We Are ‘in Our Lane’

In her president’s column in the December 7, 2018, issue, Dr. Altha Stewart employs the phrase “staying in our lane” and the term “biopsychosocial.” These have important connotations and associations.

The National Rifle Association, adjuring physicians to “stay in their lane”, used the phrase as a warning to those ostensibly straying, often dangerously, from paths defined by rules and common agreement. “Biopsychosocial” is a term more honored in usage than definition. It has been attacked as a “there is not there, there” concept.

Psychiatry suffers from the lack of a unifying theory (our “lane”). The widely used biopsychosocial concept has been put forward as providing this. Human beings function in a nexus comprising the soma (biology), psyche (mental states, normal and abnormal), and the social. Psychiatrists are specialist physicians who research, teach, train, and treat patients using this perspective. It can therefore be well said, and Dr. Stewart does so, that psychiatry is indeed “in its lane” when it addresses “psychological trauma and senseless tragedies.” The biopsychosocial concept and approach defines “the lane” down which disturbed people (biologically and psychologically) are impelled toward the tragedy of violence to others (the social aspect). And recent scientific discoveries in all three biopsychosocial domains are increasingly elucidating the mechanisms that weave them indissolubly together, thus forming this “lane.”

Demands for an “integrated,” “collaborative,” “biopsychosocial” approach are increasingly heard from many sides. I submit that satisfaction of these demands (by “staying in our lane”) are crucial for patient satisfaction, improved outcomes, and reduced stigma on the part of the public, as well as for the recruitment and retention of psychiatrists.

J. Pierre Loebel, M.D.

Seattle, Wash. ■