The Problem with Modern Psychiatry

My new running route takes me right past Riverview Community High School. As I ran by the home of the Pirates the girl’s softball team was playing, I heard the shot of a track gun and cheers from the stands. I was immediately overcome by nostalgia.

As my mind wandered from May track meets to the perfect Michigan spring evenings, I began to think about Mr. Franka and the Advanced Psychology course I took as a junior in high school.

Psychology was the only elective that I could take. I’m not very artistic, I have no knowledge about electrical engineering and I am lost when it comes to any automotive technology. I excelled at psychology and as a naïve sixteen year-old I decided I was going to go to college, major in psychology and then go to medical school and eventually specialize in psychiatry. I thought psychiatrists knew more than psychologists and I would be able to fully understand human behavior.

During my collegiate years I began to better understand the differences between psychiatry and psychology and became frustrated with the use of medications to treat all mental illnesses. I developed a pompous, liberal idealism that good universities promote toward psychology and abandoned all biological etiologies theorized in mental illnesses.

I was an ambitious teenager and college student. (By the way where did that ambition go?) My life has followed that teenage plan fairly closely, but now I have realized I can never practice in the field of psychiatry.

As my knowledge has expanded and matured throughout medical school I haven lessened my undergraduate philosophies and understood there may be some biological factors attributing to mental illnesses and moreover that medication can actually be helpful in the treatment and hopeful recovery of these disorders.

Anti-depressants, mood stabilizers, anti-psychotics, etc. have been helpful in the symptomatic treatment of depression, bipolar disorders and psychosis. One treatment I have not changed my views on throughout my schooling is electroconvulsive therapy (ECT).

ECT, once the first line treatment for mood disorders and depression, is now only indicated in cases of refractory depression and depression unresponsive to medical management. Although it is not as inhumane as it has been portrayed in popular media (One Flew Over the Cuckoo’s Nest) it is still an outrageously absurd treatment.

Two electrodes are applied bitemporally and electricity is sent into the brain causing tonic/clonic (grand mal) seizures. The 30-60 second seizures are done 2-3 times/week for roughly twelve weeks. The mechanism of action (why tonic/clonic seizures alleviate depression) is unknown.

Last Friday I was a part of five ECT. I was morally and ethically torn about this when my attending asked me to participate Thursday before I left the hospital. If I were a pro-life individual and a physician asked me to participate in an abortion I would have the right to decline care for that patient. However, I was not sure what my boundaries were with ECT. Thus, I sat in on these treatments like a good medical student.

It reminded me of why I began to dislike psychiatry so much as an undergrad at Michigan State University. Psychiatry should be based in the healing of the human soul, as Sigmund Freud intended it to be when he founded the profession. However, over the years the discipline of psychiatry has been anything but healing, from the overt racist research of Social Darwinism to the Frontal Lobotomy and Egaz Moniz’s Nobel Prize to medications with serious adverse reactions and health risks.

The prevalence of psychiatric illnesses has not decreased since the advent of modern psychiatry, which largely deserted its founder’s principles. Recently a study was done in the Psychiatric Services Journal and the authors reported a disturbing trend in the routine practice of mental illnesses. They illustrated that psychiatrists often followed the evidence-based guidelines for pharmacological therapies, but were poor at following the recommendations for psychotherapy treatments, such as psychoanalysis. Although the authors pointed to some methodological flaws in their study, their conclusions represent what I have seen from working in group homes and now on the psychiatric ward at Henry Ford Wyandotte Hospital.

These psychiatrists who treat solely with medications and with ECT do not mean to do harm to their patients. However, these practices do not offer to promote a true healing of an individual’s mental illness.

For the rest of my run I remembered why I loved psychology as high school student. It was a vibrant and interesting topic that allowed for intellectual debate. But as I matured as a person and student I began to see the problems with modern psychiatry. The use of medications and ECT are taking precedent over efficacious psychotherapies. I have done a good job following the goals I set out for myself as a sixteen year-old, but now I have to go in a different direction as I realized I cannot practice in a field of medicine that has become myopic in it’s treatments and theories about psychopathologies.