Postpsychiatry:'Riverdance' for traditional psychiatry
Traditions change in any profession as new knowledge emerges and
sometimes a revolution is necessary if a profession stagnates. Dr's
Bracken and Thomas eloquently outline a new direction for psychiatry based
on a thoughtful philosophical critique of the history of psychiatry,
providing a much needed challenge to the current dominant paradigm of
bioreductionism. Traditional biological psychiatry does not serve many of
our patients well.(1) The psychobable of the early 20th century has been
replaced by biobabble. Physicians are routinely informing patients with
mental health disorders that their condition is caused by a biochemical
imbalance that can be corrected by drugs in the same way that insulin
treats diabetes, despite the limited basis for this belief.(2)
Lipowski has commented on the disempowering effect of this belief on
patients : "Chemical imbalance confuses the distinction between etiology
and correlation, cause and mechanism, a common confusion in our field. It
gives the patient the misleading impression that his or her imbalance is
the cause of his or her illness, that it needs to be fixed by purely
chemical means, that psychotherapy is useless, and that personal effort
and responsibility have no part to play in getting better" (3)
Why do psychiatrists view neurophysiological approaches to mental
illness as more valuable than others? The desire to remain a legitimate
'medical' specialty is certainly one, the pervasive influence of
pharmaceutical companies another, the political need to distinguish
ourselves from the non-medical therapists may also play a part.
The eminent Harvard psychiatrist and anthropologist Arthur Kleinman
has made observations similar to those of Bracken and Thomas on the
limitations of the dominant current concepts in psychiatry: "In this
golden age of biomedical research and treatments, we are witnessing the
problem of what shall become of symbolic healing. Perhaps, over the next
century in North America, it will wither away in the profession of
medicine, to be practiced only in the folk and popular areas of health
care. Perhaps it will continue to hang on as a marginal but inalienable
aspect of psychiatry and the primary care professions, which themselves
will be transformed into the high-technology image of the rest of
medicine. This question must be asked of psychiatry per se: Can it
continue to legitimize psychosocial problems, humanistic interest,
symbolic interventions as medical concerns? If not, will psychiatry as we
know it survive? Alternately, is there the possibility that by opening
these medical concerns to the human sciences (psychology, sociology,
anthropology, history, philosophy, literary studies) - by doing these
things that run against the grain, so to speak - that psychiatrists can
make the meaning of illness experience and the social sources of human
misery and symbolic healing an integral part of a more broadly conceived
science of medicine and health care?" (4)
Drs. Bracken and Thomas are to be congratulated for rekindling this debate
on the future of our profession.
References:
(1)Experiencing Psychiatry,User's Views of Services
Rogers, A., Pilgrim, D., Lacey R.,
Macmillan Press (1993)
(2)Blaming the Brain
Valenstein, E.,
The Free Press (2000)
(3)Psychiatry, Mindless or Brainless, both or neither?
Lipowski, Z.,
Can. J. Psych.: 34:249-254 (1989)
(4)Rethinking Psychiatry
Kleinman,A.,
The Free Press (1989)
Competing interests:
No competing interests
07 April 2001
Patrick G Coll
Clinical Assistant Professor,Dept of Psychiatry, University of Calgary
Rapid Response:
Postpsychiatry:'Riverdance' for traditional psychiatry
Traditions change in any profession as new knowledge emerges and
sometimes a revolution is necessary if a profession stagnates. Dr's
Bracken and Thomas eloquently outline a new direction for psychiatry based
on a thoughtful philosophical critique of the history of psychiatry,
providing a much needed challenge to the current dominant paradigm of
bioreductionism. Traditional biological psychiatry does not serve many of
our patients well.(1) The psychobable of the early 20th century has been
replaced by biobabble. Physicians are routinely informing patients with
mental health disorders that their condition is caused by a biochemical
imbalance that can be corrected by drugs in the same way that insulin
treats diabetes, despite the limited basis for this belief.(2)
Lipowski has commented on the disempowering effect of this belief on
patients : "Chemical imbalance confuses the distinction between etiology
and correlation, cause and mechanism, a common confusion in our field. It
gives the patient the misleading impression that his or her imbalance is
the cause of his or her illness, that it needs to be fixed by purely
chemical means, that psychotherapy is useless, and that personal effort
and responsibility have no part to play in getting better" (3)
Why do psychiatrists view neurophysiological approaches to mental
illness as more valuable than others? The desire to remain a legitimate
'medical' specialty is certainly one, the pervasive influence of
pharmaceutical companies another, the political need to distinguish
ourselves from the non-medical therapists may also play a part.
The eminent Harvard psychiatrist and anthropologist Arthur Kleinman
has made observations similar to those of Bracken and Thomas on the
limitations of the dominant current concepts in psychiatry: "In this
golden age of biomedical research and treatments, we are witnessing the
problem of what shall become of symbolic healing. Perhaps, over the next
century in North America, it will wither away in the profession of
medicine, to be practiced only in the folk and popular areas of health
care. Perhaps it will continue to hang on as a marginal but inalienable
aspect of psychiatry and the primary care professions, which themselves
will be transformed into the high-technology image of the rest of
medicine. This question must be asked of psychiatry per se: Can it
continue to legitimize psychosocial problems, humanistic interest,
symbolic interventions as medical concerns? If not, will psychiatry as we
know it survive? Alternately, is there the possibility that by opening
these medical concerns to the human sciences (psychology, sociology,
anthropology, history, philosophy, literary studies) - by doing these
things that run against the grain, so to speak - that psychiatrists can
make the meaning of illness experience and the social sources of human
misery and symbolic healing an integral part of a more broadly conceived
science of medicine and health care?" (4)
Drs. Bracken and Thomas are to be congratulated for rekindling this debate
on the future of our profession.
References:
(1)Experiencing Psychiatry,User's Views of Services
Rogers, A., Pilgrim, D., Lacey R.,
Macmillan Press (1993)
(2)Blaming the Brain
Valenstein, E.,
The Free Press (2000)
(3)Psychiatry, Mindless or Brainless, both or neither?
Lipowski, Z.,
Can. J. Psych.: 34:249-254 (1989)
(4)Rethinking Psychiatry
Kleinman,A.,
The Free Press (1989)
Competing interests: No competing interests