Friday, March 12, 2010

Whither Psychiatry?

This just amuses me: Psychiatry a floundering discipline.

The new draft of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM): "A manual's draft reflects how diagnoses have grown foggier, drugs more ineffective."

What the discipline badly needs is close attention to patients and their individual symptoms, in order to carve out the real diseases from the vast pool of symptoms that DSM keeps reshuffling into different "disorders." This kind of careful attention to what patients actually have is called "psychopathology," and its absence distinguishes American psychiatry from the European tradition. With DSM-V, American psychiatry is headed in exactly the opposite direction: defining ever-widening circles of the population as mentally ill with vague and undifferentiated diagnoses and treating them with powerful drugs.

I don't have much to say about this, but it is troubling that with a fair bit of genuine mental illness in the world, American psychiatry (I presume Canadian as well) is becoming not more focussed and precise, but less. I've also read recently that virtually no psychiatrists any long depend primarily or solely on "talk," such as Freudian or Jungian psychotherapy that figured in so many books and movies. To satisfy funding agencies, public and private, it is more convenient to prescribe medications and then use appointments to monitor medications and adjust as needed. Such appointments can be quite short. See here.

I have a family member who I believe could have benefited from some kind of help at some point in her life. She was probably symptomatic in the 50s, but God knows what anyone would have done then. In the 60s, living in a small town, maybe some kind of talk therapy would have been available to clarify her issues, maybe not. By the 70s there would have drugs available; but would they have been prescribed in a responsible way? Would she have taken them? Who knows?

h/t Health Business Blog, Grand Rounds 6:24.

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