Podcasts & Videos 31st - 50th
50th Maudsley Debate: CBT for psychosis
48th Maudsley Debate: Enabling or labelling?
Recently, the evidence base pertaining to CBTp has been called into question, with a meta-analysis in the British Journal of Psychiatry showing a small level of efficacy in studies with more methodological rigour. On the back of this, a randomised controlled trial (RCT) in the Lancet suggested it had beneficial effects in people with psychosis who were not taking antipsychotic medication (which has been the mainstay of treatment for psychosis for over 50 years). Amidst all of this, the question remains as to whether its benefits have been overstated, and the question arises, “has CBT for psychosis been oversold?”
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A video of the debate is also available here.
Motion: "This House believes that CBT for psychosis has been oversold"
For the motion:
Peter McKenna, Research Psychiatrist, Barcelona
Keith Laws, Professor of Cognitive Neuropsychology, University of Hertfordshire
Against the motion:
David Kingdon, Professor of Mental Health Care Delivery, University of Southampton
Peter Kinderman, Professor of Clinical Psychology, University of Liverpool
Chair: Professor Sir Robin Murray, Institute of Psychiatry
47th Maudsley Debate: Risk in psychiatry
Some argue that a rigorously standardised system of classification of mental disorders forms an essential role in conceptualising a patient's problem, in predicting what treatments are likely to be effective, and in conducting valid scientific research.
Others consider psychiatric diagnoses to be no more than labels, which lack scientific and predictive validity and serve only to stigmatise and objectify those who suffer from mental disorders.
If you wish to download the debate in MP3 format right click the following link as "Save target as" Download the 48th Maudsley Debate Podcast
The motion was: "This House believes that psychiatric diagnosis has advanced the care of people with mental health problems."
Speaking for the motion:
- Prof Norman Sartorius, former president of the World Psychiatric Association
- Prof Anthony David, Professor of Cognitive Neuropsychiatry, Institute of Psychiatry
Speaking against the motion:
- Dr Felicity Callard, Senior Lecturer in Social Science for Medical Humanities, Durham University and Chair of the Board, Mental Disability Advocacy Center
- Dr Pat Bracken, Clinical Director of Mental Health in West Cork and author of "Post- Psychiatry: Mental Health in a Post-Modern World".
- Sir Simon Wessely, Professor of Psychological Medicine and Vice Dean for Academic Psychiatry, Institute of Psychiatry
46th Maudsley Debate: The challenge of legal highs
Mental health professionals frequently make predictions about the risks of harm posed by patients to themselves and others, and attempt to reduce these, often by enforcing treatment and admission to hospital.
The concept of risk has gained increasing prominence from high profile failures of care, with publicity in the media further highlighting harms caused by those with mental illness. More broadly, in all areas of medicine and indeed society, individuals and institutions are increasingly being held accountable for adverse outcomes, further driving the risk agenda.
Reducing harm is an intuitive and desirable goal. Is a focus on risk an effective way of achieving this goal? Are we able to predict risks with any degree of accuracy? And do our attempts to reduce risk cause harm in themselves, and distract from other aspects of care?
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Chair: Dr Gwen Adshead, Broadmoor Hospital
For: Dr Matthew Large, University of New South Wales, Sydney
Professor George Szmukler, Institute of Psychiatry, King's
Against: Professor John Morgan, Royal College of Psychiatrists
Professor Tom Fahy, Institute of Psychiatry, King's
45th Maudsley Debate: Insane?
On November 15th the Institute of Ideas and the Institute of Psychiatry collaborated for the first time to create a Debate on the challenges associated with legal highs, novel psychoactive substances and less mainstream drugs.
The police, the parliamentarians, the addictions psychiatrists, the general practitioners, the voluntary sector and the family members of those harmed by these drugs were all represented.
A radical departure from the house style meant that there were five speakers, no polarised speeches and no vote. Despite the absence of a democratic voice the audience took part with gusto.
In the preceding weeks the ban of more synthetic cannabinoids and methoxetamine were announced, along with increased detection of deaths from mephedrone and the appearance of 57 new drugs within 11 months.
Did the panel and audience find solutions to this fast changing situation?
Listen for yourself, but I would argue that this constructive discourse fleshed out some promising ideas involving education, novel treatment services and adaptation of regulatory mechanisms.
One thing was clear from all present. The continuation of the status quo cannot cope with the growing challenges of what one young journalism student in the audience dubbed a 'drug revolution'.
