In an editorial in this month’s British Journal of Psychiatry, Peter Tyrer contemplates the future of the profession. It seems that pieces like this happen every 6 months or so in psychiatry and never in other medical specialties. Tyrer discusses a recent conference in Belgrade where one of the speakers predicted that psychiatry would vanish and be absorbed into neurology. That is after he develops the theme that neurology is so different from psychiatry that he could not possible entertain the idea of being a neurologist. He would not have gone into psychiatry if it was a branch of neurology. I think the problem for psychiatry and psychiatrists is really encapsulated in a single sentence in this editorial and it is also one of the main reasons I keep writing this blog:
"We live in turbulent economic times and may have a right to be gloomy, but I was quite disturbed to hear speaker after speaker predicting the demise of our profession or its absorption into neurology or some other discipline, as the funding for mental illness and respect for psychiatrists gets progressively less."
There is probably no better recipe for the demise of a profession than continuing to obsess about the future. Pick a direction, any direction and the critics be damned. It seems that the personality of most psychiatrists does not allow for that action. We can dissect how psychiatrists as a group may be different from other specialists but I think the problem is that introspection and the need to understand motivations and emotions has translated into a lack of action and a really very annoying tendency to never take a stand. I have also observed and equally annoying trait of uncritically accepting any criticism that comes down the pike as though it is generally legitimate. All of the maladies in Dr. Tyrer’s piece including stigma, decreased funding, and a lack of respect for psychiatry come from those places. Tyrer goes on to say that he sees no connection between stigmatization and discrimination and psychiatry’s lack of direction.
Let me suggest that at many levels this is the perception of a lack of direction. The psychiatrists I know are trained to high levels of competency, technically skilled and care about what happens to their patients. They successfully treat mental illness, save lives, correct misdiagnoses, and improve the lives of millions of people. What they do every day differs considerably from what is written in the American press. The sensational and inaccurate headlines can only be countered by aggressive political activity against all of the distortion that is typically being passed about psychiatrists. For a moment, I was going to write that this is an American phenomenon, but then I recalled the work of Claire Bithell in the UK, showing that coverage of psychiatry was less often than other specialties and when it did happen it was four times as likely to be negatively framed.
How about at least getting the word out that this trend exists and it biases people at all levels including the people who are responsible for funding treatment? Here in the US, an unrealistically negative press feeds into a health care system that is set up to exploit patients with mental illness and the mental health professionals trying to treat them by providing disproportionately less funding. It was so blatant that a parity law had to be passed to attempt to counter that discrimination. But even as I type this note, large health insurance companies are trying to figure out a way to avoid paying for specific treatment settings, therapies, and drugs recommended by psychiatrists. Nothing helps their cause more than propaganda against psychiatrists.
So let’s break the deadlock of continuing to obsess about the future of a specialty when the current practitioners know what they are doing and treat people as successfully as they get treated by any other specialists. This is not about the difference between psychotherapy or medications or treatment philosophies. This is about the difference between a stroke and a psychiatric disorder. I have had to educate many practitioners about that difference over the years, always when they were misdiagnosed with a mental illness. Some of those practitioners were neurologists. That is proof of an unique skill set that nobody else in medicine seems to have and for psychiatry that is just the tip of the skill set iceberg.
George Dawson, MD, DFAPA