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In the past he had attempted to gain access to 10 Downing St, Buckingham Palace and the American Embassy. He responded well to treatment, but he was consistent in his refusal to accept it other than under legal compulsion. When well he would acknowledge that his actions had been ill advised, but he attributed this to understandable outrage rather than mental illness. He insisted that he only wanted to talk to powerful people. He denied any intention to harm them. Ken’s refusal to accept treatment meant that there were recurrent episodes of disinhibited and alarming behaviour.

Main points in this chapter 1. Psychiatrists’ claim to special expertise in helping people suffering from mental disorder arises solely from their scientific training. 2. The essence of science is intellectual rigour and, as far as possible, psychiatrists need to apply this to all areas of their practice. 3. Evidence, experience and context are the principle factors that legitimately influence clinical decision making. 4. It is the professional’s responsibility to hold these three ‘forces’ in balance.

People are urged to confront those things that frighten them the most and which they most want to avoid. People who do not want medication are persuaded to take drugs, whilst people who like taking drugs are encouraged to stop. There 24 Chapter 3: Treatment objectives seems to be an underlying principle of treatment that, according to mental health services, whatever you want is the opposite of what is good for you. Sometimes we believe this so strongly that we force people to do things they do not want to do.

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