Patient Commentary: Online screening for depression—old (paternalistic) wine in new (digital) bottlesBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4207 (Published 13 September 2017) Cite this as: BMJ 2017;358:j4207
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Re: Patient Commentary: Online screening for depression—old (paternalistic) wine in new (digital) bottles
Thank you for the wonderful commentary. Eerily, it echoes my own thoughts to such a degree that I had to do a double take to check who the author was! It is good to know there's at least one other person out there who feels this way.
I should say, though, that from my own perspective as a psychiatrist in the U.S., it is both the system and the public who demand a narrow medicalised view of psychological distress. Any attempt to broaden the conversation is met with outright hostility from all, including patients. To try to not slap a DSM diagnosis on anyone who walks through the door, and worse, to try and minimize medications instead of prescribing them in a knee jerk fashion, is akin to professional suicide.
Attention to the psyche and the outer world were once par for the course for the psychodynamic psychiatrist and for systems oriented ones. Listening to the patients story was the sine qua non of psychiatry. These days, outside perhaps of some old timey consulting rooms, mindless bio-psychiatry has annihilated all else.
Discussion of meaning and context are practically forbidden. I have been told directly to "leave the psychotherapist outside the door". More commonly, reductionism is the inevitable end result of a mental health industry that revolves around coding, billing, 15 minute 'medchecks', and pressure to move patients along the assembly line as efficiently as possible.
Both psychiatrists and non psychiatric physicians have both fallen prey to simplistic, reductionistic descriptions and treatment. Some psychiatrists are quick to proclaim their disdain for 'Freud' and their conviction in the supremacy of 'scientific psychiatry', which in truth is anything but scientific. Others claim they do therapy in every 15 minute 'medcheck'. Yet others, wishing things were different but feeling coerced, are quick to give assurance that yes, they do give medication. It's not the fact that these doctors do indeed prescribe medications that is the issue; it's the unconsciously defensive reason why they state this. This is the sign of a 'proper' psychiatrist, after all.
At times it seems the worst offenders in this regard are social workers and other non-M.D therapists, who believe in the fiction of "chemical imbalance on the brain". They are so convinced that any psychological distress must be given a diagnosis and a prescription, that just like patients, they are aghast if you explain this is not the case.
This state of affairs, at least here in the US, has long since devolved beyond the point of no return. If rational, psychodynamic, systems oriented mental health services exist in any country, they should be carefully preserved and nurtured, like little redwood saplings, in the hope that one day, in a better world, the area devoted to clear cuts and concrete will diminish and the old growth forests will flourish, for our descendants to wander in, and to wonder.
Competing interests: No competing interests