How American Psychiatry Can Save Itself: Part 2
Keys to Regaining the Confidence of the General Public
by Ronald W. Pies, MD |
March 1, 2012
Dr Pies is Editor in Chief Emeritus of Psychiatric Times and Professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY, and Tufts University School of Medicine, Boston. He is the au-thor, most recently, of Becoming a Mensch: Timeless Talmudic Ethics for Everyone; The Judaic Foundations of Cognitive Behavioral Therapy; and a collection of short stories, Ziprin’s Ghost. Acknowledgment—I would like to thank Joseph Pierre, MD, and James Knoll IV, MD, for their helpful comments on this essay.
But on an even more fundamental level, I believe psychiatrists must reclaim and reinvent our role as holistic healers—doctors who are as comfortable with motives as with molecules, and as willing to employ poetry as prescribe pills.9 When guided by sound evidence, this is not promiscuous eclecticism, but rather what I have termed, “polythetic pluralism.” I favor an expansion of the psychiatry residency to 5 years, so that residents may receive enhanced training in psychotherapy and the humanities, eg, literature, comparative religion, and philosophy.10 The added year could also be used to provide greater integration of psychiatric and neurobehavioral training. To be sure: this expansion would pose additional financial challenges and require greater sacrifice on the part of trainees, but I believe it would strengthen the foundations of psychiatric practice and enhance our stature as a medical specialty. (Ideally, I would also favor a concomitant reduction in medical school training from 4 to 3 years, with substantial streamlining and condensation of the pre-clinical curriculum.)
Finally, and most important, psychiatry must maintain a single-minded focus on our primary ethical and clinical mission: not the development of elegant conceptual models or ideal diagnostic criteria, but the relief of our patients’ profound suffering and incapacity.11
Pies RW. How American psychiatry can save itself. Psychiatr Times.
Friedman RA. The role of psychiatrists who write for popular media: experts, commentators, or educators? Am J Psychiatry.
Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry.
Sartorius N, Gaebel W, Cleveland HR, et al. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry.
Pies R, Thommi S, Ghaemi SN. Getting it from both sides: foundational and anti-foundational critiques of psychiatry. Association for the Advancement of Philosophy and Psychiatry (AAPP) Bulletin.
Mishara A, Schwartz MA. Who’s on first? Mental disorders by any other name? Association for the Advancement of Philosophy and Psychiatry (AAPP) Bulletin.
. Accessed February 7, 2012.
Paris J. The six most essential questions in psychiatric diagnosis: a pluralogue. In: Phillips J, Frances A, eds. Philos Ethics Humanit Med.
Pierre J. The six most essential questions in psychiatric diagnosis: a pluralogue. In: Phillips J, Frances A, eds. Philos Ethics Humanit Med.
Pies R. Reclaiming our role as healers: a response to Prof. Kecmanovic. Psychiatr Danub.
Pies R, Geppert CM. Psychiatry encompasses much more than clinical neuroscience. Acad Med.
Knoll JL 4th. Psychiatry: awaken and return to the path. Psychiatr Times.
. Accessed February 7, 2012.