Psychiatry and Art

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.

 

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.

 

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.