor Stephen A. Kent without attribution.  Around 300 words of the 685-word piece are almost identical to a a paper by Kent titled The Globalization of Scientology, Influence, Control, and Opposition in Transnational Markets.
(a particularly perspicacious discussion of a similar subject can be found here). The paper blamed a ‘production error’ and altered the article in its web archives to properly attribute Kent.

An investigation in 2006 by the South London and Maudsley trust, where Persaud is a consultant, found that parts of his book, From The Edge Of The Couch, appeared also to have been copied.  Persaud admitted that his book had not been adequately sourced and said that he had made these mistakes after overcommitting himself

As a result of these embarrassments Persaud resigned as host of the BBC Radio 4 programme All In The Mind in April 2006 because of the controversy, but returned in April 2007.  He also relinquished an honorary position at the Centre for Public Engagement in  Mental Health Sciences. 

At the extreme the GMC have the power to strike doctors off the medical register, although I think that this would be unlikely (and harsh) in this case.  Punishment not withstanding, Persaud has done his reputation enormous damage.  It is hard to imagine that all these occasions can be the result of errors, as the omissions of citations are too many and too blatant.  Persaud is an clever and able man; can it be that he started to believe his own publicity machine and considered that in order to maintain his omniscient image he had to appear to have to originated all the wisdom that he imparted? 

And if he is chastised, will he bear his soul on Richard and Judy to regain the public’s trust?  I do hope so.

It starts early: UCAS finds that 800 prospective medical students plagiarised their medical school application forms BBC

Is It Plagiarism… Or Is It Wikipedia-Like Collaboration?  - a slightly connected article I happened across.

More On Raj Persaud: 

‘Psychiatrist to face plagiarism charges at GMC hearing’ Guardian 4 December 2007

Raj Persaud: TV Psychiatrist admits Plagiarism Guardian 16 June 2008

‘He took paragraphs from my work, word for word’ - psychiatrist faces plagiarism charge Guardian November 7 2005

Raj Persaud BBC Profile

Plagiarism Row dogs radio doctor BBC News 3 April 2006

Kirstin Davis has been annoying me this morning.  The doctors’ on call room here is full of celebrity magazines; they’re always a few weeks old and these ones have a lot about the new Sex and the City movie.  Here are some of the headlines:

Now Magazine 26 May 2008

Kristin: ‘I’m a recovering alcoholic’

Q: You admitted to suffering from alcoholism in your twenties.  Is there any truth in the rumours that you relapsed and went back to rehab?
A: I haven’t had a drink for 20 years now.  I haven’t kept it a secret but people don’t really know about it*

{nb the other four headlines were Cynthia: ‘I’ll wed my lesbian lover’, SJP: ‘I’ll miss Carrie’ and Kim ‘My tomboy keeps me young’}

Reveal Magazine 24 - 30 May 2008

‘I’m not ashamed to be an alcoholic’

‘Her co-stars may be toasting the release of the new Sex and the city movie with champagne, but Kristin Davis won’t be joining them
The star, who plays Charlotte in the New York-based sitcom, hasn’t drunk alcohol in more than 20 years because she had a drink problem.
She says ‘I’m an alcoholic, but I haven’t kept it a secret.  I’ve been sober for a really long time now’

She certainly doesn’t look like an alcoholic to me.  Davis is 43, and since you can legally drink at 21 in the USA this didn’t provide her with much of a window of opportunity to get really stuck in.  Neither article gives us much in the way of details as to what Davis got up to whilst she was a boozing. 

Some more digging revealed this interview from the Guardian in 2002:

‘To the outside world, I was a good girl. But I drank a lot, which was rebellious because my parents didn’t drink at all. In the South, pretty much everybody drinks. There was always lots of alcohol, lots of access to alcohol, people sitting around every night with a Mint Julep, or whatever.’ …. At high school, it was just crazy. We’d all be behind the gym drinking, about 20 people passing around bourbon or whatever.’

Throughout our conversation, Davis has been sipping water, but she refuses my offer of wine: ‘No, I’ve been sober a long time.’ Did she end up having problems with alcohol? ‘Oh yes.’ I didn’t know that. ‘Not many people do. There’s this whole thing in America about talking about all your addictions and problems and I’m not really into that**. But it’s not like I want to keep it a secret either.’ What happened? ‘Oh, nothing that bad. I just realised that drinking was counterproductive to what I was trying to do. Acting is very difficult in weird ways. You’d have to get to class by 8am, work all day, rehearse all night, and it’s not really good to do when you’re hung over. I’d wanted to be an actress my whole life, that was my goal, that was all I cared about. Something had to go, so I chose drinking to go.’ Has it been difficult? ‘Oh yeah. Sometimes it would be nice to just have some red wine with dinner, but it’s not worth the risk. I have a great life, a great situation. Why would I want to risk self-destructive behaviour? Even though I might not, I might , do you know what I’m saying? You just never know.’

