Wednesday, June 06, 2018

Psychiatry should be more scientific

An advertisement article in the Guardian paid for by the Royal College of Psychiatrists uses Mary-Ellen Lynall (who I've mentioned in a previous post) to promote young doctors coming into psychiatry. I'm not sure if it really improves recruitment by speculating that "brain inflammation may be a cause of depression and in five or 10 years we could have a blood test to detect whether that inflammation is present", because this is merely misguided wishful thinking (eg. see previous post).

What worries me is that the apparent motivation for this campaign is that newly qualified doctors don't think psychiatry is very scientific. That's not surprising considering what's promoted as apparent advances in psychiatry, including seeing brain inflammation as the cause of mental illness (eg. see another previous post). Junior doctors are right to laugh at psychiatry if that's all that's on offer.

Psychiatry isn't just about physical disease, as the advertorial indicates. It's a human science, and not just focused on the brain. Nor is the rest of medicine just focused on the body and psychiatry needs to promote itself as a truly patient-centred scientific medical discipline (eg. see another previous post).

2 comments:

Chris O’Loughlin said...

Not entirely sure what the point of this is. Presumably there is common ground that people exist in social environments, that a person is more than “a brain”, but also that mental states arise from brain function (though might not be always best explained by this). To explore the biological basis of symptoms/syndromes seems inherently laudable, and hard to see why something (earlier post) is intrinsically not worth pursuing particularly when the relationship between (in this instance) inflammation and psychiatric presentations is so well established, even if hitherto rather bluntly. (Though with many successes including NMDA autoantibodies and other psychiatric presentations of autoimmune and endocrine pathologies, and even going back to general paresis). This doesn’t diminish the value of wider exploration (psychological mechanisms, humanist interpretations, social psychiatry) or interventions but supplements it, and vice versa, - unless we are heading back to dichotomous factions depicted in Faulk’s Human Traces. I find the work coming out of Cambridge, and particularly what some of the trainees have achieved, impressive and thought provoking.

Duncan Double said...

Chris

Thanks for your comment. I agree it is important to get the right balance. I’m not expecting you to be a critical psychiatrist but I am trying to encourage debate about whether functional mental illness should be seen as brain disease (eg. http://criticalpsychiatry.blogspot.com/2017/03/the-faith-of-mainstream-psychiatry.html). I also agree it’s not helpful to undermine trainees but they do need to know there is this debate in psychiatry. Some of them may be interested in Cambridge conference in September http://institute.criticalpsychiatry.org.uk/Conference.pdf (at this point in time programme is being modified to add an additional session of a service user panel).

Best wishes, Duncan