Berezin's article

[Dharma]

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http://www.madinamerica.com/2015/01/call-arms-future-psychiatry-stake/

Found this after Googling "future of psychiatry." Not sure if it's been discussed here yet but thought it was worth sharing, not because I agree with his perspective but because i found it thought provoking.

I don't know much of his work besides what I have read in the article, but I find it a bit contradictory that his approach to "save psychiatry" entails a deeper divide (or wider I should say) between it and biomedical sciences. There is almost a slight disdain for the neurological perspective of behavior (as young as this perspective may be); he almost uses "neurotransmitter" like it's a bad word that taints his beloved field.

Maybe some of you with actual experience in psych can comment on your opinion on this article? As an M3 interested in psych (and medicine) I find Berezin's commentary a bit off putting. How is his "psychiatry" any different than psychology?

Be careful venturing into the comments section though. Some doozies down there...

 

[OldPsychDoc]

He's grinding his ax against an outdated, oversimplified biological hypothesis, basing his polemic on the false assumption that that is what "all psychiatrists" actually believe, and arguing against a model of psychiatry that is a caricature of what is actually practiced.

But as long as we continue to produce doctors and psychiatrists with inadequate and unsophisticated views of neuroscience, this argument will continue to be attractive to the anti-psychiatrists among us.

 

[F0nzie]

He's grinding his ax against an outdated, oversimplified biological hypothesis, basing his polemic on the false assumption that that is what "all psychiatrists" actually believe, and arguing against a model of psychiatry that is a caricature of what is actually practiced.

But as long as we continue to produce doctors and psychiatrists with inadequate and unsophisticated views of neuroscience, this argument will continue to be attractive to the anti-psychiatrists among us.

BAM OPD!!! wuuuttt

 

[strangeglove]

"The real source of human suffering is not the brain. Suffering is the experience of a person, a human being, in the context of damage to his or her play of consciousness. This damage is the consequence of deprivation and abuse in our emotional environments during the formation of our personalities. This takes place in relation to the unique constellation of our temperaments."

Mind-brain dualism much?

 

[OldPsychDoc]

"This damage is the consequence of deprivation and abuse in our emotional environments during the formation of our personalities. This takes place in THE BRAIN."

Mind-brain dualism much?

Don't worry, I fixed it.

 

[Ceke2002]

Don't worry, I fixed it.

Oh thank god! I read that article and suddenly decided all my mental health problems must stem from my lungs and possibly my right leg, I've spent the last 4 hours trying to hyperventilate and hop my way to normality, it hasn't been working.

 

[hamstergang]

"The real issue, whatever it may be — anger, masochism, etc. — needs to be addressed in a real way to truly get to the bottom of it. I believe these uses of drugs interfere with therapy, and do not permit real mourning and healing. Real therapy is useful under all circumstances."

It seems to me that he not only doesn't understand the biological aspects well, but he also doesn't understand psychotherapy very well. Therapy doesn't actually purport to get to the real bottom of an issue. Whatever modality you choose is based on some model that may or may not reflect reality, but has been shown to help with symptoms when you work within that model. Is there any more evidence for the realness of these models than the chemical imbalance model?

Also, therapy is certainly not always useful, even though he pretends it is.

 

[Jorje286]

"The real source of human suffering is not the brain. Suffering is the experience of a person, a human being, in the context of damage to his or her play of consciousness. This damage is the consequence of deprivation and abuse in our emotional environments during the formation of our personalities. This takes place in relation to the unique constellation of our temperaments."

Mind-brain dualism much?

Actually he does not seem to be a dualist at all. If anything, he seems like a hardcore monoist. In the same article, he also mentions this:

'The biology of the brain creates and informs our character as a whole. Parts of the brain — such as neurotransmitters and the various brain modules — do not operate independently. They operate as a whole to simply create the play of consciousness itself. (See – “The Secrets of Consciousness, the limbic-cortex is organized as a drama in the brain.”)'

The article he links to makes a very strong case for consciousness being caused strictly by brain mechanisms. His main point of contention is about the 'neurotransmitter theory' of psychiatric disease and how neuroscience has failed to look at the brain in a much more integrative manner. He's right, but what kind of eminent psychiatrist or neuroscientist takes this theory seriously nowadays? And from this he infers that drugs are useless (since they are purported to work strictly on neurotransmitters). He doesn't quote a single study to make his point, and moreover, the therapeutic function of SSRIs (or others) may not be related to simply increasing Serotonin, but to work indirectly on complicated neural circuits in the brain, that ultimately modify the 'play that is consciousness'.

 

[Drbobbe]

This is Dr. Berezin. If you were to read the book, you will find that this new paradigm is firmly rooted in neuroscience and the science of the brain . One blog article is merely shorthand. I would suggest keeping an open mind and and think for yourselves. You are the future of psychiatry.

 

[Ceke2002]

This is Dr. Berezin. If you were to read the book, you will find that this new paradigm is firmly rooted in neuroscience and the science of the brain . One blog article is merely shorthand. I would suggest keeping an open mind and and think for yourselves. You are the future of psychiatry.

But doesn't thinking for one's self also mean thinking on a critical level. You say 'if you were to read the book' - okay, great, I go ahead and read the book, I am now a proud member of the IRAB (I Read A Book) brigade, wonderful, brilliant, so tell me exactly how this book reading experience will allow me to keep an open mind and think for myself if I am not also questioning, challenging and thinking critically at the same time.

 

[hamstergang]

This is Dr. Berezin. If you were to read the book, you will find that this new paradigm is firmly rooted in neuroscience and the science of the brain . One blog article is merely shorthand. I would suggest keeping an open mind and and think for yourselves. You are the future of psychiatry.

Assuming this is really who you say you are, I appreciate you coming to this forum and interacting with us. That said, telling us to go buy and read your book isn't very convincing. Perhaps you could address a few points?

What exactly is this new paradigm? If it's that psychotherapy works, we already knew that and it isn't new. If it's that meds don't work, that doesn't sound true and I don't know how you'd back that up with neuroscience. If it's that psychotherapy actually gets to the root of the problem, I again don't know how you'd support that.

 

[HarryMTieboutMD]

He's grinding his ax against an outdated, oversimplified biological hypothesis, basing his polemic on the false assumption that that is what "all psychiatrists" actually believe, and arguing against a model of psychiatry that is a caricature of what is actually practiced.

But as long as we continue to produce doctors and psychiatrists with inadequate and unsophisticated views of neuroscience, this argument will continue to be attractive to the anti-psychiatrists among us.

Perfect response to this article. This guy Berezin is academically irrelevant, playing on his affiliation with Harvard Medical School (loose, at best). He criticizes giants like Danny Weinberger, Joel Kleinman, Robert Cloninger, etc who have made enormous strides in exploring causes and mechanisms of psychopathology. See Dr. Weinberger's video for an elegant, sensible argument from one the world's greatest biological psychiatrist: http://www.libd.org/viewpoints/understanding-schizophrenia