‘The Netherlands is the best country if you have psychological problems’
There is a lot of grumbling in the supporters of Elnathan Prinsen, who will say goodbye today during a conference for psychiatrists as chairman of the Dutch Association for Psychiatry (NVvP). Psychiatrists groan under the pressure of work, complain about the lack of autonomy and lack of patient contact. They grumble about administrative burdens, about health insurers and the health care system. The profession could possibly be limited to ‘a purely business service’, according to the well-known psychiatrist Damiaan Denys. During a period of four out of ten Dutch people will develop a psychiatric disorder at some point in their life.
Denys, your curator as chairman of the NVVP, speaks of a crisis in psychiatry. Do you see it that way?
“The word crisis comes to his credit. But the Netherlands is the best country to live in if you have psychological problems. How can you then speak of a ‘crisis’? However, a lot is expected from psychiatry. We must, for example, prevent society and citizens from any danger and be people, the future malleable, looking for the malleability of life. Psychiatry has also been given a major role. “Help me when I suffer,” they ask. But psychiatrists are not always able to provide adequate help. And that’s fine, of course, even if it’s often called.”
Fine?
“Yes fine. I want to compare psychiatry with other parts of medicine. Take neurology. What neurological disorders can a neurologist actually cure? And what is the success of an oncologist? His treatments are often aimed at extending life by a few months. Look at COPD from diabetes; if you have those diseases, you have them for the rest of your life. Most illnesses are just chronic. This is no different in psychiatry: patients have to learn to live with it. And it’s good to live with. We can discuss it. And, after a few weeks of treatment, people with short-term psychotic disorders are often completely better. A mania can also disappear quickly after the intervention of a therapist – with always a risk of relapse, later in life. It is therefore not true that psychiatry is inferior to other branches of medicine in terms of success. Sometimes it is even the other way around: There are studies that psychotropic drugs are at least as effective as the medication from an internist. In addition to pharmacotherapy, there is also psychotherapy, which makes these kinds of strange effects even more interesting.”
But research also showed that to help one patient get rid of his obsessive-compulsive disorder, 25 people become obsessive. And so there are more figures about the effect of treatments.
“Yes, but what does that say?”
Well, that there are 24 patients with forced unnecessary and without good results.
“So I think that’s special. How many people take a cholesterol-lowering drug? How many people have to take that drug to prevent one death? That is much more than those executed for coercion. But we don’t say about cholesterol-lowering drugs that the rest should just stop taking it, do we? Medicine has numerous interventions – often combined interventions than psychiatry knows. For those 24 patients, it does not mean that they do not benefit at all from treatment. selection: the image that psychiatry is less successful is incorrect.”
Elnathan Princes (40) Among other things, he worked as a psychiatrist in the crisis service in Deventer and was manager of the emergency mental health care division at the Dimence care institution. During his exclusion from the Dutch Psychiatric Association, he also worked as a psychiatrist at the Rijnstate Hospital in Arnhem. In the 150-year existence of the NVvP, he was the first chairman who was not a professor.
Why did that image arise?
“Maybe it has to do with the elusiveness of a mental disorder. You cannot measure this exactly, you cannot always indicate exactly when a disorder starts and what the course will be. On the contrary, it has an enormous need, effects and claims; that’s real science! Blood samples, for example, to determine the cholesterol level, for example. But what does it say if there is an elevated cholesterol level? Nothing. There is only a risk of high blood pressure in combination with smoking. But how high is exactly?
“We psychiatrists can also measure things, for example with questionnaires. We also know a lot about risks. That going through trauma at a young age is a risk factor for a psychological problem later on.
“When a cardiac surgeon implants a pig heart in a patient, it is world news. We are those kinds of innovative, imaginative examples. We have known for ten years really as deep brain stimulation, which was originally developed for Parkinson’s patients. Certain patients, for example under duress, benefit from stimulating parts of the brain with electrical impulses.
