This Just In - Psychiatry is Still Dead

Patient Expert

I’ve never met an irony I didn’t like. Case in point:

The other day, on Psychiatric Times, I came across a June 4 commentary titled Psychiatry is Alive and - Well, It’s Complicated.

Psychiatric Times is a private publication whose audience comprises “psychiatrists and allied mental health professionals who treat mental disorders.” The author of the piece, Ronald Pies, is a professor of psychiatry at SUNY and Tufts, and represents an enlightened voice in the profession.

“Is psychiatry as we know it ‘dead’?” begins Dr Pies’ commentary. There is a footnote. The footnote reads:

1. McManamy J. It’s official: psychiatry is dead. HealthCentral. Accessed May 27, 2015.

Note: While I disagree with John McManamy’s dire verdict on psychiatry, I do agree with him that the views and voices of our patients need to be heard by psychiatry’s leadership. I also believe that in revising DSM-5 and developing the next DSM, review by an independent scientific council, outside the APA, would be a prudent, confidence-building step.

Although my piece on HealthCentral was obviously the reason for Dr Pies’ commentary, he did not make reference to it in the main body of his piece, nor did he address the points I raised. My case went something like this:

The field of mental health is going through a major paradigm shift that may bypass psychiatry completely. According to Thomas Kuhn in his classic 1962 The Structure of Scientific Revolutions, radical shifts in how we think - say from a Ptolemaic universe to a Copernican one - come from outside the field.

Today, we use the word, “disruption.” The point is the same: Change is happening far too quickly for the psychiatric profession to adopt. My Exhibit A was the DSM-5, psychiatry’s latest iteration of its diagnostic bible published in 20013. It is the work of psychiatry’s old guard and bears only a tenuous connection to reality.

But don’t take my word for it. In a 2012 piece on PsychCentral, Dr Pies proposed scrapping the DSM in its entirety and starting over. Basically, on this topic, his views and mine almost perfectly align. But I go on to make this point:

I could write at length about how a field that has been co-opted by Big Pharma is ill-equipped to meet the challenges of the new post-Big Pharma era. But what we really need to know is that psychiatry is a closed shop that does not welcome outsiders, even from within its ranks.

In his commentary, Dr Pies does acknowledge that psychiatry is facing a “current crisis,” but that it has the will to survive and even thrive. Dr Pies bases his case on the dedicated practitioners he has had the honor to work with. As he concludes:

Nonetheless, psychiatry (with a small “p”) is very much alive. And it is still the medical specialty that best embodies the teaching of the medieval physician and philosopher Maimonides: “The physician does not cure a disease, he cures a diseased person.”

Naturally, I don’t expect any psychiatrist to agree with my view that psychiatry is dead. It’s not about who is right and who is wrong - reality will sort that out all in its good time. What I was happy with was the fact that my piece had initiated a dialogue. This is the type of conversation we can all learn from.

Getting to the irony …

Recall my assertion about psychiatry being a closed shop. After reading Dr Pies’ commentary, I decided to post a comment thanking him for his piece and welcoming an ongoing dialogue. I went to the comments section, only to encounter this notice:

Comments are only available to qualified healthcare professionals. If you believe you are seeing this message in error, please update your profile with the correct professional information.

I rest my case.

Further reading ...

It's Official - Psychiatry is Dead

RIP Diagnostic Psychiatry