Psychiatry in Dissent (Again)
Vivek Datta, Resident Physician
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seatt
Bracken et al.1 lament the current trend for senior psychiatrists to call for the further medicalisation of psychiatry. They correctly highlight the failure of the neurosciences and the new genetics to bear out the promise of revolutionising psychiatry. They then go on to suggest that psychiatry should place 'social, cultural, and psychological dimensions' at the heart of its practice and engage in 'relationships, meanings and values'. In doing so, they miss the point entirely.
Psychiatry is the medical specialty concerned with the treatment of mental illness. As such, psychiatrists are the most expensive providers of mental health care. In financially constrained times, this makes the psychiatrist's role the most precarious. The defining features of the medically trained psychiatrist are in the technical acts of making diagnoses and prescribing treatments. The increasing emphasis on psychopharmacology and biomedical diagnosis is what has secured the place of the psychiatrist as the leader of the mental healthcare team. There is nothing about the primacy of 'relationships, meanings and values' that require the extensive training or expensive services of a psychiatrist.
Whilst an irredeemably biomedical and technical psychiatry will ultimately spell the demise of the specialty, the psychiatry Bracken et al. envision would immediately render psychiatry obsolete. To be sure, 'being listened to, taken seriously, and being treated with kindness, dignity and respect' are important for all clinicians, in all areas of healthcare, but they will never form the cornerstones of a sustainable psychiatry.
We are constantly reminded that psychiatry is in crisis, be this a crisis of existence, a crisis of identity, or a crisis in recruitment.2 The real crisis in psychiatry is a crisis of purpose. Psychiatry has attempted to stay relevant and its attempts have been futile because psychiatry is relevant. Psychiatry will always be relevant, as long as we remember that it is about the medical, psychological, social and spiritual care of the mentally ill. It cannot be anything more. It must not be anything less.
1. Bracken P, Thomas P, Timimi S, Asen E, Behr G, Beuster C, et al. Psychiatry beyond the current paradigm. Br J Psychiatry 2012; 201:430-434
2. Craddock N, Antebi D, Attenburrow M-J, Bailey A, Carson A, Cowen P, et al. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 6-9.
Conflict of Interest: