Saturday, November 19, 2005

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.


Blogger HEADoc said...

I think we have the same philosophy.

5:17 AM  
Anonymous Anonymous said...

OK to march biologism through the streets, its head fitted with a dunce hat ,,, as long as biologism isn't confused with biology.

6:58 AM  
Blogger Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Americans love the idea of a silver bullet to "fix" them. The new wonder drugs for diabetes are supposed to turn off the munchie mechanism. Whatever happened to exercise and small portions? Thus with psychiatry. Why are so many children hyperactive? Is it environmental pollutants? TV? Lack of exercise and creative play? Immunizations? We don't know, but we'll spend a hell of alot of money to medicate these kids so they don't act out in class, but we won't spend a fraction on seeking the cause of the hyperactivity. We're pill-happy,and we often forget there's a real person on the other side of the consulting room.

8:47 PM  
Anonymous Anonymous said...


Have you seen the new French flic "Psy ou charlatan"? They don't make them that way anymore...

1:23 AM  
Anonymous Anonymous said...

It is good to find others contemplating the same things. I keep telling my colleagues that mind and spirit are getting lost in the focus on brain.

4:51 AM  
Anonymous Anonymous said...

As a child psychologist for the past 25 years, I think Dr. Andreasen is correct in her view that we sometimes over focus on biological explanations of psychiatric disorders, missing the complicated contributions of the unique life story of each individual.

Scientists who have researched the multiple of causes psychiatric disorders have learned much over the past fifty years about people's brains and minds. Yet, we still have no idea about how the brain produces the mind, or how consciousness flows from brain tissue. This brain-mind knowledge gap is a serious barrier to fully understanding mental problems.

We do know - and are learning more - that some people suffer from diseases --- depression, bipolar disorders, anxieties, schizophrenia, autism, attention deficit disorder --- and sometimes medicine for these diseases along with compassionate understanding and care saves the mental and physical lives of many.

I have witnessed many children and adolescents who have benefited from psychiatric medications and many who have benefited from psychological counseling.
Medicines sometimes help to repair a person's "hard drive." Psychological counseling often does much to repair a person's software --- revising self-image, and providing lessons in living a productive life.

Most people who have psychiatric difficulties never seek help. And many of those who seek help do not get the proper treatment.

We still need to reduce the stigma of psychiatric problems. People are suspicious of psychiatric problems that are both intangible and real.

Perhaps when there are reliable biological measures of these disorders, more people will take advantage of available treatments.

On a related note, I recommend Dr. Andreasen's new book "Creativity and the Brain"

7:53 PM  
Blogger DrDiSaia said...

It seems that these are problems with modern medicine in general. Everybody wants a "quick fix." The docs are trying to get to the next patient and the patients want to not need to come back to the office. A problem with many psychotropics is that once started there is rarely a plan to stop them. And the drug industry couldn't be happier.

9:56 PM  
Blogger Grace O'Malley said...

Great blog! Especially enjoyed this discussion and will be sure to check back. Keep up the good work.

10:13 PM  
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8:58 AM  

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