Abdication of the Mind

I found the letter by Dr. Rodrigo Muñoz in the July 2 issue, titled“ Against the Mutilation of Clinical Psychiatry,” to be eloquent, well thought out, and important.

Psychiatrists are being marginalized to “medication managers,” while psychologists and social workers are increasingly in charge of our patients. It used to be the case that the training in psychotherapy that psychiatrists got exceeded the training that psychologists got. Psychiatrists had major expertise in not only the biology but also the psychology of the biopsychosocial model. Psychiatry could be distinguished from neurology in that neurologists knew only about symptoms, diagnoses, and treatments, while psychiatrists also knew about the psychodynamic interior. Now psychiatrists learn only a brand of minor neurology, with some behavioral therapy thrown in.

To get my CME credits, I have gone to innumerable psychopharmacology presentations. These pharmacology experts think that their treatment is the total treatment of patients (with some behavior therapy thrown in, done by psychologists). Their research is substantially funded by drug companies that allow them to publish only their positive results. This research provides them with lengthening CVs and promotes their academic careers. These psychopharmacology researchers then come to predominate in academic departments, and they are responsible for the narrow and restricted kind of training that today's young psychiatrists get.

When they think about it, these psychopharmacologists proudly think that they have promoted the return of psychiatric practice to medical practice. In the real world, they have actually promoted a marginalization of psychiatrists and an abdication of leadership of the mental health team.

I strongly agree with Dr. Muñoz's ideas, and APA and psychiatry department chairs ought to take a better look at what is really going on out there.