Where Psychiatry took a wrong turn

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Wednesday, February 2. 2011

Where Psychiatry took a wrong turn

Psychiatry made a wrong turn when it tried to turn its back on the heart and soul, and appeared to decide that it was better, or easier, or most cost-effective, or more "medical"-sounding, to view humans as bags of chemicals and containers of symptoms.

In his "Reflections on Sacred Texts," the Boring Old Man sees it pretty much the way I see it (h/t to Dr. X). I have a similar aversion to the DSM. My "sacred text" is the individual with the problem. Most patients I see do not fit neatly into any box, and I do not try to squeeze them into one.

The good doctors of most patient-oriented specialities - Internal Medicine, Family Practice, Surgery, etc. - seem to take more personal interest in understanding their patients and their lives than many "Biological Psychiatrists" do these days.

Psychiatry spans a broad range of problems, from pure brain abnormalities to regular difficult life problems, with complicated mixtures being the most frequent.

Fortunately for our patients, some us are still interested in getting to know them and in figuring out what ails them beyond their symptom checklist.

Posted by Dr. Joy Bliss in Our Essays, Psychology, and Dr. Bliss, The Culture, "Culture," Pop Culture and Recreation at 17:56 | Comments (5) | Trackbacks (0)

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I can't help but think that this emphasis on categorization or labeling of each patient into some neat little box isn't due to government intervention in the health care system. While the DSM existed prior to the federal governments biggest intrusion into medicine, i.e. Medicare, it wasn't until then that the CPT procedural codes were developed. In "accepting" the feds intrusion into the exam room, we have become more concerned with finding a label that fits the government's rules for payment and documenting a history and physical that some insurance auditor will find useful rather than placing the patient first.

Of course, in accepting third parties, such as the government in the case of retirees or employers in the case of workers, as being responsible for paying for their medical bills, patients have unwittingly supported this arrangement.

It's a sad situation when I, as a retired physician, notice that my doctor is checking his watch during my visit even when I come with a complicated problem.

#1 Mike M on 2011-02-02 20:45 (Reply)

Schizophrenia. With that one word, at least a part of your argument is in ruins. You blow a kiss in that direction, but it never seems to be part of your main point.

I have significant agreement with your premise that modern psychiatry pretends to a scientific rigor that is often illusory, brought about by cultural and political ideas and the "Physics Envy" endemic to the social sciences. But you consistently treat real medical knowledge as if it of a piece with the great wall of mush (which may or may not be resolving into something more precise. Some of both, I think).

You can sit for five minutes with some floridly psychotic or manic patient, prescribe the appropriate Abilify or Depakote, adjust the dosages on the basis of the unit staff reports over the next few days, and change them forever, without really knowing them or understanding them in the least. We do it all the time. Sometimes it really is analogous to antibiotics. It's not the norm, even in our narrow area, but it isn't rare, either.

#2 Assistant Village Idiot (Link) on 2011-02-02 21:21 (Reply)

I believe I did mention the spectrum in my post. However, I'll stand by my view and I think your comment reinforces it.

#2.1 Dr. B. on 2011-02-03 08:21 (Reply)

Let me add, the phrase "took a wrong turn" is revealing. Before the turn, we believed that autism was caused by cold rejecting parenting, schizophrenia by homosexual panic, and mania by internalised unrealistic parental expectations. We were trained to ask about toilet training, whether the child was breast or bottle-fed, and all religious belief was regarded as pathological.

Any turn would have been a good turn, I think.

#3 Assistant Village Idiot (Link) on 2011-02-02 21:38 (Reply)

Categorizing patients goes together with the politicization of psychiatry. The Left puts all of us into economic/social categories, and sees the individual through political prisms of class warfare and political correctness.

#4 Ben David on 2011-02-03 03:21 (Reply)

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Wednesday, February 2. 2011

Where Psychiatry took a wrong turn