Psychiatry and Art

Discussion in 'Psychiatry' started by sloop, Dec 2, 2017.

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  1. sloop

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    I’m not sure that I have a specific idea for the direction of this thread but I’ve been having a growing sentiment recently that I was wondering if other people shared.

    Since moving to a new city for residency that happens to have multiple awesome and free art museums (one of which is a block from my apartment), I think I have a new appreciation for how beneficial art is not only for my personal but also my professional development.

    Now, to be honest, I know very little about the historical and technical aspects of painting, sculpture and the like (I know a decent amount about poetry). Still, when I look at some of these paintings I can’t help but get the feeling that they teach me something about human mental life that is scarcely directly learned from psychiatric practice. That is, I get the feeling that while psychiatry is great at teaching how to understand and interpret the objective aspects of a patient’s mental life (what they might be able to tell you about their mental life and what their behaviors might mean), art has a way of giving one the best glimpse possible into what it might be like to feel what another person feels.

    For one example: The other week I was re-reading some of Wilfred Owen’s poems and was thinking about how even though I can obviously never fully know the qualia of someone who has gone through war trauma, his works are some of the closest I feel that I’ve been able to come to understanding what that might be like.

    Now I’m not yet exactly sure about the concrete ways that this has impacted me as a psychiatrist but I’m sure it has. Perhaps it has made me better at validating people with neurotic personality vulnerabilities who are acting in ways that can be frustrating. I’m sure there are other ways too, but I’m struggling to place a finger on them.

    I guess I’m wondering if any of you have had similar feelings and, if so, if there have been any particular works that you feel have influenced you. This might be literary, fine art, theater, cinema, etc.
     
    #1 sloop, Dec 2, 2017
    Last edited: Dec 2, 2017
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  3. Candidate2017

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    Psychiatry is for sure an art. Art is self expression. The better of an artist you are, the better you express yourself. The better you express yourself, the better your patients respond. People who can express themselves well also tend to be people who can recognize different forms of expression. Transference, countertransference, all that yin yang.
     
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  4. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Psychiatry deals with the mental functions which are most unique to and distinctive of humans--so it should be no surprise that many of us value and contribute to the Humanities.
     
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  5. nitemagi

    nitemagi Senior Member
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    Art and expression is very intimate to what we do, once we get past nomenclature and pathology and closer to the nature of human ways of connecting to others and understanding ourselves.

    For me it was definitely film and TV, which led to my second career pursuits.
     
  6. valid username

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    I spent several years as a public artist before going back to school. It was wonderful, but physically demanding (clay is heavy, scaffolds are high, etc).

    Anyway, this simple job has gained a surprising amount of attention during interviews. Almost every interviewer has to at least mention it even though I have experience that is somewhat more relevant.

    I know this is not at all what you were asking. I just thought it was interesting. The only thing I can figure out is that they may have googled my name. Eh. Maybe not.
     
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  7. valid username

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    Art reflects our ability to overcome adversity through harmony, balance, variety, and unity. Psychiatrists are artists.
     
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  8. Sunny in Psych

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    I had a conversation with a neuropsychologist who said that psychiatry could be replaced with algorithms. I disagreed for many reasons and this is one of them. There is an art to psychiatry and we must use intuition and expertise to truly do good work. It is an art and a science... this is why I love my career.
     
  9. sloop

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    This seems pretty ridiculous for many reasons. First of all, even a perfect algorithm can only produce a result as good as its input. Humans (in my experience, at least) have a really hard time identifying whether something is a rumination, racing thoughts, or obsessions . There are many other examples–is it a hallucination, an illusion, or a delusional percept? These things would likely receive different weighting even in the hypothetical perfect algorithm.

    I also don't think that the probability calculus is at all clear enough for algorithmic decision-making. So many of our patients represent unique situations and it's not like there have been studies on populations that are perfectly analogous to them. I recently had a patient with two bipolar first degree relatives but no history of mania, hypomania or mixed episodes presenting with depression, who when treated with an antidepressant had one or two really low amplitude and kind of vague manic symptoms while otherwise still generally looking depressed. I was trying to figure out whether this was just a patient with a resolving depression or evolving TEAS. Obviously the pretest probability is high, but how much should one read into low amplitude symptoms in such a case. I don't know how much an algorithm would help me in this situation. I don't think there's an evidence base for knowing the probability of one hypothesis over another in this very specific case. Ultimately that's going to be a judgment call based on a qualitative synthesis rather than a number crunching game.
     
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  10. Sunny in Psych

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    I 100% agree. Those are the intricacies that we must discern. Often Bipolar II hypomania is expressed as more agitation and we can then deduct that adding a mood stabilizer may be helpful. How does an algorithm pick up on this? Truthfully, each of us may choose a different direction if care, and certainly different medication. In the case you posted, I would likely add lamictal, a good choice for more "soft signs" than meeting direct criteria. But ask 3 others and they may each go various directions with treatment-- and none of them are wrong. How do we put together an algorithm for a patient such as I saw yesterday with mild MR, schizophrenia, and ODD? Try to make a step by step for that. I don't see that being the wave of the future, but this guy did.
     
    #9 Sunny in Psych, Dec 15, 2017
    Last edited: Dec 15, 2017
  11. sloop

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    I decided to keep plowing forward with the SSRI, hoping that if it's TEAS it will declare itself more clearly in the hospital. If it becomes more clear that I'm dealing with bipolar, my plan was to start lamictal. I hate declaring people as bipolar when there's not a clear history or presentation for it, if for no other reason than my (limited) experience so far has been that people get called bipolar once based on a soft call and then will often spend a good portion of their lives on all sorts of mood stabilizers with providers shying away from the medications that are actually likely to be helpful rather than actually clarify the diagnosis. I've encountered way too many people carrying specious bipolar diagnoses based on "episodes" that were highly questionable.

    If the symptoms were just a little more overt, I agree with you though. I would have discontinued the SSRI and started lamictal.
     
  12. Sunny in Psych

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    That was probably best. You saw the symptoms first hand. Bipolar can be overdiagnosed, but I more often see patients who have been treated for depression for years with antidepressants and no improvement. They are bipolar and so relieved when the meds are corrected. Just keep an eye... at least 8 weeks on an SSRI before I consider anything else.
     

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