Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for October 11th, 2010

Psychiatry in Evolution

Posted by Dr. Vollmer on October 11, 2010, the theme and inspiration for my blog returns. In the midst of our discussion of psychoanalytic training, a psychiatric resident said spontaneously “most of my fellow residents  plan to do meds only.” “Meds only,” that phrase has stuck in my mind in a way that I am trying to understand. What does the word “only” mean? Does this mean no long-term psychotherapy? Or, does it mean that they do not plan to learn manual based therapies such as cognitive-behavioral therapy? Maybe the “only” means that they are choosing what they perceive to be an easier career path. Of course, maybe this resident does not adequately reflect the professional mood of his classmates; nevertheless the “meds only” comment, I have heard before, many times.

    Prozac came on the market in 1988. I graduated medical school in 1986. I chose a field in which “meds only” was not an option. Would I have had a different career choice if I had known what was coming down the pike? Should I have known it was coming? I thought I was entering into a field in which the profession shared an unending fascination with the interface between mind and brain, along with the interface between mind and body. Don’t get me wrong. Many of my colleagues, both younger and older than I, share this passion. Still, I am amazed when I hear rookies say “meds only” as if they are self-denigrating their knowledge base and expertise; as if they are conscious of the fact that they are only using a subset of their skill set. I also know that many of these folks who say “meds only” are doing so much more than “meds only” yet, in their minds they are saying that so as not to embrace the complexity of working in a field where so much is uncertain; where  there are no diagnostic tests. Maybe they say “meds only” to distinguish themselves from other psychiatrists who do not understand that kind of practice.

    “Meds only” implies to me a hurriedness to their work; the antithesis of a slow, thoughtful understanding of the human struggle for happiness and fulfillment. This polarization is not real. Many therapists who do not work with medication, for a variety of reasons, both conscious and unconscious, hurry their patients along to the path of “wellness”. Likewise, many folks who do “meds only” have a tremendous amount of patience with regards to the sometimes, slow, uphill road to wellness.

    I would like to see the “meds only” crowd characterize themselves as psychiatrists who focus on medication after doing a comprehensive assessment. Perhaps they should call themselves “Psychiatric diagnostician, with medication follow-up, if necessary.” I know that is a mouthful, but I think it is more meaningful than “meds only”.  Why not call themselves Psychopharmacologists? I imagine my readers asking. My problem with that is that all psychiatrists are psychopharmacologists. All of us understand that medication changes the brain, and in so doing, changes how people experience their world. Language is important to convey the complexity of our field. “Meds only” degrades all of us.

Posted in Musings, Psychiatry in Transition | 5 Comments »

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