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Columns Correspondence columns the columns correspondence HoNOS-ABI: ‘You don’t read my papers Bulletin, September 2004, 28,317-318). Whilst there may indeed be a paradigm an under-utilised anymore’: an investigation shift underway in a ‘postmodern’ direc- into the use of Barbra resource? tion, running counter to this is just as Streisand song titles in the potent a trend, which has a distinctly Consistent use of outcome measures psychiatric literature ‘modernist’ flavour. If modernism is a across specialist centres is vital to assess paradigm encouraging empirical measure- the effectiveness of interventions and As long standing fans of Barbra Streisand, ment, reductionist classification, techni- guide policy development. It is important we read with interest the papers from Drs cism, etc., then one need not look beyond to have a global yardstick to compare Cunningham and Bromley entitled ‘You one’s everyday practice to see that outcomes. However, as noted by Gilbody don’t bring me flowers anymore: an ‘modernist’ values dominate and are likely et al (2002), this often does not happen. investigation into the experience of to do so in the near future. Many of us The sequelae of brain injury are complex stigma by psychiatric in-patients’ express reservations about an emerging and rehabilitation programmes imple- (Psychiatric Bulletin, October 2004, 28, psychiatric culture permeating all areas of mented to treat brain-injured individuals 371-374). It seemed strangely familiar to training and practice, which places are multi-faceted. In response, the Health us, a case of ‘Second Time Around’.Where disproportionate emphasis on that which of the Nation Outcome Scales - Acquired had we seen that title before? In-depth can be measured, compared and tabu- Brain Injury (HoNOS-ABI) was designed research of our own curriculum vitae lated. CPD points, star ratings, crude and introduced in 1999. Courtenay (2002) provided the answer - we had already performance indicators such as ‘bed proposed that the under-utilisation of published a paper on the same subject occupancy days’, requirements for judge- outcome measures resulted from lack of with the same title (Weiner et al,1999). ments about risk to be denoted in training and limited availability. The So could this be our first citation? Sadly discrete categories such as H M or L are HoNOS-ABI has been made widely not. What we thought was an ‘Evergreen’ but a few examples of the ‘symbols’ of this available in the UK. paper had failed to register in Drs culture. In order to evaluate the use and Cunningham and Bromleys’ ‘Memory’.We Secondly, some branches of psychiatry application of the scale nationally, we were initially upset, it was indeed a ‘Cryin’ will be resistant to accommodating the distributed a questionnaire by e-mail to Time’.‘What Kind of Fool’ are they, to postmodern model, which holds knowl- consultant psychiatrists at twenty major have ignored our efforts? But on reflec- edge to be tentative and partial, and brain injury units across the UK. There was tion we decided that there should be ‘No replaces absolute truth claims with ‘rela- a 35% response rate; one of the respon- More Tears’. Provided that the Bulletin tive’ or ‘pluralistic’ truth. The challenge dents used a specialised HoNOS-ABI publishes this letter and gives us our cita- for psychiatry to tolerate ambiguity is designed for children and another two tion, we can go back to ‘The Way We more likely to be met at the non-coer- employed the scale regularly. None of the Were’.We can then all agree to a mora- cive end of the spectrum than at the others used the scale as part of routine torium on the use of Streisand titles in the criminal justice interface. The criminal clinical practice, and perhaps the lack of psychiatric literature, in which case it will justice system relies much more on response from others indicates the same. be ‘Happy Days are Here Again’. absolute or dogmatic assertions and There appears to be a large hiatus encourages suppression of ambiguity in between the discussion of outcome WEINER, A.,WESSELY, S. & LEWIS, G. (1999) ‘Youdon’t psychiatric judgements around risk, bringme flowers anymore’:ananalysis of gift giving to measures in research literature and the dangerousness and diagnoses. Whilst medical and psychiatric inpatients. Social Psychiatry & application of scales in routine clinical Psychiatric Epidemiology, 34,136-140. this is perhaps understandable given practice. Could it be that different scales that such judgements lead to very are utilised across centres? The clinical *Simon Wessely Institute of Psychiatry,Weston unambiguous disposals, the notion of a effectiveness of outcome measures can Education Centre, Cutcombe Rd, London truly postmodern psychiatry remains only be maximised if they are all SE5 9RJ, Glyn Lewis University of Bristol, illusory. standardised across the nation. Andrew Weiner University of Bristol COURTENAY, K. P. (2002) Use of outcome measures LAUGHARNE, R. (2004) Psychiatry in the future.The by psychiatrists. BritishJournal of Psychiatry, 180, next15 years: postmodern challenges and 551. opportunities for psychiatry. Psychiatric Bulletin, 28, GILBODY, S. M., HOUSE, A. O. & SHELDON,T.A. (2002) 317-318. Outcome research in mental health. British Journal of Psychiatry, 181,8-16. C. Marke Lishman Brain Injury Unit, Postmodern psychiatry: Tony B. Benning Locum Consultant Psychiatrist, *E. Leigh Lishman Brain Injury Unit,The Maudsley an illusion? Haringey Dual Service, Maple Unit, Q1Block, Hospital, Denmark Hill, London SE5 8AZ, UK, St Ann’s Hospital, St Ann’s Road,Tottenham N15 3DT e-mail: [email protected], S. Fleminger I read with interest Laugharne’s article and HaringeyAssertive OutreachTeam (East Lishman Brain Injury Unit about postmodern psychiatry (Psychiatric Sector) 35.

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