Psychiatry on the Edge

August 25, 2014

At a time when our field is under attack from many quarters, it is critically important to be able to discuss what it is that we do as psychiatrists in a non-defensive and intellectually rigorous manner. Help here.

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Reviewed by Jeffrey S. Barkin, MD

by Ronald William Pies, MD;
Hauppauge, NY: Nova Science Publishers; 2014
202 pages • $170 (hardcover)

Dr Pies’s latest book, Psychiatry on the Edge, is a masterful collection of his writings. In addition to having been editor of Psychiatric Times, Dr Pies is a prolific scholar who has written on a wide range of topics: psychopharmacology, medical causes of psychiatric illnesses, ethics, Judaism, Buddhism, Stoicism, cognitive-behavioral therapy, and poetry. In this volume, he explores how we can begin to understand what psychiatry is and what it is not. At a time when our field is under attack from many quarters, it is critically important to be able to discuss what it is that we do as psychiatrists in a non-defensive and intellectually rigorous manner. To do so, it is helpful to critically view our field from different vantage points and prisms.

Dr Pies engages the reader in a thoughtful review of relevant philosophy, drawing on original source material. On a process level, we are taught about philosophic principles salient to our field. For those of us who never took philosophy (or who are a little rusty), we are treated to a highly educational and enjoyable overview. How best to learn about philosophy than to relate it to our field and what better way to learn about psychiatry than to draw on philosophy as a field of thought that is different from our usual intellectual framework! This book offers the reader an intellectual opportunity to learn (or relearn) philosophic principles and, by applying the basics of rational philosophic thought, be able to critically explore the very nature of psychiatry, including the many misunderstandings and negative polemic offered about our field in the popular press or when we are asked existential questions by our patients and others.

Dr Pies is an exceptional author and scholar, able to draw on many different areas and write in an enjoyable manner, which exemplifies such fantastic “synthetic thought.” This volume helps focus our attention on the central vexing issue our field faces: how do we embrace an evidence-based, scientifically driven mindset while simultaneously maintaining the art of medicine and the critical empathic connection with our patients, both of which are necessary for treating the hallmarks of disease: suffering and incapacity.

Pies offers the concept of “polythetic pluralism,” which embraces the world of both medical science and the healing arts. The essay “Can Psychiatry Be Both a Medical Science and a Healing Art? The Case for Polythetic Pluralism” should be read by all psychiatry professionals. The book goes a long way in debunking the belief that psychiatry is not scientifically based, reminding us that mental health signs and symptoms are as real as the headaches that a neurologist treats.

The fact that mental phenomena are subjectively experienced does not detract from the validity of symptoms representing disease. As an example, affect and mood can be assessed in a reliable manner and can reflect valid distress and illness despite being subjectively experienced. Logical positivism is put in a safe perspective that does not allow it to crowd out the very meaning of psychiatric illness.

Dr Pies is a very wise physician who shares his knowledge and insights with true generosity. In addition to learning about philosophic thinking, he shares insights into many topics, including health care as a basic human right, psychiatrist participation in executions and interrogations, gun control, and Internet ethics, to name a few.

This is a thinking person’s collection, with much to learn, enjoy, and share. Psychiatry on the Edge develops a dialogue that helps us define who we are and what we do as psychiatrists-critical in understanding our field and sharing it with others. I highly recommend this contribution, because the reader will be rewarded with much knowledge and many deep insights.

Disclosures:

Dr Barkin is Associate Medical Director of Goold Health Systems an Emdeon Company, in Portland, Me.