The Continuing Demedicalization of Psychiatry

August 18, 2015

A story of what can happen (and has happened) when the expertise of a psychiatrist is not followed in complex cases that involve substance use and other disorders.

PSYCHIATRIC VIEWS ON THE NEWS

The military’s inadequate response to treating PTSD for those on active duty in the “War on Terror” is well known. Less publicized are issues such as one highlighted in a recent USA Today article.1 The article draws attention to the withdrawal of the Army’s substance abuse program after it shifted to non-medical responsibility in 2010. The reported result is a drop in quality of care.

Despite the substance abuse classification in DSM, this sort of separation is also common in civilian life. At best, addiction physicians-not psychiatrists-usually have administrative leadership. This is somehow supposed to reflect that triumphing over substance abuse is a matter of willpower and that treatment means submitting to a Higher Power (as in AA), rather than to psychiatric treatment for substance abuse.

Of course, in the military, substance abuse is often complicated not only by another psychiatric diagnosis but by traumatic brain injury (TBI) and other brain damage. Certainly, the typical psychiatrist would be the expert at assessing all of these possibilities.

[[{"type":"media","view_mode":"media_crop","fid":"40540","attributes":{"alt":"demedicalization","class":"media-image media-image-right","id":"media_crop_8974320423766","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4173","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 139px; width: 180px; float: right;","title":" ©Somchaij-Shutterstock","typeof":"foaf:Image"}}]]The story in USA Today exemplified what can happen (and has happened) when the expertise of a psychiatrist is not followed in complex cases that involve substance use and other disorders. Despite concerns conveyed by the treating psychiatrist, who later resigned, “a two-star general with no medical background concluded that the 31-year-old soldier’s behavior- drunken driving, speeding, missed appointments and urinalysis cheating-had nothing to do with [TBI] or emotional problems and kicked him out of the Army” before the recommended psychiatric hospitalization. Apparent suicide occurred not long thereafter.

Reconsideration of the administrative and clinical responsibility for substance abusers may be long overdue, especially those with dual or triple diagnoses, in civilian or military life. That principle may be applicable to any category in DSM.

References:

Zoroya G. Another soldier spurned by Army dies of apparent suicide. USA Today. August 4, 2015. http://www.usatoday.com/story/news/nation/2015/08/04/another-soldier-spurned-army-dies-apparent-suicide/30726649. Accessed August 13, 2015.