So, in summary Davis drank a lot whilst she was a rebellious student but then she realized that hangovers weren’t compatible with having a career and making something of yourself.  So she stopped.  Um, I did that too (without actually stopping mind).  Does that mean that I’m an alcoholic too?  ’Alcoholic’ is a poorly defined term, and this is where the confusion may lie.  But if by alcoholic Davis means ‘alcohol dependent’ she’s stretching it rather thin.  If a psychiatrist were to do this, this would be an example of criterion or diagnostic creep, where a previously well defined syndrome widens to include experiences that were previously thought to be a part of normal experience.  Has Davis actually seen a doctor, or is she a self-appointed recovering alcoholic?  PTSD is often accused of criterion creep and this can occur easily for psychiatric syndromes, where the aetiology is unknown. 

Why has Davis appropriated the language of psychiatry and addiction to explain her own reaction to what many people would consider a normal stage of many people’s lives?  Perhaps as a way to draw attention to herself, to explain other failings in her life about which we know nothing, or so that she may permanently have one foot in Parsons‘ sick role.  My esteemed colleague, on call with me today, ‘Dr Cynic’ is proposing that Davis is so boring that her alcoholic ploy is a way to spice herself up in the eyes of her public. 

For what it’s worth, ICD-10 requires that three of the following criteria be experienced or exhibited at some time during the last year for a diagnosis of dependence:

A strong desire or sense of compulsion to take the substance

Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use

Physiological withdrawal state when substance use has ceased or been reduced, as evidenced by either of the following: the characteristic withdrawal syndrome for the substance or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms

Evidence of tolerance, such that increased doses of psychoactive substance are required to achieve effects originally produced by lower doses

Progressive neglect of alternative pleasures or interests because of psychoactive substance use and increased amount of time necessary to obtain or take the substance or to recover from its effects.

Persisting with substance use despite clear evidence of overly harmful consequences (physical or mental)

For an interesting account of the effect of alcohol and other drugs on society try the following two books by Griffith Edwards:

Matters of Substance - Why Everyone’s a User   Amazon  Waterstones

Alcohol: the World’s favourite drug

*It’s certainly out of the bag now - I don’t think that talking to NOW magazine is a very effective way of keeping a low profile on this one.

** So what are you doing talking about it here then?

I wrote a post about this the other day before I’d actually seen it and I’ve watched it now.

For anyone who didn’t see it, ‘The Doctor Who Hears Voices‘ was a film shown during the past few days on Channel 4. It concerns a doctor called ‘Ruth’ – her identity has been changed, but we are told that the documentary is a mix of film of Dr May taken throughout the actual treatment, spliced with reenactments of Dr May’s sessions with ‘Ruth’ with Ruth being played by actress Ruth Wilson.  Ruth has no wish to take psychiatric medications and is currently off work with depression; she has a diagnosis of bipolar disorder.  She is sure that if she tells her work that she is ‘hearing voices’ then she will be sacked and sectioned.

I thought that I’d start this post by listing the things that I liked about the documentary.  So far I’ve only been able to think of one – that it’s good that mental health issues are being given airtime by a major television channel.

There were lots of things I found objectionable about the film. 

1. The subject’s suitability was questionable:

Was it really suitable to film a documentary over a seven month period of a vulnerable patient having a mental health crisis?  I cannot believe that this helped in her recovery, and I suspect that it simply served to raise Dr May’s profile.  Sure, she must have consented before broadcast, but by then the damage could have been done.

2. The film is misleading

Dr May is described as a doctor – whilst this is strictly true, he has a doctorate, most people would interpret this as meaning that he is a medical doctor.  He is not, he is a psychologist.

The film implies that people who have voices are always sectioned, this is not the case.  The film also gives the impression that were ‘Ruth’ to admit to be suffering auditory hallucinations, then she would be sacked and sectioned on the spot.  In fact her dismissal would have to be sanctioned under employment law, and if she were to be sectioned, this would require two independent doctors and an appropriately qualified social worker. 

No attempt is made in the film to put the treatment of this patient in context.  All that one can legitimately say about this film is that Dr May’s interaction with this patient coincided with partial recovery for this patient during one of her relapses.  Many people will leave this film thinking that because of Dr May’s limited ‘success’ that current mental health treatment is all wrong.  This cannot be concluded on basis of one case. 

