Psychiatry Is…

15 09 2010

As the above cartoon demonstrates, psychiatrists have a bad reputation of being fake doctors who simply dole out drugs and call it a day.

I don’t think that is an overly accurate representation, and I certainly don’t think that it should be what the profession is about.  As I’ve said before, I think psychiatrists heal through conversations and targeted cognitive therapies, with drugs only supporting the efforts.  My interest in psychiatry is due, in part, to the fact that we do not understand any of the disorders completely, from etiology to how the drugs actually work.  Furthermore, not only do we not understand (to a significant extent) how the pills affect the complicated circuitry and rewiring of the brain, but the drugs also cause a myriad of side effects (because many of our pharmaceuticals act on molecular targets that are in many different brain regions and tissues outside of the central nervous system), from diabetes to sexual dysfunction to cardiovascular disease and obesity.

Through many conversations and readings, I’ve come to the personal conclusion and opinion that psychiatry is, or perhaps should be, the intersection between neuroscience, anthropology, and spirituality.

Neuroscience is quite obvious, I believe, because it is the scientific understanding of the mechanisms of the brain, and how the wiring goes wrong.  It is fundamental groundwork to delineate biochemical pathways and receptors that may be implicated in a disease so corresponding treatments are appropriate (e.g., increasing activation of certain serotonin receptors in the neuronal synapse is the method of action of many antidepressants), illuminate how synaptic plasticity is implicated in changes in the brain so promotion of these longer-term changes can be involved (e.g., Alzheimer’s is associated with a decline in the molecule allopregnanolone, which has been shown to promote new neuron growth and reverse cognitive deficits when administered in a mouse model of the disease), and describe how different brain regions can be more responsible for certain aspects of function (e.g., the amygdala is strongly implicated in our interpretation of fear, and recent research has focused on potential drugs targeting this area to change/block certain memories when we think about them again so that post traumatic stress disorder patients may be treated).  Undoubtedly, neuroscience, the scientific evidence of how the brain works and malfunctions, is an integral part of psychiatry.

Anthropology is the study of humanity, and cultural anthropology in particular is the study of how different cultures have evolved over time to think and act differently.  As applied to psychiatry, I think anthropology is necessary to understand how people all around the world have thought about the brain and the mind throughout history, which will inform why different cultures approach mental health in very different ways today.  How psychiatry is interpreted by a certain culture – whether it’s just part of everyday life like in parts of NYC, or associated with shamans as in areas of Peru, or dismissed as only being necessary when you’re crazy as within areas of Asia – and how that interpretation evolved over time should completely affect the way in which the topic of mental health is tackled in that region (affecting everything from nomenclature to promotion to treatment).  In countries where immigration is frequent, I think that understanding where the patient grew up and how different cultural factors may be significant for him or her is key.

Finally, spirituality, to me, is ultimately a personal journey to seek the meaning of one’s life and where one fits in.  This path is extremely individualized and complex, and it can include anything from religion to the implications of quantum mechanics and more.  Spirituality usually involves a greater understanding of one’s place in the world, and contributes to a sense of greater purpose, unity, and connection to others.  The reason I think spirituality should be a fundamental pillar of psychiatry is because understanding how a patient uniquely values and sees his or her place in the world is instrumental to being able to understand her or his thought process, motivations, and concerns.  We cannot help anyone without being able to step in the person’s shoes, and temporarily live in that person’s reality: what they value, what they believe, what they are proud of, what makes them happy, what makes them tick, and where they see themselves in the grand scheme of life.  When someone feels that they are finally and significantly being understood, that, in and of itself, makes a gigantic impact on the individual, and would undoubtedly catalyze further gains in treating, healing, and maintaining strong mental health.  Some criticize psychiatry for overly focusing on the negative, suggesting that spirituality should be appreciated and used as a psychiatric healing tool that focuses on leveraging the positive social emotions in an individual.

Together, I think the three disciplines make up a novel way of interpreting psychiatry: one that looks beyond patients as consisting solely of their unique make-up of biochemical receptors, and towards patients as unique individuals with unique beliefs, values, and psychological needs; placed within the context of culture and history.  I believe these factors should influence everything: from how the psychiatrist interacts with the particular individual, to the selected course of treatment.

But then again, what do I know?  I’m just a Med I.

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