A commentary on civility and ethical standards in the aftermath of terrorist events in France.
Ronald W. Pies, MD
“Distress” hardly captures the inner world of those with severe forms of psychotic illnesses. Terms like “agony,” “torment,” and “anguish” would be much closer to the mark, for many patients.
The “story behind the story” is not the over-prescription of antidepressants—though it happens—but the under-availability of optimal treatment.
A limited sampling presented here lends no support to Dr Thomas Szasz’s claim that 19th century physicians regarded the term “mental disease” as merely a figure of speech; on the contrary, several prominent physicians of this era recognized such conditions as both real and debilitating.
It is time for psychiatry’s critics to drop the conspiratorial narrative of the “chemical imbalance” and acknowledge psychiatry’s efforts at integrating biological and psychosocial insights.
The ethical status of suicide is not a question psychiatrists can ignore. After all, our duty to preserve and protect life is founded on moral values, even if they are so deeply embedded in our medical ethos that we no longer sense their moral underpinnings.
The physician’s knowledge is almost always fragmentary and incomplete--and often, “we see through a glass, darkly.” But we must not allow these limitations to deter us from diagnosing and treating our patients to the best of our ability.
While it is true that the intense grief of bereavement and major depressive disorder often share some features—for example, tearfulness, insomnia, low mood, and decreased appetite—there are many substantive differences.
The ethical aim of psychiatry is the relief of suffering and incapacity.
When critics of psychiatric diagnosis insist that terms like “schizophrenia” or “bipolar disorder” are inherently stigmatizing, they are unwittingly perpetuating the very prejudice they wish to end. It is time to shine a bright light on this self-fulfilling prophecy.