I came across an article in The New Republic by Sally Satel entitled "Science and Sorrow," in which she critiques The Loss of Sadness by Allan Horwitz and Jerome Wakefield. I thought her article was extremely well written and interesting. Has anyone had a chance to read the actual book? If so, any thoughts?
The Loss of Sadness
- Thread starter Moki
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I've read the book and thought it was wonderful. Much was conjecture, but i thought it was well meant and dead on in some respects.
I'd love to read that article. I'm off to find it online right now if it's there.
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Here's a link to the article.
http://www.sallysatelmd.com/html/2008-02-27_TNR.pdf
It's great. And the author is right on target. The final section of the article is the best.
I've always been uncomfortable with residents and docs using the DSM like scripture. And the problem is not the DSM. The DSM is useful but misused. The problem is resident education.
The laziness in all of us wishes to streamline our work, but mental illness is too nuanced. One of my wise attendings said "it's better to ask yourself if the medication will help this patient than whether the patient has this or that disorder." The answer requires you to know your medicine and REALLY know your patient.
And I cherish so-called 'normal' depression. I think we do tremendous disservice to humankind when we pathologize emotions that give one incentive for meaningful self-improvement.
So the article and the book are both rad.
http://www.sallysatelmd.com/html/2008-02-27_TNR.pdf
It's great. And the author is right on target. The final section of the article is the best.
I've always been uncomfortable with residents and docs using the DSM like scripture. And the problem is not the DSM. The DSM is useful but misused. The problem is resident education.
The laziness in all of us wishes to streamline our work, but mental illness is too nuanced. One of my wise attendings said "it's better to ask yourself if the medication will help this patient than whether the patient has this or that disorder." The answer requires you to know your medicine and REALLY know your patient.
And I cherish so-called 'normal' depression. I think we do tremendous disservice to humankind when we pathologize emotions that give one incentive for meaningful self-improvement.
So the article and the book are both rad.
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When I started my first rotation in psychiatry (after medical school), I found one patient really confusing, unable to ascertain her DSM-IV diagnosis for myself (I was not the only one - the team thought the woman had personality disorder, but my consultant thought that she was rapid cycling bipolar). I voiced my confusion to my consultant during our weekly supervision meeting. He listened patiently to my whining, and then said that my primary concern should always be trying to help the patient, not trying to label them, for a DSM label means frequently means nothing whilst the physician's attitude means the world in the therapeutic endeavour. This was an eye-opener for me. Later, as I was reading Yalom's The Gift of Therapy, I run into same advice from the author of the book. I came to believe now that psychiatry is still as much art as it is science, and we should indeed adopt the flexible attitude of the physician-artist, evaluating each patient on the individual basis and deciding on therapy (pharmacological or psychological, or both) which in our educated opinion is suited to this particular patient - not to the DSM category that we are trying to squeeze them into as physicians-scientists.
I have not read the book referred to in the original post, yet, but it is on my reading list. Let me also re-iterate that Rosenhan's On Being Sane in Insane Places is a really good read for any aspiring psychiatrist - I posted a link to the paper on the useful psych read sticky.
I printed out the Rosenhan article. Thank you. I'm looking forward to reading it.
In Satel's article, she expresses a belief that, as the senior academic psychiatrists "versed in psychodynamic tradition, yet enthusiastic about new medications and biological discoveries" retire, newer generations of psychiatrists suffer in their training as a result. She goes on to write: " As teachers, mentors, and department chairmen, they ensured that residents were trained in an eclectic fashion that combined descriptive, psychodynamic, and biological perspectives; that they learned how to listen and how to observe."
From your individual experiences, how accurate is this perception, both in present training and as a future trend?
On a side note, what is the sense in the psychiatric community about DSM-V? A sense of anticipation, forboding, indifference . . . . ?
In Satel's article, she expresses a belief that, as the senior academic psychiatrists "versed in psychodynamic tradition, yet enthusiastic about new medications and biological discoveries" retire, newer generations of psychiatrists suffer in their training as a result. She goes on to write: " As teachers, mentors, and department chairmen, they ensured that residents were trained in an eclectic fashion that combined descriptive, psychodynamic, and biological perspectives; that they learned how to listen and how to observe."
From your individual experiences, how accurate is this perception, both in present training and as a future trend?
On a side note, what is the sense in the psychiatric community about DSM-V? A sense of anticipation, forboding, indifference . . . . ?
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