Shirah Vollmer MD

The Musings of Dr. Vollmer

Is The ‘Self’ Lost in Psychiatry?

Posted by Dr. Vollmer on April 29, 2013

http://www.nytimes.com/2013/04/28/magazine/the-problem-with-how-we-treat-bipolar-disorder.html?pagewanted=all

Linda Logan talks says ” for many psychiatrists, mental disorders are medical problems to be treated with medications, and a patient’s crisis of self is not very likely to come up in a 15 minute session with a psychopharmacologist.” She goes on to say that non-medical professionals are taking on the task of understanding the self, but “new therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness.” This is my rant and so I will continue to both understand that my professional world is changing and, at the same time, attempt to push back and bring the “self” back to psychiatry, in my own way, through my work and through this blog.

Many in my cohort went into psychiatry because we felt that the patient had the disease, as opposed to our medical colleagues who treated patients like they were the disease. This personal aspect of psychiatry was the draw. The “liver patient in room one,” was the inspiration for leaving a field in which people were defined by what organ system failed, and not their social histories, their occupational histories, or their contributions to society. As psychiatry becomes more “medical,” patients are now a “disease” and there seems to be little value in understanding how the person copes with their illness, but rather the value, is in getting rid of symptoms. Clearly both are important. Moreover, it is important, in my mind, that one clinician be able to look at both symptom relief and coping styles. When these two issues are bifurcated, the patient is left to feeling misunderstood and frustrated, as Linda Logan articulates clearly in this article.

Of course there are exceptions, but the trend in psychiatry is towards this medicalization, which means towards a depersonalization of care. This trend crushes my soul. If we, as psychiatrists, do not carry the banner of knowing our patients, for the human beings they have worked hard to become, then who is going to provide comprehensive care to those with crippling neuroses and/or psychoses? Who is going to see the big picture of medication management within the context of defense mechanisms and family dynamics? Who is going to understand that to lean too much towards nature or nurture is to rob the patient of the complexity of their condition? We, as psychiatrists, must embrace both complexity and uncertainty. If we do not do this, then patients will suffer, and as they are, by definition, compromised, and hence  mostly unable to advocate for themselves. This is my rant, one which bears repetition, and so I will continue to post on this topic. Thank you, Linda Logan for triggering my continuous outrage.

4 Responses to “Is The ‘Self’ Lost in Psychiatry?”

  1. Jon said

    Right on! Rant on!! Write on!!!

  2. Shelly said

    I agree with Jon. Your blog was right on. It reminds me of psychiatry in my country: 15 minute sessions to check on medications at a large teaching hospital– 10 minutes of which the resident documents facts in the computer, and 5 minutes of which he tries to get the patient to sign up to donate bloods for a clinical trial. The patient is indeed “the bipolar in my office,” and not a person suffering with an affective disorder.

    • Shirah Vollmer said

      Thanks, Shelly. I want to repeat that I am just so sad about this transformation of psychiatry. As much as I love neuroscience, I am deeply wounded to think that the specialty I chose for the personal nature of the discipline has become the impersonal approach that I so wanted to avoid.

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