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Dr Owen Bowden-Jones, consultant psychiatrist and chair, Faculty of Addictions, Royal College of Psychiatrists
Dr Michael Fitzpatrick, GP; author, The Tyranny of Health: doctors and the regulation of lifestyle and Defeating Austism: a damaging delusion
Tim Hollis, chief constable, Humberside Police; chair, ACPO Drugs Committee
Molly Meacher, chair, All Party Parliamentary Group on Drug Policy Reform; former Chair, East London NHS Foundation Trust
Chair: David Bowden, coordinator, UK Battle Satellites; poetry editor, Culture Wars; TV columnist, spiked
44th Maudsley Debate: Wake up to the unconscious
The 45th Maudsley Debate took place on 19 July 2012 and was entitled "Insane? Cases such as that of Anders Breivik demonstrate that fanaticism is a form of madness."
Speakers for the motion:
Dr Raj Persaud, Consultant Psychiatrist and Emeritus Visiting Gresham Professor for Public Understanding of Psychiatry
Prof Max Taylor, Centre for the Study of Terrorism and Political Violence, St Andrews University
Prof Simon Wessely, Director, King's Centre for Military Health Research, Institute of Psychiatry, King's College London
Maajid Nawaz, Chairman of the counter-extremism think-tank, Quilliam
Chair: Prof. Tom Fahy, Professor of Forensic Mental Health Science, Institute of Psychiatry, Kings College London
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43rd Maudsley Debate: Care in the community
This house believes that psychoanalysis has a valuable place in modern mental health service. Chaired by Prof Sir Robin Murray. For the motion were Prof Peter Fonagy and Prof Alessandrea Lemma. Against the motion were Prof Lewis Wolpert and Prof Paul Salkovskis.
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42nd Maudsley Debate: Prudent or paranoid
This house believes that the closure of psychiatric beds has gone too far.A Maudsley Debate to mark the 50th anniversary of Enoch Powell’s ‘water tower’ speech, which marked the beginning of the process of deinstitutionalisationChaired by Professor Simon Wessely – Head, Department of Psychological Medicine.For the motion were Professor Peter Tyrer, author John O’Donoghue and Dr Trevor Turner.Against the motion were Dr Rachel Perkins, Professor Julian Leff and Professor Sonia Johnson
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41st Maudsley Debate: Love is a drug
This house believes that child protection has become a form of madness. Proposing the motion were consultant psychiatrist Dr Alain Greggoire and children's lawyer and novelist Simonetta Agnello Hornby who argued that child protection policies fail to detect 90% of the cruelty children suffer and let down high risk groups. For effective treatment to be possible we must cease our dependency on child protection and move from child to family focused policies, investing in early (pre-birth) interventions that target the most vulnerable families. Opposing the motion, associate professor of clinical psychiatry Dr Margaret Spinelli and author and performing arts director Remi Kapo argued that child protection is an evidence-based rational response which must be developed and refined to curtail the incidence and prevalence of child abuse. The debate was chaired by Professor Louis Appleby.
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40th Maudsley Debate: Capitalism cares?
41st Maudsley Debate: Love is a Drug
This house believes that female sexual arousal disorder is a fabrication
A work of fiction dreamt up by ‘Big Pharma’ or an under-recognised and under-treated condition that has been side-lined by clinicians for too long? The controversy around the definition, prevalence, treatment and even existence of female sexual arousal disorder has proved inflammatory since the term first emerged in the late 1990s. Debate around the condition has not abated; it has become a flashpoint for arguments relating to ‘medicalisation’, inappropriate prescribing and the trustworthiness of published medical evidence & the research methodologies used. It has also been the subject of argument within feminist literature and its place within the wider history of sexual health & functioning has been a source of argument.
So, a ‘drug marketing merging with medical science in a fascinating and frightening way ’ or is there a ‘need for the assessment and treatment of women along the lines of men being assessed and treated for erectile dysfunction’ . With psychiatrists, physicians, journalists, academics and feminist writers on either side of the argument it is a source of fascinating debate.
Assembled for the 41st Maudsley debate were four highly eminent speakers and Chair who put forth the arguments for and against.
Chair – Prof Dinesh Bhugra
For – Dr Petra Boynton, Dr Ben Goldacre
Against – Dr Sandy Goldbeck-Wood, Dr John Dean
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39th Maudsley Debate: Care or killing
This House Believes That The NHS Mental Health Services Should Not Fear The Private Sector
Chair – Professor Sir David Goldberg
Speaking For the motion:Prof Elaine Murphy, Prof Philip Sugarman
Speaking Against the motion: Prof Allyson Pollock, Dr Laurence Buckma
One hundred and sixty eight voted in this 40th Maudsley Debate. Taking place during the so called age of austerity, this was a politically hot debate with Andrew Lansley’s freshly published ‘Equity & Excellence: Liberating the NHS’ White Paper appearing to encourage increased participation of the private sector and competition for funding in the provision of health care
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38th Maudsley Debate: There would be no genius without madness
This house believes doctors should be allowed to assist some people with suicide.
