Psychiatry in the Modern Age, Why All the Negativity?

There is a great deal of information on the web about the risks of psychiatric medications-and less about their benefits. Much of this information is found by people who have, for whatever reason, engaged their psychiatrist for help with mental health issues and then they research the web to find out all they can about a drug before they take it. My patients most often want to discuss the usually negative information they find posted by people without any apparent credentials or experience yet who seem to go out of their way to criticize the practice of psychiatry in general and psychiatric medications in particular. I think this issue needs some perspective.

I really enjoy practicing psychiatry in today’s world-it makes me feel reassured that my patient is engaged in improving their own mental health when I get a call to discuss something they’ve found on the web. Doing their own research makes them an informed patient and the best patients are well-informed. Gone with good riddance are the days when the patient always does what the doctor says without question. Gone also are the days when mental illness was considered a matter of weak will and not something to be treated by a physician, but some are still living in this past.

Having said this, even today, there is no area of medicine that has more critics than psychiatry. I think it has to do with the fact that psychiatry, unlike some other areas of medicine, is heavier on the art as opposed to the science side of medicine. This is not to say that we don’t understand biologically how psychiatric medications work, we know more about psychiatric drug pharmacology than we do about drugs used in most other areas of medicine, but unlike other areas of medicine and surgery, what works for one patient doesn’t necessarily work for the next, and there is likely some biological reason for this that is yet to be discovered.

As an example, I have to rely on a patient’s history and symptoms to diagnose depression, but there is no “depressant level” that I can order from a lab, and there is no technique of physical exam that can elicit confirmatory signs of depression. There is, however, the history of exactly what has interfered with the patient’s normal function and we have the mental status exam which can confirm the diagnosis after the lab tests have ruled out “biological causes” of depression (e.g., hypothyroidism). It isn’t easy, and it isn’t quick, but there are reliable ways to diagnose and treat people with mental illness-and here is the kicker: suffering people get better! Why there are so many critics of psychiatry is not something I personally understand-perhaps it is because every family has someone who has been devastated by mental illness and we transfer our negative feelings about the illness to the psychiatrist, but I’m not sure.

I am sure that when a patient responds to treatment (medications and therapy), it is a good thing, and I don’t see these people post their positive experiences nearly as much as the critics post their negative views, I guess for obvious reasons. For me, and I admit my bias from my training, there is nothing more devastating to a patient than a mental disorder, and conversely, there is nothing more rewarding in all of medicine than to improve the lives of those suffering with mental illness.