Psychiatry on the Edge

In many ways, it is "the best of times and the worst of times" for the field of psychiatry. New discoveries in neuroscience are leading us to a better understanding of several major disorders, such as schizophrenia and bipolar disorder. New and effective treatments are gradually emerging for these conditions, sometimes combining medication with brief, targeted forms of psychotherapy. And, psychiatrists are increasingly aware of the role of culture and spiritual values in working emphatically with patients. At the same time, psychiatry is being challenged from several quarters, with both its diagnostic system and treatment methods, the subject of great controversy. Mental illness itself continues to be misunderstood or stigmatised, and those who treat psychiatric disorders have been subject to harsh criticism and hostility. Economic pressures have encroached on psychiatry's ability to provide psychotherapy for many patients, and the "biopsychosocial model" of treatment has been undermined. For all these reasons, psychiatry finds itself "on the edge" -- the edge of both great promise and equally great peril. In this collection of essays drawn from his many years writing for Psychiatric Times, Ronald W Pies, MD, defends psychiatry against its detractors, while also acknowledging the profession's shortcomings and challenges. He provides a robust defence of both the science and the art of psychiatric treatment, while moving beyond the symptom-based, DSM approach to diagnosis. Dr Pies takes on the positivist critics who insist that only bodily disease is "real", and emphasises that both psychiatry and general medicine identify disease states by the presence of substantial suffering and incapacity. He also espouses a broad-based, humanistic approach to the care of the patient, drawing on several philosophical and spiritual traditions. Finally, Pies argues that psychiatry cannot be viewed apart from the system of ethical values that underlie medical practice in general, and offers some caveats regarding the misuse of psychiatric expertise for non-medical purposes. Unifying all these essays is the teaching of the 12th century physician and sage, Maimonides, who said, "The physician does not treat a disease; but rather, the diseased person."