3. The film is unrepresentative and unrealistic:

‘Ruth’ is not a particularly representative patient.  She is above average intelligence, and I cannot help but notice, is played by a young and beautiful actress.  I wonder if this film would have been made if its subject matter was a typical London inner city patient.

Whilst Ruth Wilson played the role believably, her depiction was not challenging to the viewer.  The most chaotic thing she does is put her head under a stream and walk out in front of a slow moving lorry.  She remains coherent and well turned-out throughout.  What if she did other things less palatable to the body beautiful: neglected personal care, started to have sex with (unattractive) strangers or lived in a filthy house?  Let’s consider how much publicity a conventional psychiatrist, offering medications to a patient who would go home much better the following week, would muster – not much I expect. 

Early on, we are told that Dr May sees Ruth in an unofficial capacity in addition to his NHS work.  Even if it worked, about which I remain dubious, there is simply not the capacity within the health service to allow all patients with serious mental health problems this sort of intensive input. 

At the end of the film, we are encouraged to think that ‘Ruth’ has managed to return to work successfully, despite continuing to have auditory hallucinations.  It is implied that this is because Dr May and ‘Ruth’ manage to pinpoint the identity of the voice which is troubling her; this is over simplistic.  We are told nothing of the long term outcome of this case.  Remember that both bipolar affective disorder and schizophrenia (the two terms are used interchangeably during the film) are chronic disorders of a relapsing and remitting nature. 

4. Dr May is deeply unprofessional:

Dr May shows a total distain for other professionals working in the psychiatric field.  Informed by his own experiences, he says that people who work on psychiatric wards consider their patients to be ‘degenerate’.  Psychiatric wards are not nice places, but they are staffed in the main by caring people who do an extremely difficult job with very difficult patients.  It is insulting to suggest that, to a person, they all consider patients with mental health problems in this way.   

Dr May’s relationship with ‘Ruth’ seriously blurs the boundary between patient and professional.  Ruth is seen to stay with his family and there is no mention of any other important relationships in Ruth’s life, for instance the support which might be available from parents or friends.  Instead, Dr May positions himself as a svengali character and it appears that his professional zeal for alternative psychiatric treatment may be an expression of his own personal distaste for the psychiatric profession with Ruth as a unwitting pawn.

Ruth is an extremely vulnerable patient.  The programme takes place over the course of seven months, during which time who, if anyone if managing the risks she poses to herself and others?  At one stage Dr May admits that she has been told by the voice that she hears that she should kill her parents.  He simply considers this to be ‘useful’.  At another Ruth goes missing and Dr May is concerned that she may have committed suicide.  When asked about why he is reluctant to talk to camera about this he admits that he is reluctant, in our risk adverse age, to implicate himself on camera, perhaps realising how far out on a limb he has gone. He is also described as using a technique which many psychiatrists think ‘irresponsible and dangerous’.  Imagine if your surgeon told you he wanted to try a procedure on you that other surgeons thought ‘irresponsible and dangerous’ – you would not be impressed, and neither should we be. 

In discouraging Ruth from seeking any professional advice but his own, Dr May steers her away from evidence based (but I grant, imperfect) methods of treating mental illness, towards his own paradigm.  In the film she is portrayed as manic for in excess of six months, and would have been unlikely to have been so were she on appropriate medication.  In addition to not seeing a psychiatrist, in isolating her, Ruth would also not be helped by the array of other professionals who work in community mental health.  We see her at the end, apparently recovered, but where on earth is her follow-up?

Dr May has a professional case to answer in his attitude to the panel that is to decide whether Ruth is safe to be practicing as a doctor.  This panel is not there simply to get in Ruth’s way, but to make sure that vulnerable patients are to be treated safely by competent doctors.  Whilst being aware that Ruth has symptoms of serious mental illness, Dr May encourages Ruth to lie to the panel and also coaches her to do so. 

This is in direct contradiction to the GMC good practice guidelines which state:

‘If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients.’  (my italics)

I don’t doubt that a lot of patients are not keen on taking antipsychotic medications.  It’s widely known that people with mental health problems have trouble finding and keeping employment.  If Dr May’s work aims to help people with their mental health problems get back into employment and deal more effectively with their illness, they we’re on the same side.  And perhaps there’s a four hour version of this film which would clear up all of the above concerns.  But this film is unbalanced and unhelpful.

Here’s a guardian review of the TV show and some interesting comments.

Kathryn Flett in the Observer didn’t like it much either 

Addendum: Dr May has kindly commented on this piece below.  There’s a BMJ review of TDWHV available on his website, which raises some interesting points.