Abstract
Today clinical psychiatry in America is under pressure from employers, insurance companies, and government to compromise patient care. That such a conflict is inherent in our work should not surprise us. Administrators of public and private funds are charged with seeing that resources are well spent. What is alarming is the extent to which clinical psychiatry is bending to these interests to the detriment of patients' needs.
There is no room in America today for research into areas other than the brain. A new generation of psychiatrists are being trained to focus on the brain. Americans are enthralled with computers and data bases, and because computers simplify the task of collecting information about mental disorders in families, the "genetic load" has become the preferred etiological explanation for mental disorders. Such an explanation eliminates the need for the slow, more difficult, and frequently painful task of collecting data that permits examination of the meaning and impact of these disorders in the context of the patient's psychosocial history.
As businesses in America become more efficient and lucrative, employees are placed under greater stress. When stress-reducing techniques fail, people turn to the health delivery system. When the health system fails, they crowd the jails or become homeless. Those concerned about the rising cost of health care in this country fail to see a connection between health care costs and the increasing stress experienced by Americans as corporations compete for profit.
An ideology of the brain's central role in mental disorders, coming from the alliance of psychiatry, government, businesses, research, and families of patients, is dominating the field of American psychiatry and pushing psychiatric patients into the medical model, to be treated by biochemical alterations when talking therapies may be more effective. The approaches used by Freud, Sullivan, Adolf Meyer, Frieda Fromm-Reich-mann, and many others that involved looking for meaning in patients' speech are now being suppressed in the name of quality care and scientific progress.
In America the pendulum always swings back. I hope it will swing back so that the needs of patients and their families are considered in the social context in which they live. But such a change should occur quickly because mental patients in America are suffering. American clinical psychiatry has the responsibility to see that clinical needs are met and that psychiatry does not sell itself to other interests, to the detriment of patients.
