BBC From our own correspondent ‘A shoulder to cry on in Baghdad’ - Psychiatrists in Baghdad 31 May 2008

(From our own correspondent homepage)

‘How Britons get high - drug users tell their stories’  Observer 20 July 2008

Regular readers of this blog beware, this is about as close as I get to gossiping.

General Medical Council’s fitness to practise panel starring TV psychiatrist Raj Persaud has, to paraphrase the late Japanse Emperor Hirohito, developed not necessarily to Dr Persaud’s advantage.

The panel’s ruling is not reported on the GMC website, but has been carried by Reuters and the Guardian.

Initially the GMC choose to dance around Dr Persaud, setting him up for a fall:

‘You are an eminent psychiatrist with a distinguished academic record who has combined a clinical career as a consultant psychiatrist with work in the media and journalism"

Before poking him in the eye:

‘The panel is of the view that you must have known that your actions in allowing the work of others to be seen as though it was your own would be considered dishonest by ordinary people*‘

And then delivering the knock-out blow:

‘The panel has therefore determined that your actions were dishonest in accordance with the accepted definition of dishonesty in these proceedings.’

So, true to my title, Persaud is giving psychiatry a bad name.  We’ll find out whether he’s also down for the count when the panel rules whether this impacts on Persaud’s fitness to practice and what sanctions to impose on him.  He could be struck off the medical register. 

The most interesting question is why a man such as Persaud could score such a spectacular own goal.  One of my regular comment contributors has been nudging me towards giving Persaud a psychiatric diagnosis; this would be amusing, but alas won’t get us very far, and worse could be a bogus simplification of complex motivations of which even Persaud himself may not be aware. Former New Labour wonk turned psychotherapist Derek Draper has done some armchair psychoanalysis of Persaud in the Guardian today. 

Persaud himself has said that he was under a great deal of stress and the pressure of his commitments lead to his behaviour.  This reasoning has a plea of insanity and diminished responsibility whiff about it and for me is a little too neat.  Stress certainly can make people act strangely, but the general opinion of where I work is that Persaud is a narcissist and the reported misdemeanors are just the tip of a much bigger plagiarism iceberg below the surface.

If Persaud liked to be seen as a man of great erudition, this would of course require a lot of ideas and simply regurgitating other people’s isn’t nearly as satisfying as thinking them up yourself.  It is however difficult to be original whilst you’re also writing two books and holding down a full time job as well as doing private practice.  Whether stupidly, or wilfully (and one of the witnesses in this case Professor Richard Bentall, can’t make up his mind on this) one solution to this quandary is pass off other people’s ideas as your own.  One of the articles which has caused all this stink has been subsequently amended with the correct attribution of text.  But by doing so, Persaud appears no better than someone reading out of a book in front of a class, something he might clearly wish to avoid.  He tried to blame his plagiarism on sub-editors, an action that looks nearly as bad as the plagiarism itself. 

Perhaps, as Draper aruges, Persaud was seized by a evangelical zeal, and wished to bring psychiatry to the masses.  In the pursuit of this greater good, does it really matter who wrote the words, so long as people read them?  Or maybe it is all narcissism as my colleagues contend.  Persaud was simply to famous to bother with what the little people do: ‘fess up when someone has had a better idea than us.  He didn’t believe in credit where credit is due, but would rather have all the glory for himself.

But none of this explains why it was so ineptly executed.  Exhausted by the same driving ambition that had made him so successful, perhaps he subconsciously wanted a way out, a way to return to being an ordinary doctor again.  Alas his actions have put this modest wish into jeopardy. 

Or he was simply lazy and couldn’t bothered.  I’m sure that he’d have chastised a medical student for that.

But what use all this speculating: Dr Persaud, Richard and Judy’s couch beckons you.  Lie down, close your eyes and tell us why.

In the press

Persaud’s plagiarism was dishonesty rules medical Council Guardian 19 June 2008

Persaud’s blatant cribs were flabbergasting, professor tells tribunal Guardian 18 June 2008

TV psychiatrist found guilty of disrepute Reuters 19 June 2008

Media Psychiatrist fights for his job Guardian 17 June 2008

* ‘Ordinary people’ - that’s me and you kids.  Dr Persaud is a ‘celebrity’

I got home from the pub the other night and was casually scanning through the TV channels, when I happened across the second half of a curiously compelling documentary.  ‘The Perfect Penis‘ was about an American psychology student who was paying $4000 to have his penis lengthened.  This is not my area of expertise, but apparently this involves cutting a ligament located in the pubis.  A lot of the penis is actually in the body and cutting this lets a bit more of it protrude. 

The next bit sounds worse: to complete the job, the gentleman must then hang a weight off his member for no less than eight hours a day for several weeks after the op.  As well as sounding painful and unbelievably tedious, the results appear barely worth the trouble, with Wikipedia quoting an increase in penis length of 2-3cm and netdoctor stating that the only study available suggested that average increase in length was 0.5cm.  

The chap who was having it done actually seemed pretty normal, although my suspicions of obsessive/narcissistic personality traits were raised by his buff physique.  I didn’t catch all the programme so I didn’t see if he had a psychiatric evaluation.  I suspect not, as it might have spoilt things and there was a bit where he was talking to this psychology supervisor, who said sensible things which were completely ignored.  We got to have a look at the ‘inadequate’ equipment towards the end of the show and it looked perfectly fine to me.  We were also told at the end of the show that the penis surgeon had recently bought a new house in which to keep his four rollers;  I couldn’t help thinking our poor boy had been done. 

Leaving no grotesque stone unturned, the documentary makers included an interview with ‘Mister Mark’.  Mark is a gentleman who has injected enough silicon in his testicles and penis to make his scrotum 1ft in circumference.  He was appeared pleased as punch about this, and even has a website called ‘extremecock.org’ dedicated to his enlarged genitals (full admission: in the spirit of ‘frontier psychiatry’ I did visit this website, but I really wouldn’t recommend it to anyone of an even slightly queasy disposition).  

If I was trying to drum up business for myself, I’d be concerned if the psychology student was suffering from body dysmorphic disorder; Mister Mark is a subject for another day.  At the end of the show it was revealed that he was unwell and that he may be suffering from a silicon embolis.

Body dysmorphic disorder (Also known as dymorphophobia) was first described by Morselli in 1886:

‘A subjective description of ugliness and physical defect which the patient feels is noticable to others, although the appearance is within normal limits.  The dysmorphophobic patient is really miserable in the middle of his daily routines, everywhere and at any time, he is caught by the doubt of deformity’

Typically the patient is convinced that some part of his/her body is too large, too small or misshapen.  This is usually a part of the face, but can be any body part.  To other people the appearance is normal or there may be some slight abnormality.  The patient may be constantly preoccupied and tormented by his/her mistaken belief;  he/she may blame all his other difficulties on it.  For instance they may think that if only their nose were a better shape then they might have a better life or job. 

There may be time consuming behaviours.  I once had a patient who was constantly late for work as he used to spend hours examining his nose in the mirror. There is substantial overlap with other psychiatric disorders, especially depression and social phobia.  At its extreme the BDD may be very disabling and may leave the patient housebound and unemployed.  In the absence of corrective operations, people have been known to take matters into their own hands, for instance using a clothes iron to remove wrinkles on their face.

The prevalence is 1% in the community. The treatment is often difficult and  surgery is usually contraindicated.  Patients usually will have unrealistic expectations and once the operation is complete their concern may transfer to another part of the body. 

Dr David Veale’s site has a BDD reference page which is worth a look.