“But this treatment is far from being effective and is still under development. We have known ECT, electroconvulsive therapy (electroshock therapy, ed.) for much longer. I did the latter with a patient who had suffered from major depression for twenty years, as well as several other conditions. After four treatments, the husband said: ‘Doctor, you told us beforehand that it is not a panacea. But it is a miracle cure. After twenty years I have my wife back.’ Giving such therapy to people who do not respond to other treatments we. But it also applies: often it does nothing.
“On balance, psychiatry is the most socially relevant field of medicine. Where many other doctors and specialists treat illnesses in people over seventy, we often see young people. A mental disorder starts on average at the age of eighteen, three quarters of the disorders manifest themselves before the age of 24. Those people still have their whole life ahead of them. This also shows that, for example, dropout is largely due to psychological disorders.”
If healing the psyche is so relevant, why is the focus on physical well-being? Why is so little money going to mental health care?
“Okay, let’s start at the back. But thinking and awareness about the importance of metal is changing. Of course that doesn’t happen quickly, that’s how it often happens in the Netherlands. For example, schools in Brabant are running the Storm project to identify mental problems in young people and to increase their resilience. So there are more examples. Courses are also given to educate people with patients – for schools and companies.
“Meaningfulness is undervalued in our current society. By meaning I mean more like religion and spirituality, it is also about the feeling of belonging to something, to an association, the neighbourhood. You have to be in touch with people around you, to feel that you have something profound about life. Those who do not have that from less, extra if there is material and mental setback. Anyone who thinks above all that life can be made, that it is mainly about ‘it’ and above all wants to roll through life as easily as possible, will have a hard time if the opposite turns out to be the case. The resilience is then clearly less. The other side is that if you get mental problems at a young age and it is sometimes more difficult to find the meaning of life.”
Okay, so the citizen has to change. But doesn’t that also apply to society?
“Yes, the stigma of mental health problems is great. In terms of things, a lot has to change, on all levels. I mean: if a school doesn’t know how to deal with your mental problem, you can’t get a diploma and therefore you can’t get a job. Then you can draw out what the rest of your life looks like. with regard to the implementation of the labor market with regard to the implementation of the labor market. While we also know that the labor market will eventually come to a standstill due to aging and having a job is also important for recovery. Try changing the school system, the labor market and healthcare, so that they fit together well.”
“Let me come to my personal situation, which I know best. Our son has suffered a serious car accident brain injury. He is not intelligent, but can only function at his old level for fifteen minutes. Then he needs to rest, recover from stimuli. But it is already made difficult for him at school. Of course he is in special education, but every child has his own disability and that creates a lot of incentives. Combined with what my son needs, that turns out badly. He never gets his diploma this way, which makes the chance of a job small and thus the chance of his life on benefits is destined.
“I can best imagine that there is work that he can do well, if he can build in sufficient moments of rest. So the question is: How can we ensure that he gets a diploma after all? Because within the current school system it appears to be difficult to create the most optimal conditions.
“While you can also calculate the required investment for small-scale education so that he can actually finish school and get back to work. If you compare that with a benefit, the calculation seems simple. Municipalities and the government involved in that, they don’t have to pay a lifelong benefit and they get money because my son, who is permanently working, pays tax in the long term. Health insurers also benefit, because people who feel good about themselves, who work, make less use of healthcare. So there are benefits on all sides, but not who should make the investment: the school.
“You can only arrange these kinds of things in conjunction, in the network around the person, with a cost analysis in the long run. But go for it. If children get mental problems, there are consequences and consequences. Really, in practice there are the parents often do it alone, all that misery also with waiting lists, they mourn the loss. We are not even able to relieve them! I am highly educated, know something about legislation and care, but now we have also to private education – that is very expensive and who is it for?So the coherence of things has to change, not only for people with psychological problems, but also for the rest of society.
“I am convinced that things can also be improved within mental health care. In fact, I believe that the most health benefits can be achieved by changing an organization, even more than with the introduction of a new treatment intervention. If you find that, you should be where you have influence. That is why I am going to work as a director at the Parnassia Group – but I will continue to treat one day a week. It is all about them in the end.”
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