What's Growing?

Jun 16, 2016

Here are a few things that make me glad I'm a psychiatrist.

Editor in Chief

Summer is now upon us, and my garden has never looked better. I guess that’s the only good thing, at least temporarily, about global warming. Nothing really froze here during the winter, and we had an early and very wet spring, so my roses are already blooming. Until the global weather gets too hot for anything to grow, I’ll enjoy it.

[[{"type":"media","view_mode":"media_crop","fid":"49431","attributes":{"alt":"© world of vector/shutterstock.com","class":"media-image media-image-right","id":"media_crop_1166949114932","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5962","media_crop_rotate":"0","media_crop_scale_h":"150","media_crop_scale_w":"103","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"© world of vector/shutterstock.com","typeof":"foaf:Image"}}]]Of course, my garden isn’t the only thing that’s growing. Unfortunately, yet another celebrity-Prince, in this case-has succumbed to what was almost certainly an overdose of opiate prescription medications. The timing coincided, coincidentally or not, with the airing of a documentary on PBS about Janis Joplin, another incredibly talented singer who died decades ago as a result of her opiate addiction. The only good thing about Prince’s death, if one can find any good in it, is that this brought even more attention to the epidemic of opiate addiction, which I wrote about last month. I still wonder why the efforts to overcome this problem within medicine have been so relatively scarce, outside of ongoing attempts to educate physicians about opiate addiction and its treatment by the American Academy of Addiction Psychiatry

I was, however, somewhat glad to see the “Open Letter to America’s Physicians on the Opiate Epidemic” from American Medical Association (AMA) President Steven Stack posted on the AMA website. It was a copy of his Huffington Post blog from the same day. Dr. Stack is an emergency physician from my own state of Kentucky, and thus common sense tells me he has to have been aware of the magnitude of this problem for a long time.

I was concerned, though, that it took well over a month following the publication of the CDC and FDA advisory recommendations on opiate use in pain treatment for the AMA president to post his letter. Furthermore, while his letter paraphrases some of the most important CDC recommendations, he not only doesn’t refer physicians to them, he doesn’t even mention that they were published. And it also bothers me that while acknowledging that the opiate epidemic often “has started from a prescription pad,” he attributes this to flawed “public policies” that “compelled doctors to treat pain more aggressively.” I guess that assertion is a topic for a more serious and lengthy debate than I have room for here.

Speaking of debates and addictions, and I may be criticized for this usage given the preceding paragraphs, but the ubiquity of the droning on about this year’s presidential election on the 24-hour news channels is strangely addicting-when I’m not working or gardening-to me at least. One thing I’ve noticed more than in prior years is the nature of those “experts” who are regularly called upon to talk, seemingly endlessly, about the political bombshells of the day.

Most of the people seem to be there solely because they are advocates for one candidate or another. Rather than anyone with real expertise in political analysis, the panelists seem to have been selected in large part because they are fierce advocates for their chosen candidates, in hopes, I guess, of generating verbal fireworks to keep up the ratings. And I’m sorry to say I’m one of those watching, which keeps it going. Even the promos for the primary election reports on one of the news channels are clearly geared to make the election coverage seem like an upcoming professional wrestling or Super Bowl broadcast.

This kind of thing makes me glad to be a psychiatrist. Having recently been to the American Psychiatric Association annual meeting in Atlanta, I am again gratified that, whatever our controversies, our profession is one in which professional disagreements almost always are dealt with, ultimately, by reasonably dispassionate reviews of data gathered with exceptionally high standards for scientific research.

Of course, being human, we aren’t always as dispassionate as I may be implying. Actually, some of our debates over the years have been very passionate. A debate, however, about whether childhood bipolar disorder really exists, or whether there is overprescribing of stimulant medications to young children is ultimately addressed by evaluating what we already know and seeking to fill in the gaps in our knowledge. Sometimes it takes a very, very long time to find the right answer, but that is what we’re always trying to do.

I don’t hear anyone asserting that schizophrenia is caused by “schizophrenogenic mothers” anymore, thank goodness-a result of decades of careful and groundbreaking research that continues to elucidate the biological, especially now genetic, antecedents of this terribly disabling illness. Nor, thanks to the Recovery After an Initial Schizophrenia Episode (RAISE) study results published last fall (only one of the most recent of an increasingly large body of such research), will many people, including those determining reimbursement policies, be supporting a treatment plan for schizophrenia that is unidimensionally based on medication alone.

The nice thing about being in a medical profession like psychiatry is that I could write volumes, not just a brief column, about the ever-expanding scientific basis for understanding human thought, emotions, and behaviors in wellness and illness, which forms the foundation for how we understand our patients and decide on the best treatments for their illnesses.

Although we all have days when we’d rather be working in the garden (or whatever your favorite escape/therapy might be), it’s wonderful to know that our work is based on our synthesizing what we’ve learned from clinical experience and the best scientific evidence, making it ever more gratifying that we can be of more effective help to our patients. That’s worth a pat on the back. Enjoy the summer!

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