Magazine article Clinical Psychiatry News

Let the Psychiatric Gaines Begin!

Magazine article Clinical Psychiatry News

Let the Psychiatric Gaines Begin!

Article excerpt

The Olympics bring out the best in the world's premier athletes every 4 years. The 2008 competition, held in August in Beijing, set many new records.

The following month, the Paralympic Games for athletes with disabilities also were held in Beijing. Similar competitions were held and new world records were set. Nonatheletic fields, such as mathematics and science, also hold so-called Olympics.

According to "Sport Psychiatry: Theory and Practice," (New York: W.W. Norton, 2000), psychiatrists and other mental health professionals possibly do play some role in helping athletes achieve peak performance, but we have nothing comparable to the Olympics in our field. The closest event we have might be the intermittent World Congress of Psychiatry, sponsored by the World Psychiatric Association. Held this year Sept. 20-25 in Prague, the World Congress received a fraction of the media attention garnered by the Beijing Olympics.

I was unable to attend the congress, but I looked over the schedule of presentations. Of course, nothing appeared overtly competitive. Rather, the focus, as is usually the case at such medical gatherings, was to present updates, summaries, or new information. Some advances were promised in sessions such as "New Technologies for a Therapeutic Improvement in Psychiatry." Like the Olympics, the World Congress did feature contributions from small countries, such as "System Intervention in an Emerging Context: The Algerian Experience." Some prizes were awarded, but these were secondary to the purpose of the meeting.

While I thought about these recent international events, it struck me that advances in psychiatry are made much more slowly than those in athletics. For example, the typical antipsychotics I prescribed 30 years ago are just now undergoing a renaissance. We continually are reminded not to forget lithium, that old standby for "manic depressive" disorder. The newer antidepressants may have some advantages as far as side effects go, but it is still unclear how much more effective they really are.

We now have cognitive-behavioral therapy. But the value of long-term psycho-dynamic psychotherapy is being confirmed (JAMA 2008;300:1551-65).

Does the excellence sparked by intense athletic competition suggest that the body is more adaptable than the mind, even though we know that the mind influences how the body performs? Does competition in sports, as in business, spur faster development?

Asking those questions is not to suggest that competition is all good. In his classic book, "The Madness in Sports" (New York: Appleton-Century-Crofts, 1967), the psychiatrist Arnold R. Beisser described the many problems created by competition, including guilt from victory. Sports can bring excitement, enhanced family interactions, and community cohesion, but fans can become overzealous.

Recently in Milwaukee, where I live, our basebail team made the playoffs for the first time in 26 years. Of course, the achievement made front-page news, and stories included comments on the ecstasy of victory. This one was typical: "It was just electric for the last couple of innings. I can't believe I'm a part of this." I was struck by a quote from a fan who discussed the agony of defeat in the 1982 World Series with St. Louis: "This is my earliest memory: When I was 4, my dad threw a Pabst Blue Ribbon at the TV set when the Brewers lost in the seventh game to the Cardinals."

I was unable to make a total emotional connection to all of the excitement about the Brewers, because I'm still loyal to the Chicago White Sox. I grew up on the South Side of Chicago, and memories of attending and watching games with my father still have a special place in my heart. Because of my love for the game, my life goal was to play professional baseball, until I broke a leg in high school and decided to become a physician instead--much to my mother's delight. …

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