Background: Globally interest has grown in promoting the rights of patients, especially psychiatric patients. Two core elements of patients’ rights are the rights to be treated in a dignified manner and to give feedback about services. Psychiatric patients may feel treated in an undignified manner, especially during involuntary hospital admissions.Aim: We explored the relationship between Mental Health Care Act 17 of 2002 (MHCA) status and dignity-related complaints.Setting: The study was conducted at a specialist state psychiatric hospital.Methods: We reviewed 120 registered complaints by psychiatric inpatients, retrieved the clinical files, and analysed 70 complaints. Fisher’s exact tests described the relationship between patients’ MHCA status and the frequency of dignity-related or other categories of complaints. Logistic regression analyses were adjusted for potential covariates.Results: Most complaints were from single, literate male patients, aged 30–39 years, with mood disorders. Most complainants were admitted involuntarily (60%). Dignity-related complaints (n = 41; 58%) outnumbered nondignity-related complaints (n = 29; 41%). The proportion of dignity-related complaints was higher in involuntary (64%) and assisted (60%) patients than in voluntary patients (44%). Dignity-related complaints were not significantly associated with MHCA status (χ2 = 2.03 and p = 0.36). Involuntary patients were more than twice as likely as assisted and voluntary patients to complain about dignity-related matters (Odds ratio [OR]: 2.25; 95% confidence interval [CI] [0.71; 7.13]; p = 0.16).Conclusion: Involuntary patients are more likely to complain about dignity-related matters. Qualitative research is recommended for a deeper understanding of patients’ experiences during admission.

This article aims to describe the difference between descriptive and dynamic psychiatry. As part of the latter every psychiatrist should be able to construct a psychodynamic formulation. A psychodynamic formulation, an indication of psychological mindedness, helps the psychiatrist to recognize the unique, personal aspects of the illness and the life of the patient. The formulation furthermore helps with the initial orientation towards the patient: it anticipates and predicts how the patient might interact with the psychiatrist and how defenses and underlying conflicts will manifest themselves in treatment. The formulation can therefore be very useful in the treatment of any patient, since it can help to understand and manage the patient's attitude towards being prescribed medication, as well as compliance and prognosis and serve as an initial guide in the psychotherapy. The psychodynamic formulation is unfortunately seldom incorporated in the psychiatric presentation of patients; guidelines are therefore given to especially help psychiatric trainees with the construction of such a formulation.

BackgroundThe biopsychosocial model emphasises the role of human relationships in psychiatric care. Therapeutic relationships that improve treatment outcome and provide containment are desperately needed by patients in distress. Despite the importance of human relationships, they are neglected in an era dominated by biological psychiatry.AimThis qualitative research project explores the experiences, perceptions and subsequent needs of patients. The role of therapeutic relationships, and the factors that patients felt influenced their relationship with their therapists, were examined.SettingA psychiatric training hospital in South Africa.MethodThirty in-depth semi-structured interviews were conducted with 15 inpatients. A qualitative, explorative-descriptive, collective case study design was used. Purposive sampling ensured maximum variation and richness of information. Grounded theory methods were used to analyse transcribed recordings.ResultsPatients valued therapeutic relationships that provide containment and potentially obviate the need for ‘measures of control’. A model of containment was developed to demonstrate the various factors that interact in the attempt to provide containment to patients in a psychiatric training hospital system.ConclusionTraining hospitals should emphasise the role of therapeutic relationships in achieving containment and positive treatment outcomes. In developing countries, severe shortcomings in mental healthcare resources hinder the building of personal therapeutic relationships.

BackgroundAlthough religion and spirituality are increasingly recognised as important in the understanding and treatment of patients, there are also concerns about their role in psychiatry. The recommendation for the integration of spirituality in the approach to psychiatric practice highlights the importance to further think about this practice.ObjectiveTo contribute to the debate on the role of spirituality in psychiatry by considering the opinions of two prominent thinkers in this field, the theologian Tillich, and the psychoanalyst Symington.MethodThe approach of Tillich and Symington to mental health problems are compared. Narcissism is focussed on, since Symington describes narcissism as the core of all pathology and states that the prime aim of psychoanalysis is the transformation of narcissism. The contributions of Kohut and Kernberg are also briefly discussed.ResultsIn Symington’s opinion more than psychoanalysis is needed to help those in the grip of narcissism. Tillich emphasises the difference between existential anxiety and anxiety due to psychopathology. Psychotherapy can only heal the latter. Yet he also states that we are incapable of change without self-acceptance. For this a larger experience of acceptance or grace is needed, since we are incapable of offering ourselves this type of acceptance.ConclusionIn the struggle to get a grip on narcissism, good nurturing experiences, transformative selfobjects, a confrontation with the darker sides of the self and the message of ultimate acceptance are needed. Religion and spirituality have an important contribution to make to psychiatric or psychotherapeutic treatment.

If you talk about things you have not experienced, you are wasting your and other people’s time. As you continue the practice of looking deeply, you will see this more and more clearly, and you will save a lot of paper and publishing enterprises and have more time to enjoy your tea and live your daily life in mindfulness.’Psychotherapy has been viewed as a core clinical activity of psychiatrists.Is this still the case in our modern era, with more and more focus on pharmacotherapy? As we prepare for the Fellowship of the College of Psychiatrists of South Africa (FCPsych) to be the only exit examination to qualify as a psychiatrist in South Africa, it is prudent to reconsider this and related questions