Everything You Wanted To Know About Psychiatry In 30 minutes or Less....

 

It has been a week since I gave a presentation to the Philolectian Society in Anoka, Minnesota.  The Philolectians are primarily retired educators and their colleagues who decided they wanted to promote education in their county. They do this by topical discussions on a monthly basis and fund raising for scholarships that they award to high school students.  They were founded 134 years ago.  I gave them a presentation on substance use disorders about 5 years ago – but my current presentation was entitled “Everything You Wanted To Know About Psychiatry In 30 Minutes of Less.”  It was the mile high view – but that is the one that is typically lacking in American culture.

The venue was a sports bar conference room in an old building. There was no projection equipment and it had spotty WiFi coverage so I decided I should test it out ahead of time. I opted to use a Chromecast device to the television HDMI port – but did not realize at the time that it does require WiFi in order to work.  Connection to my home TVs was not a problem but there is continuous WiFi as the background.  Failing the Chromecast, I was given an LED projector that also required WiFi. I ended up printing out hand outs for the attendees. The 12 slides follow and total time was about 45 minutes – 30 minutes of presentation and a 15 minute Q & A.  My presentation style is to focus on slide design.  For that reason I avoid the standard templates and try to cover as much of the slide with graphics as possible when they are used.  My second overall principle is to free associate to the slides and never read them. They are there to keep me on track.  What I actually end up saying varies considerably from lecture to lecture – modifiable by various factors including what the group has indicated what they want to hear, what I have been thinking about that day, and what I have been reding that week. The process is like Frank Zappa described his guitar playing. Every live performance is unique – no set of notes is identical.  I can’t claim mastering lectures like he mastered the guitar but there is some creative process involved in lecturing.

The title slide uses a background of abstract art taken off of one of my paintings at home. The artist is Stephen Capiz.  It represents a very small area of a larger abstract painting with the tile information superimposed. The title was chosen to keep the atmosphere casual. I wanted people to be comfortable that this was not a presentation to mental health professionals but to a general audience.

Slide number 2 is a critical three - fold message that is frequently missed or distorted.  Psychiatric disorders have been observed and discussed since ancient times.  That means they are easily recognizable to people with no training. It means that they are real and can’t be explained away.  You must be incredibly naïve or sheltered to not have that experience.  Psychiatrists only exist because they were the doctors interested in treating these disorders. That is as true today as it was in the 18^th and 19^th century.  The only difference is that modern psychiatrists have uniform training. And finally as you would expect, the diagnostic system has undergone successive refinement over the centuries.  The DSM is used as an example here but the ICD could be used as well. (with all slides click on them to expand and get a better quality graphic - this is apparently an artifact of the blogger format).

 

Slide 3  provides a little more detail on the evolution of the DSM systems. Counting the total diagnoses is always a point for rhetorical digressions.  I finally figured out how to do it and listed my specific technique in this post.  To a professional audience, I might include studies on how many of the diagnoses are actually used.  This audience did not find any of this controversial.

Slide 4 is a great timeline of how psychiatry developed from a discipline that Kendler refers to as protopsychiatry to the modern era starting in about 1920 in the US and about 40 years earlier in Europe.  The audience was extremely interested in the low percentage of physicians attending medical schools in 1900 and that lectures could be attended by purchasing tickets. The transition from asylum doctors with no particular training to psychiatrists was also a focal point.

Slide 5 was necessary because there is still a lot of emphasis on Freud. I remembered that Freud was an important figure to my college English professors and that some of the teachers in the audience were about that age. I emphasized that Freud was an important figure in psychoanalysis, but that there were many European psychiatrists that provided knowledge, literature, and training to their American counterparts and that many were self-taught and active across the fields of psychiatry, neurology, neuropathology, and neuropsychiatry.

Slide 6 is a very brief outline of the basic educational milestones of the various mental health disciplines.  Minnesota has a confusing array of designations including unlicensed mental health practitioners so I kept it simple.  In the previous slide on the psychiatry timeline I did mention how in the early 20^th century most practitioners considered themselves neuropsychiatrists and practiced both neurology and psychiatry. When the American board of Psychiatry and Neurology informed practitioners that they would need to take board exams in both psychiatry and neurology the era of separate specialties was begun.

Slide 7 is one of my favorite graphics.  It is produced from the current educational requirements for residency training and Melissa Farmer, PhD greatly assisted me with the graphic design. My overall emphasis was to point out how these training requirements should result in a physician who is not only an expert in diagnosis, but also interviewing, maintaining relationships over time, and capable of therapeutic discussions.

Slide 8 attempts to capture the pattern matching aspects of psychiatric practice and why training and experience are necessary.  It illustrates how previous exposure to various diagnostic and therapeutic elements can lead to problem recognition and resolution.

Slide 9 is a rough sketch of the diagnostic process and how it has to be adapted to the situation.  I provided several examples of referrals that I saw as referrals who needed immediate emergency medical attention.  We discussed how that can occur.

Slide 10 is a list of psychiatric subspeciality care.

Slide 11 is an explanation of the current workforce and how the practice environment has deteriorated over the past 40 years. I emphasized rationing as the main problem and several audience members were aware of the shortage of psychiatric beds and state hospital closures.  The city of Anoka has one of the few remaining state hospitals – Anoka Metro Regional Treatment Center. In the future if I am projecting - this slide would be split to 2 separate slides. 

Slide 12 – I had to leave the audience with a reason why they are exposed to antipsychiatry rhetoric and discussed the basis for it, the special interests involved, and in most cases - the lack of any basis in reality.

The presentation went very well. There was additional interest in the medical and psychiatric effects of the pandemic.  Several audience members were interested in my opinions about the Department of Human Services in Minnesota and how they factor into the current rationed system of care. I am currently expanding some of the graphics in case there is any additional interest and as an outline for some of my other writing.

 

George Dawson, MD, DFAPA