Don't forget to connect with patient experience: conversations on trust, ties and surprise At the time of writing, we are mourning the loss of Stephen Hawking, whose contributions to science I previously celebrated.
1Based on an analogy with Hawking's theories of time and space, knowledge can improve our lives, yet what is known is changed by use in the real world. Indeed, the scaling up of innovations usually [includes measures to specifically] guard against knowledge and evidence being fractioned or changed during the process of application and transmission through professional networks and health systems, and in public discourse. Is this always desirable or effective?We need the Hawking innovators, patients and scientists, in psychiatry. Recent research on the cultural transmission of innovation has shown how progressive and remarkable individuals (like Hawking) can have a disproportionate influence on advances in society, more so than shared social movements, as these face greater resistance, less diversity of opinion and inherent expectations of conformity. By contrast, innovators act like cultural reservoirs and incubators that permit the selection of advantages (social, cultural or biological). 2,3 There is an important place for more variation of views and approaches and protection of local and personalised approaches to recovery, seeing patient as innovators. Exceptional people and exceptional views should be welcomed as avenues to improve mental healthcare. Yet, much evidence is lost if it is perceived to not have generalisable survival value for large numbers of people in the health system. The role of patient experience and perspectives and choice as a determinant of which bodies of knowledge are retained and promoted -cultural selection -has not been well studied. This necessarily requires [that interventions are subject to] adaptation and refinement to meet personal needs. Information about [refining] adaptations could be especially valuable for advancing the care of complex health conditions that are persistent, distressing and challenging for clinicians. Gathering patient experiences for these conditions and similar contexts could open up new therapeutic avenues. Patient experience can also help to reconcile contradictions in the evidence.Knowledge about the role of hospital admission in suicide prevention is controversial. 4 Large and Kapur (pp. 269-273) debate whether in-patient admission is a potentially harmful experience for patients who are experiencing suicidal ideas; whether admission leads to dependence and a lifting of agency and empowerment. The counterargument is that the risk of suicide is intrinsic to an illness experience. Studies of patient experiences are needed here, and these may help to deepen our understanding of what works, where and for whom. For example, suicidal patients value a sense of safety and security, connection, protection and control, and mutual recognition and confirmation, rather than technical or physical aspects of the care environment. 5,6 There is more to c...