Why do so many people have distorted views of Psychiatry as a profession?

[Spiderwoman]

Pls correct me if I'm wrong. Isn't depression a disease just as is diabetes, appendisitis, etc? There is a pathology (Imbalance of chemicals), right? What would be wrong if we look for the cause, and run a test, if a test can really prove it. Having science backing up the diagnosis has nothing to do with insecurity of a physician, in any field.

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[OldPsychDoc]

You're right that the idea of mental illness as punishment for "sins" is part of a moralistic view of psychiatry that we have suffered from for some time. My point is that we as a field have overreacted to this issue, so that we are overly compelled to look for biological explanations for things that really don't need them because we feel that we need to legitimize our field in the eyes of all the other "real" medical specialties, where they can point to concrete physical exam and lab findings to reify the objects of their ministrations. I think that there are many psychiatrists who are interested in finding some kind of objective lab test for mental illnesses - not to help their patients, but to allay insecurities about their specialty being somehow less scientific than others. These are the same psychiatrists who tell their patients that depression is a disease just like diabetes and feel a little bit better about themselves every time they say this.

WARNING: the following reflects personal philosophical opinion, and should in no way be taken as the official position of SDN, the NBME, the ABPN, the APA, or OPD's employer.

I think that our effort to reject the moralistic view of psychiatry, whether we mean a religious moralism (such as raised in the posts above) or a psychodynamic moralism (schizophrenigenic mothers anyone?), we may be swinging the pendulum too far and rejecting the reality that actions and choices bring consequences which affect our emotional wellbeing and that of others.

I believe sin is a reality--there is individual sin related to personal imperfections which cause problems for us; there is relational sin which harms others through selfishness; there is social sin which operates on systemic levels to marginalize and oppress. There is also a kind of naturalistic sin, what some might term a fallen state of nature, or maybe just "the way things are"--the propensity for microbes to cause disease, genes to get misreplicated, tectonic plates to knock around. All sin brings suffering on some level. Acknowledging that sin is a reality does not mean that suffering should not be alleviated, nor that all suffering is somehow directly attributable to sin. I also do not believe that acknowledging that people sin means that we can stand in judgment like some finger-pointing caricature of a preacher, because to acknowledge the reality of sin is to acknowledge that it is a part of each of us as well.

When a young girl gets her HPA axis permanently stuck on "STRESS" because she was sexually abused by her uncle, and subsequently berated by her mother, then chooses another abuser as her mate and drinks when pregnant with his child, who in turn grows up in an unsafe neighborhood, maybe with lead in his bedroom paint and playground soil, and attends an under-funded, over-crowded school---well, its all sin. And just because I have not experienced these things gives me no claim to moral superiority in this situation. Maybe the best thing about being a doctor is the opportunity to "fight sin" on these levels by trying to do a little bit each day to reverse this suffering.

 

[Spiderwoman]

well said

 

[erg923]

Pls correct me if I'm wrong. Isn't depression a disease just as is diabetes, appendisitis, etc? There is a pathology (Imbalance of chemicals), right? What would be wrong if we look for the cause, and run a test, if a test can really prove it. Having science backing up the diagnosis has nothing to do with insecurity of a physician, in any field.

I think anyone who is in this field realizes that the etiology of mental illnesses (including depression) are multifactorial and much more complicated than we actually view/understand them currently. The term "chemical imbalance" is a misnomer and is so simplified an explanation it might as well be false. Yes, of course their are strong correlations among serotonin and cortisol in depression, and yes, medicines that act on serotonergic systems (among many other mind you) seem to relieve symptoms of depression. But, I think any reasonable person can see that there is probably alot more going on here, both biologically, and of course, SOCIALLY.

Although mental illness is as important to treat as any other disease, I would say NO, its not the same thing as diabetes, cancer etc. As of today, psychiatric illnesses are all syndromes. Some have associated biological abnormalities that we have observed, and some dont. The dysregularization of the HPA axis system in chronic depressives, a variety of structural brain abnormalities in schizophrenia, etc. But certainly nothing we have pinned downed as "THE PATHOLOGY" behind any of the psychiatric illnesses. And there probably wont be any ONE pathology that explains all the symptoms of bipolar or schizophrenia. Its multifactorial. Multiple brains systems, multiple dysfunctions that all result and/or influence the other, and multiple environmental influences that shape the course of the illness and how symptoms are expressed.

 

[BabyPsychDoc]

Whether you believe in God or not, I think everyone would agree that every action has reaction. You drink when pregnant - you are going to end up with a FAS kid. You are getting stoned when you are 12 - you increase your risk of developing psychotic illness because you mess up your cannabinoid receptors. It is simple. It is biological. And I see nothing moralistic about it.

And there probably wont be any ONE pathology that explains all the symptoms of bipolar or schizophrenia. Its multifactorial. Multiple brains systems, multiple dysfunctions that all result and/or influence the other, and multiple environmental influences that shape the course of the illness and how symptoms are expressed.

And that is the beauty of psychiatry - you will never get bored and you will never be replaced by a machine running tests.

 

[Faebinder]

Biopsychosocial model?

Biologic, psychologic, and social factors are involved in every psychiatric disease. It's clear that the biologic factors must be involved to result in the disease. Not everyone who is abused becomes depressed or suicidal. It's unclear how much of the social factors are involved but they certainly seem to affect the psychologic aspect of the disease. Psychologic factors seem to be a result rather than affecting factors.

I am sure the insurance companies would love the revolutionary step of discovering a neurotransmittor that can be tested to distinguish Major Depression from waste basket diagnosis of Depression NOS.

 

[TheWowEffect]

I think anyone who is in this field realizes that the etiology of mental illnesses (including depression) are multifactorial and much more complicated than we actually view/understand them currently. The term "chemical imbalance" is a misnomer and is so simplified an explanation it might as well be false. Yes, of course their are strong correlations among serotonin and cortisol in depression, and yes, medicines that act on serotonergic systems (among many other mind you) seem to relieve symptoms of depression. But, I think any reasonable person can see that there is probably alot more going on here, both biologically, and of course, SOCIALLY.

Although mental illness is as important to treat as any other disease, I would say NO, its not the same thing as diabetes, cancer etc. As of today, psychiatric illnesses are all syndromes. Some have associated biological abnormalities that we have observed, and some dont. The dysregularization of the HPA axis system in chronic depressives, a variety of structural brain abnormalities in schizophrenia, etc. But certainly nothing we have pinned downed as "THE PATHOLOGY" behind any of the psychiatric illnesses. And there probably wont be any ONE pathology that explains all the symptoms of bipolar or schizophrenia. Its multifactorial. Multiple brains systems, multiple dysfunctions that all result and/or influence the other, and multiple environmental influences that shape the course of the illness and how symptoms are expressed.

Hmmm...multifactorial!!! That is the buzz word I get from your post. Well then, so is diabetes; as is hypertension; so is dementia; as is myocardial infarction. These are as multifactorial as any other illness known to mankind. Of course, different factors are in play here. I see no wrong in using this analogy for mental illness because it helps to dispel the stigma about mental illness to some extent. Much better than saying that there are certain "chemical imbalances"; which again, there are but have not been fully elucidated yet. We are getting closer though. It might take many more years but we'll get there.