Acad Psychiatry 30:218-226, June 2006
doi: 10.1176/appi.ap.30.3.218
© 2006 Academic Psychiatry
The Problem of the Psychopharmacologist
Nicholas Kontos, M.D., John Querques, M.D. and Oliver Freudenreich, M.D.
Received July 4, 2005; revised October 6, 2005; accepted October 10, 2005. Dr. Kontos is Associate Director of Consultation-Liaison Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, and Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts. Dr. Querques is Assistant in Psychiatry, Massachusetts General Hospital, and Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts. Dr. Freudenreich is Director, Massachusetts General Hospital First Break and Early Psychosis Program, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts. Address correspondence to Dr. Kontos, Cambridge Hospital, 1493 Cambridge Street, Macht Building, Cambridge, MA 02139;
[email protected] (E-mail). Copyright © 2006 Academic Psychiatry.
ABSTRACT:
OBJECTIVE: The psychopharmacologist designation currently pervades and heavily influences the practice, perception, and teaching of clinical psychiatry. The authors hope to make a case and provide the raw material for informed discussion of this role during psychiatric residency training. METHOD: A definition for the psychopharmacologist is sought. Historical trends in psychiatry which contributed most to its evolution are explored. Problems of the psychopharmacologist role are delineated. Extant solutions to psychiatrys problematic adaptation to an increasingly biological clinical role are critiqued, and a more effective one is pursued. RESULTS: The term psychopharmacologist seems linked to presumed scientific and medical approaches, a goal of symptom relief through medication, and often other providers who are considered patients "primary" treaters. The role derives largely from economic and remedicalization trends. Aspects of disengagement are determined to form the core problem of the psychopharmacologist. The authors propose that psychiatry is defined by its practice of the medical model and call attention to three areas where the psychopharmacologist role and the medical model collide. CONCLUSIONS: Engaging psychiatric residents in a new dialogue about their role as physician will challenge the previously unquestioned psychopharmacologist categorization, begin to address its problems, and bring a vital element to trainees professional identity development.
INTRODUCTION:
Nothing quite excites my ire so much as being pigeonholed in a strictly biological slot just because I am medically minded.
Thomas P. Hackett (1)
The potential effectiveness of every physician has increased dramatically in the past 50 years due to advances in biomedical science. In clinical psychiatry, however, an interesting phenomenon has occurred in which many of those affected by these advances have come to identify themselves with the science itself and call themselves psychopharmacologists. The term psychopharmacologist is now common parlance among physicians, nonphysician mental health professionals, and patients (2, 3), but has been subjected to surprisingly little academic scrutiny.
Many departments of psychiatry now have clinical divisions of psychopharmacology; patients are referred to as "psychopharm patients" and are seen in "psychopharm clinics;" psychiatric residents are trained in these clinics and may also have "psychopharm supervisors." These experiences contribute to the formation of residents professional identities, and the authors of this article submit that they do so at the expense of trainees physicianhood and of thoughtful, medically minded patient care. Our position stems from a bias that the most vital and potentially effective role identification for the psychiatrist is that of a doctor utilizing a medical model, and that the psychopharmacologist categorization is erroneously co-opting this possibility.
In this article, we set out to explore definitions, origins, and problems of the psychopharmacologist role, and then to identify solutions to those problems. At various points we offer specific ideas on discussing these usually neglected topics with residents. The authors recognize that the very title of this piece may offend some psychiatrists and that what follows cannot capture the practice philosophies of all self-identified psychopharmacologists. Any controversy caused is not only welcome, but desirable, as our goal is not to put forth truisms, but rather to stimulate informed discussion about an important issue that has somehow eluded such discussion to date.
