Article : Medicine and the Mind — The Consequences of Psychiatry’s Identity Crisis

Medicine and the Mind — The Consequences of Psychiatry’s Identity Crisis
List of authors.

• Caleb Gardner, M.D.,
• and Arthur Kleinman, M.D.

In psychiatry, checklists of symptoms now take the place of thoughtful diagnosis, and trial-and-error “medication management” dominates practice. We face stark limitations of biologic treatments, while finding less time to work with patients on difficult problems.

Links :

https://www.nejm.org/doi/full/10.1056/NEJMp1910603
https://sci-hub.se/downloads/2019-10-31/11/10.1056@NEJMp1910603.pdf

I thought it might be of interest to somebody.

When did the word "biologic" replace the word "biological" in the English language? It grated on me every time I read it.

 

Not much meat but it's a good commentary on the limitations in the specialty. Psychiatry has clearly overstepped itself in making pronouncements and assertions based on little to no facts at all, sometimes even against all the facts in evidence. The author suggests a humbling drawback, but unclear on what this could look like.

I doubt this is a popular sentiment, but it is needed. There is currently a lot of pressure in basically going all-in on the old model of making assertions out of personal beliefs and bullying them until people just give it and relent. The careful language used clearly shows this is a sensitive subject, that psychiatry will have to relent some of its own pathologies of mind before that happens. Narcissism and hubris seem to be defining traits in getting to the top of this field and act as dead weight against any change away from the failed status quo.

This is very much welcome. Because as much as is being written about the limits of our understanding of biology and physiology, the mind-over-matter magical psychology side has not achieved anything more despite a near century-long head-start. Especially as technology won't provide new insights the way it does in a biological framework. Modern humans are just as smart as our ancestors were in the last ice age and we clearly know by now that even genius does not suddenly come up with full solutions to real problems, the universe simply does not work like that.

Good overall, but I disagree that psychotherapy is particularly important, as without an actual understanding it remains mostly people selling their personal perspective on something they have very little understanding of. It provides human contact and not a particularly good one at that. But absolutely the field has to be rebuilt, from more humble roots that stop trying to make personal opinions the indisputable truth where very opposition to those ideas should be taken as a sign of insanity. Self-fulfilling prophecies belong in churches, not in science.

Integrating epidemiology and social science could be interesting, as the saboteurs who have hijacked our disease pay no attention to what those tell them, simply inventing their own facts and statistics to fit their needs. The creation of a transient chronic syndrome of one symptom is just about the best example one needs of how thoroughly psychiatry has jumped far too many sharks.

 

I shouldn't get too enthusiastic about Kleinman. As chair of the CIBA symposium he said, in conclusion:

If we were to meet again even four years from now in another symposium on chronic fatigue syndrome, I suggest that there would be as many social scientists present as there are virologists, immunologists and psychiatrists now. Although some of you may see things differently, I think increased social science attention to this subject will be a good thing.

I suspect most of us are amongst those who think differently.

 

It serves for it in the American language.

 

Thanks for the info @Jonathan Edwards . I've never come across it before.

 

That did not age well at all.

 

This usage is unusual in my experience. In the U.S., you typically only hear 'biologic' in reference to pharmaceutical proteins in TV ads. These days, 'biological' is what would be expected in the context of this paper. Maybe it's different in some professional circles but this would sound weird to everyone else.

 

I agree that the use of 'biologic' to describe biological drugs (in fact proteins manufactured by genetic engineering methods) is salient. However, over the years I found my manuscripts edited by journals using American English to remove the -al from various -ical words. Thus a process would be immunologic. Thinking about it there must have been some sort of slippage in the language habits somewhere because nobody talks of surgic operations. On the other hand nobody talks of dopaminergical signalling or scientifical thinking.