Chair: Professor Simon Wessely
Speaking for the motion: Baroness Mary Warnock, Professor Raymond Tallis
Speaking Against the motion: Professor Rachel Jenkins, Baroness Ilora Finlay
The movement to increase patient choice has been growing dramatically for years. The Telegraph reports that in January 2010, 80% of 2,053 adults felt that when patients with terminal illness choose suicide, those who assist them should not be prosecuted.However if doctors assist patients with suicide, they can potentially be convicted and imprisoned.
At this 39th Maudsley Debate this house proposes that doctors should be allowed to assist some people with suicide. However, are we so certain that choosing death is not an uncontrolled symptom of mental disorders that we should be treating?
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37th Maudsley Debate: They'll sell it, lose it or abuse it
Speaking for the motion: Professor Gordon Claridge, Emeritus Professor of Abnormal Psychology in Oxford University and Emeritus Fellow of Magdalen College
Jonathan Naess, Director of Stand To Reason, RADAR Person of the Year 2008
Speaking against the motion: Dr Liz Miller, General Practitioner, Occupational Health Physician and Psychological Health Specialist, MIND Champion of 2008
Professor Michael Trimble, Emeritus Professor of Behavioural Neurology and Consultant Physician, National Hospital Queen Square
Chair: Dr James MacCabe, Senior Lecturer in Psychiatry at the IoP and Honorary Consultant Psychiatrist at the National Psychosis Unit.
Despite the tube strike on June 10th 2009 two hundred and thirty people attended the Wolfson Lecture Theatre of the Institute of Psychiatry to partake in the 38th and arguably the most creative Maudsley Debate. The motion was ‘this house believes that mental disorder is the price we pay for exceptional creativity’.
Before any speaker had taken to the podium a majority of 118 had voiced their opposition to the motion, whilst a significant minority of 73 voted for and 33 opted out by abstaining.
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36th Maudsley Debate: The drugs don't work
Can you trust researchers with your confidential data?
This house believes that clinical research has too few safeguards for consent and confidentiality.
Speaking for the motion: Professor Ross Anderson - Cambridge University, Dr Dermot Ward - Society of Clinical Psychiatrists
Speaking against the motion: Sir Mark Walport - Wellcome Trust, Professor Charles Warlow - Edinburgh University
Chair: Professor Simon Wessely - Institute of Psychiatry
Set against a background of rising public concern about surveillance and data collection, is medical research now viewed with suspicion? Are there enough safeguards for privacy in NHS research? Are the goalposts for safeguards shifting as centralized health databases allow for unprecedented data access?
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35th Maudsley Debate: Happily ever after
This House Believes Antidepressants are no Better than Placebo.
Speaking for the motion:
Irving Kirsch, Professor of Psychology, University of Hull and lead author of the now notorious meta-analysis suggesting that selective serotonin reuptake inhibitors were little better than placebo (Kirsch I et al. (2008) Initial Severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine). He is a Fellow of the American Psychological Association and Past-President of the American Psychological Association’s Hypnosis Division.
Dr Joanna Moncrief, Senior Lecturer Social and Community Psychiatry, UCL. And Co-Chair of Critical Psychiatry Network. She is author of The Myth of the Chemical Cure: a Critique of Psychiatric Drug Treatment (2007) published by Palgrav
Speaking against the motion:
Prof Wolpert is Professor Emeritus in Biology as Applied to Medicine, University College London. A distinguished scientist, he is as famous for revelation that he suffered from severe depressive illness requiring antidepressant therapy. This was the basis for his book 'Malignant Sadness: the Anatomy of Depression' and a BBC television series on the subject. He is also the author of 'The Unnatural Nature of Science' and his most recent book is 'Six Impossible Things Before Breakfast' (2007). He is a Fellow of both the Royal Society and the Royal Society of Literature.
Prof Goodwin is W.A. Handley Professor of Psychiatry at the University of Oxford where he heads the Department of Psychiatry. He is an international expert in the psychopharmacology of depression and bipolar disorder, and was formerly President of the British Association for Psychopharmacology. He is a Fellow of the Academy of Medical Sciences.
Chair: Tom Fahy, Professor of Forensic Mental Health, Institute of Psychiatry
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34th Maudsley Debate: Swallowing it whole
Is happiness overrated? How to define happiness? Is depression its polar opposite? And just who gains from re-translating and individualising collective, public issues?
Speaking for the motion:
Mr Paul Ormerod, an economist and Fellow of the British Academy of Social Sciences, writes on a range of topics to include a recent pamphlet on Happiness, Economics & Public Policy.
Dr Rachel Perkins, clinical psychologist, Director of Quality Assurance & User/Carer Experience at an NHS Trust, user of mental health services, and Vice Chair of Rethink.
Speaking against the motion:
Professor Lord Richard Layard, Emeritus Professor of Economics at the London School of Economics, where he is Head of the Programme on Well-Being, and author of Happiness – Lessons from a New Science.
