Tribalism in Psychiatry: On the Mind of John J. Miller, MD

ON YOUR MIND WITH ERIN CROWN

Series Editor Erin Crown, MHS, PA-C, Psych-CAQ

Erin Crown, MHS, PA-C, Psych-CAQ, in her first installment of "On Your Mind With Erin Crown," sits down with Psychiatric Times Editor in Chief, John J. Miller, MD. Miller identifies "tribalism in psychiatry" as the main topic on his mind, explaining that it has become a significant issue in various fields, including psychiatry. He compares current tribalism to sports rivalries and how it manifests in psychiatry, and is especially concerned about the increasing division and isolation within the field.

Tribalism can take several forms in psychiatry: including academia vs the pharmaceutical industry, different prescribing subspecialties, and the roles of various health care. Both Crown and Miller advocate for a more integrated and supportive system among all health care professionals to address the epidemic of untreated mental illness.

He believes this tribalism leads to a loss of important information and benefits for patients, colleagues, and the field as a whole. Miller recounts his early experiences with pharmaceutical industry collaborations and how they were integrated into academia and organizations like the National Institute of Mental Health. These collaborations help drive innovation and improve patient care. Both Crown and Miller reinforce the importance of continuous learning and innovation in psychiatry, noting the limited tools available when they started and the advancements made since then.

However, there are increasing administrative burdens for frontline prescribers, which reduce the time available for professional development and collaboration. Staying current with the latest scientific and clinical developments ensure clinicians can provide the best possible care for patients. The fragmentation of the psychiatric field makes this difficult; there is a strong need for better integration and collaboration among different stakeholders, including clinicians, academia, and pharma.

The psychiatric field needs to work together more cohesively, Miller emphasized, sharing that we need a unified approach among psychiatrists, psychiatric nurse practitioners, and physician assistants to address the mental health crisis effectively. The entire conversation underscores the importance of continuous learning and collaboration in psychiatry.

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Ms Crown is a psychiatric physician assistant at State College, Pennsylvania, and owner of Future Options Research.

Dr Miller is the medical director of Brain Health in Exeter, New Hampshire; editor in chief of Psychiatric Times; a voluntary consulting psychiatrist at Seacoast Mental Health Center in Exeter/Portsmouth, New Hampshire; and a consulting psychiatrist at Insight Meditation Society in Barre, Massachusetts.