How American Psychiatry Can Save Itself: Part 2

by Ronald Pies | June 16, 2012 12:04 PM EDT

Thanks for those comments, Dr. Gardiner (please forgive me if I have your professional credentials wrong). I certainly agree that no medical specialty should ever be reduced to "assembly line"practice, and I know that many psychiatrists are not at all happy with the trend toward 15-minute "med checks". That said, the average time spent with a patient in psychiatry has not dropped very much in recent years; and, as Dr. Dinah Miller pointed out in a recent piece, 70.2% of psychiatrists still provide psychotherapy to all or some of their patients.
See:

http://www.clinicalpsychiatrynews.com/views/shrink-rap-news/blog/108-a-look-behind-the-report-on-psychotherapy-trends/6d971fab884e7464ff1ea3be371f1f96.html

But we can and must do better.

I was addressing psychiatry per se in my blog, and I don't feel qualified to comment on the other professionals you mention. I do have great respect for the nurses, nurse practitioners, and other allied professionals who do so much of the work for our patients. I also favor a much stronger working relationship between psychiatrists and PCPs, so that investigations like MRIs and EEGs occur based on medical necessity and cost-effective practice.

Of course, I completely agree with the need to consider and rule out "organic" pathology in many patients presenting with apparent "psychiatric" problems, and many such patients are now given short shrift
in terms of their work-up.

Thanks again for commenting!

Best regards,
Ron Pies

by Kelly Gardiner | June 16, 2012 3:06 AM EDT

Dr. Pies,
I'd like to see a few things change:
1. No more assembly line psychiatry.
2. Properly trained clinicians i.e. Psychiatric Mental Health Nurse Practitioners are different from Family Medicine NP's and PAs who enter psychiatry without specific training or proper mentorship. Working with geriatrics and children takes specific training as well and should be required.
3. Primary Care Medical Providers who are willing to rule out non-psychiatric causes of mental illness i.e. do an MRI, EEG, etc.
Thank you

by Ronald Pies | May 14, 2012 10:58 PM EDT

Hi, Dr. Daviss (...or Steve, if I may)--

I very much appreciate your kind comments on my article, and even more, your efforts at the APA (alas, I missed your talk). It is indeed the case that we have been too passive, as a profession, in allowing others to "define"us--and often, to defame us. This is not to say that psychiatry as a profession is doing a wonderful job, or that we have nothing to learn from our more responsible critics--far from it. It is to say that the kind of visceral contempt and hatred evinced by some of the APA "protesters" has no place in a civilized exchange of views. I commend you, Dinah Miller MD and Annette Hanson MD for your efforts at "explaining, educating, and engaging" , both in your book and on your website!

By the way, your readers should take a careful look at the posting by Dr. E. Fuller Torrey, at:

http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=2085

in which Dr. Torrey demolishes many of the claims of one of psychiatry's most prolific (and often misguided) critics.

Best regards,
Ron Pies

by Steve Daviss | May 14, 2012 8:45 PM EDT

Dr Pies,
I just discovered your wonderful article about saving Psychiatry, after returning from the Annual Meeting in Philadelphia where four other psychiatrists and I gave a symposium on regaining control of the public image of psychiatry.

The "vituperative attacks"on psychiatry that you mention were certainly present at the meeting, both in the streets, with people marching around with professionally printed antipsychiatry placards, bullhorns, and expensive video screens, as well as in the Twitterverse, with half of the #apaam12 tweets coming from two psychiatry critics. Our message inside the conference room was that we are letting others define us and our profession, and that we cannot afford to hunker down, but instead must take every opportunity to explain, educate, and engage. If all 600 educational sessions were put up on Youtube, for example, then when people type "psychiatry" in the search bar, they would get more appropriate hits than the current crop, which includes "Psychiatry: Industry of Death" and "Psychiatric Drugging of [fill_in_name_of_vulnerable_group_here]."

We advocate open discourse, humility, humor, and acknowledgment of our limitations and past errors as a profession. If we don't address these public perceptions, then we will continue to sink in cultural and medical relevance.
Explain.
Educate.
Engage.

=Steve Daviss MD DFAPA
=Co-author, Shrink Rap: Three Psychiatrists Explain Their Work
=Chair, Dept of Psychiatry, Baltimore Washington Medical Center, Univ of Maryland

by Ronald Pies | May 11, 2012 1:36 AM EDT

Thanks very much for your comments, Dr. Efstathiou. I certainly agree that psychiatry must remain fully integrated with general medicine and neurology, and reflect an accurate knowledge of brain function. We should also seek endophenotypes and biomarkers for our diagnostic categories, as you say. I think a holistic approach is also needed, and prefer to say that the "object"of our treatment is neither the brain, nor the psyche (whatever that is), but the suffering person. As Maimonides said more than 8 centuries ago, "The physician does not cure a disease, but rather, the diseased person."