Suicide rates in specific age groups actually may be declining, Pies suggested.
"If you look at the epidemiologic data over the last 10 or 15 years from a number of different countries, it looks as if suicide rates have been declining in those populations above the age of 15," he said. "This decline coincides with the use of [selective serotonin reuptake inhibitors]. So, I really think the evidence [about suicidality] is inconclusive."
Future of Psychiatry
For many years, Pies has pondered the future of psychiatry. Two years ago, he won first prize from the Irwin Foundation for his essay on the future of psychiatry, "Why Psychiatry and Neurology Cannot Simply Merge," which subsequently appeared in the Journal of Neuropsychiatry and Clinical Neuroscience (2005;17:304-309). In the editorial, he explained that while psychiatry and neurology share a common substrate, the human brain, they differ in their discourses (complexes of credentials, protocols, jargon, and a specialized knowledge that defines theory and practice within the human sciences).
Neurology is fundamentally a discourse of neuroanatomical and neurophysiological relationships, he said, while psychiatry, notwithstanding its burgeoning interest in neuroscience, remains grounded in human subjectivity and existential concerns.
"Psychiatry needs to redefine itself as a medical specialty, and that is a real challenge," Pies told PT.
"Psychiatry's future, if we are to have a future as a medical specialty," he said, "will involve our creating a field, a new language and a new level of discourse." Pies proposes to call this new field encephiatrics. The term is derived from the Greek roots enkephalos (brain) and iatros (healer).
"What that means really is that we become of healers of the brain. This idea of healing the brain is based on the notion that the brain is the final common arbiter of all of the input it receives, whether biological or social or psychological or spiritual. The way psychiatry will define itself is as the medical specialty that provides optimal healing for patients with brain dysfunction," Pies said. "I see that as occurring through a mastery of not only psychopharmacology, but also of all those approaches to human suffering that we have learned as healers over these many centuries."