Tuesday, October 18, 2016

Psychiatrists are still needed

Frank Blankenship comments on Mad in America about my previous post on "Psychiatry as a cultural system". He suggests there's a simpler explanation for why psychiatrists are resistant to giving up the biomedical model than because it's like a religion - they'd be out of a job!

I do understand his view. I too was schooled in the biomedical perspective that mental illness is brain disease. It's such an ingrained perception in society that people don't think to challenge it. Medical training reinforces this indoctrination (eg. see previous post and my Lancet Psychiatry letter).

I also agree that psychiatrists are worried that non-medical professionals are taking over their job (eg. see previous post). This fear encourages them to adopt a biomedical model by focusing on "what doctors do best".

However, where I disagree is that it is important to remember that medicine is psychosocial as well as biological, if only to ensure that practice is patient-centred. It's not purely a bodily exercise. Even more so, patients go to doctors with physical symptoms which have a psychological origin. Medicine has to adopt a sociopsychobiological approach to provide an integrated perspective in practice (see previous post).

I've also mentioned before my disagreement with Peter Kinderman, who has argued that mental health care should actually be non-medical, as it is not treating 'illness' as we understand it (see
previous post). From his point of view, doctors should concentrate on the biological aspects of mental health care and this should be seen as a minority activity within the field as most psychiatric presentations are psychosocial, not biomedical, in origin. By contrast, Peter Sedgwick, in the same way as I have been saying, would have regarded Peter's position as ‘psycho-medical dualism’, because psychosocial approaches should not be separated too much from medicine. Sedgwick adopted a unitary concept of illness, beneath which is subsumed both physical and mental aspects (Cresswell & Spandler, 2009).

Conceptual conflict exists about the nature of mental illness and this is as much of an issue for psychiatrists as it is for specialists from other mental health disciplines. Merely putting psychiatrists out of a job won't solve this dilemma. And, medicine needs the specialty of psychiatry.


Mark p.s.2 said...

Regarding "Merely putting psychiatrists out of a job won't solve this dilemma."
You do not put a psychiatrist out of a job, you have people who want drugs, and need psychiatrists to prescribe/give legal drugs. As long as a person needs a prescription for drugs, society needs psychiatrists. ( legalize all drugs for adults)

Remove the "presumed guilty" of psychiatry and then you have something.
“It is better one hundred innocent Persons should be found guilty and suffer (psychiatric drugs and psychiatric prison), than that one guilty Person should escape.” says Psychiatry.

Anonymous said...

I agree that psychiatrists are still needed.

However we also need alternatives to psychiatry for those of us who don't like being coerced to swallow psychiatric drugs. Because they cause damage to our systems. I speak from 50yrs and more of personal experience. Having witnessed the damage done and picking up the pieces after.

Dr M said...

Of course psychiatrists are still needed! I 100% agree after seeing firsthand from 23 years of experience the difference we make in our patients lives.

Eric Setz said...

We have here a discussion based on the wrong question. The correct question is " do we need doctors who believe their belief systems are more important than their patients welfare", Science and medicine are not religions. The scientific method includes building models to explain and predict phenomenon. Where these models fail then it is important to go back and re-examining the assumptions made in building these models. Science evolved from natural philosophy which started by focusing on what was measurable and ignoring what wasn't. The original natural philosophers did not argue that nothing else existed. The concept that thinking, the mind and personality are simply a product of the brain and genetics is very appealing but does not stand up to examination. If you treat a symptom all you will just get symptom relief. If you treat a cause then you will get a cure or recovery. Also if you get a cure or recovery then you treated a cause. These hold true in all cases excluding spontaneous recovery. All the bio-medical doctors who are treating their patients with drugs are getting is symptom relief. If you focus on: making the patient better rather than trying to cure them, on what is right about them rather than what is wrong with them, encouraging and training them to be successful in life while using the minimum medication you will get a much more successful outcome.

Evidence that people do recovery from Schizophrenia http://www.power2u.org/evidence.html

I not only worked in a psychiatric hospital but also suffered from a psychotic episode. The most help I got was from a staff member who explained regression to me. Please do not be afraid to try this. Explain regression and tell your patient to come to the present. The least helpful thing was the staff member who became obsessed with what was wrong with me. If I had been mentally ill then there must be something wrong with me. Before I left I confronted him with my opinion that his obsession with what was wrong with me was due to his fear of mental illness -- if there is nothing wrong with me then what is to stop him from becoming mentally ill. That yes I had been severely introverted and regressed but now I was neither.