Dr Carmine Pariante, consultant psychiatrist, Head of the “Stress, Psychiatry and Immunology Lab” at the Institute of Psychiatry, and expert on stress hormones in mental health.
Chair: Professor Robin Murray from the Institute of Psychiatry
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33rd Maudsley Debate: Just or unjust
This house believes that psychiatrists are unable to resist the seductive messages on the pharmaceutical industry.
Speaking for the motion: David Healy, Professor of Psychological Medicine at the University of Cardiff. Prof Healy is arguably the most vocal critic of the influence of the pharmaceutical industry on the academic freedom of psychiatrists. A psychiatrist and former GP, Dr Peter Aitken (Director of Research and Development, Devon Partnership NHS Trust) has experience of working in the pharmaceutical industry and will second the motion.
Speaking against the motion: Prof. David Taylor is chief pharmacist in the South London and Maudsley NHS foundation Trust, and is the lead author of the Maudsley Prescribing Guidelines, which has become the de facto standard reference for clinical psychopharmacology in the UK. The second opponent will be Prof Tony Hale, Professor of Adult Mental Health at the University of Kent, a psychiatrist with experience working in the drug industry.
Chair: Robin Murray (Professor of Psychiatry, Institute of Psychiatry)
Prior to the debate, a significant majority of the audience supported the motion.
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32nd Maudsley Debate: The race blame game
This House believes that the Mental Health Bill 2006 will improve mental health care in England and Wales
After 8 years of fraught controversy, Parliament is now debating the Mental Health Bill 2006 to amend the Mental Health Act of 1983. Strongly backed by government as introducing overdue updates to the law and necessary measures for public protection, the Bill is as fiercely opposed by the united forces of the Mental Health Alliance, a coalition of 78 organisations from across the mental health spectrum campaigning to secure better mental health legislation for England and Wales.
The debate takes place at an absolutely critical point. The Bill has passed its first, second and committee stage readings in the House of Lords in January, and is expected to come to the House of Commons before Easter. Time is short for all sides to enter the debate and make their views known.
Speaking for the motion are two distinguished Forensic Consultant Psychiatrists: Professor Tony Maden, Professor of Forensic Psychiatry at ImperialCollegeLondon Professor Tom Fahy, Professor of Forensic Mental Health, Institute of Psychiatry, King’s College London
Speaking against the motion are: Dr. Rowena Daw, Vice-Chair, Mental Health Alliance Baroness Elaine Murphy, an Old Age Psychiatrist, is an independent crossbench peer, and is Chairman of Council, St George’s, University of London.
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31st Maudsley Debate: Genes are a patient's best friend
This house believes that charges of institutional racism in psychiatry damage patient care.
This highly controversial subject has received a great deal of attention recently, in large part stimulated by a commentary published in the British Medical Journal by Professors Swaran Singh and Tom Burns*. This commentary argues that current approaches to addressing ethnic inequalities in mental health and mental health care are not based on the best available evidence. Instead, the authors argue, unsubstantiated charges of racism in psychiatry drive current initiatives to reduce ethnic inequalities, the result being that other causes are ignored and patient care suffers. The implications of this analysis for mental health services and policy are far-reaching. *Singh, S & Burns, T (2006) Race and mental health: there is more to race than racism. BMJ, 333, 648-651
Speaking for the motion: Professor Swaran Singh, from the University of Warwick, and Professor Robin Murray, from the Institute of Psychiatry,
Speaking against the motion: Professor Kwame McKenzie, from University College London and the University of Central Lancaster, and Mr Lee Jasper, Senior Adviser on Equalities for the Mayor of London
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In the last few years the identification of the first susceptibility genes for schizophrenia has offered the prospect of a better understanding of the condition and better prediction of the outcome of those who develop it.
While most psychiatrists and their patients recognise the role of environmental risk factors in the aetiology of psychiatric disorder, many are distrustful of psychiatric genetics which still pays the price of an ancient stigma.
This debate asks whether we should continue to regard psychiatric geneticists as closet fascists or whether it is time to rehabilitate the reputation of psychiatric genetics.
The debate will be chaired by Simon Wessely, Professor of Epidemiological and Liaison Psychiatry the Institute of Psychiatry and Director of King’s Centre for Military Health.
Speaking for the motion: Prof. David Collier, Professor of Neuropsychiatric Genetics, Institute of Psychiatry; Prof. Robin M Murray, Professor of Psychiatry, Head of Division of Psychological Medicine, and Psychiatry, Institute of Psychiatry.
Speaking against the motion: Prof. Richard Bentall, Professor of Clinical Psychology, University of Manchester; Prof. Peter Beresford, Professor of Social Policy at Brunel University
If you wish to download the debate in MP3 format, right click the following link as "Save target as" Download the 31st Maudsley Debate Podcast