Psychiatry: "How it all went wrong."

In the New Scientist: An interview with Dr. Nancy Andreasen, professor of psychiatry and an author of DSM3. She's quite critical of modern psychiatry:

There is less emphasis on careful observation. The fundamental point is that the individual patient and his or her uniqueness should form the centrepiece of clinical practice...There is an increased tendency to make diagnosis through checklists, with less emphasis on the interesting uniqueness of each individual patient and on the humanism that lay at the heart of early psychiatry. We tend to over-biologise, we oversimplify the mechanisms of mental illness: in a reductionist framework, depression is a serotonin disease, schizophrenia a dopamine disease. But if we look only at brains, we fail to recognise the important role that personal life experiences may play in losing our minds.

It's useful for psychiatrists to remember that the word comes from the Greek psyche, which means breath, life, animating principle or spirit. Contrast that with the Greek word for mind, which is nous, or the word for brain, which is encephalon. Literally, a psychiatrist is a healer of the spirit, not of the mind or brain.

Does that explain why patients are prescribed so many drugs?

Doctors and patients began to think that most problems could be solved by popping a pill. In the US, at least, we have had some serious over-prescribing for conditions such as attention deficit disorders, anxiety and depression. Sometimes people see medicines as cosmetic surgery for the mind.

And some of those drugs can be a very mixed blessing?

Almost all medications have some side effects. The art of medicine, so to speak, is finding the right balance of dose and side effect. Some of the older antipsychotics did have side effects to do with the motor system: tremors, shuffling gait, restlessness. Newer antipsychotics have fewer of those side effects but have a tendency to produce weight gain. Some believe that modern antidepressants can cause suicide.

What's the solution to the problem of modern psychiatry?

What we need to do is collect data from all levels: molecules, cells, tissues, organs, cognitive and emotional systems, behaviour, exposure to environmental influences. This is going to require rather a lot of data. I love psychiatry because when we do it right, it is the only speciality that emphasises the understanding of individual human beings within the context of a unique environment and personal life history.