Magazine article Clinical Psychiatry News

Integration Is Key to Survival

Magazine article Clinical Psychiatry News

Integration Is Key to Survival

Article excerpt

Psychiatry in the 21st century is threatened--from without as well as within.

Increasingly, other professions are trying to take over whole areas of mental health. For neurologists, who practice "brainiatry," and for primary care physicians, psychologists, and others accredited by the state, who compete for many of the same patients (often abetted by health care systems intent on cutting costs), the stigmatization that attends psychiatric services works to their advantage.

Within psychiatry itself, there has been an unfortunate trend toward ideologic fragmentation. On one side are biologic psychiatrists, who assume that disorders occur because the brain is incorrectly wired, on another the psychologically oriented, to whom pathology means that the mind is incorrectly programmed. A third approach, community-based psychiatry, puts the emphasis on the patient's social networks and resources. Separate professional subcultures have evolved, whose members go only to their own conferences, read their own journals, and join their own societies; they fail to expose themselves to other kinds of knowledge.

The key to a viable future for psychiatry is integration within this spectrum of approaches. The field must maintain a cooperative relationship with other mental health professions. But it must also fight the trend that divides cases into "wheat" and "chaff," allowing others to monopolize the care of routine and responsive patients, and leaving psychiatrists to deal only with treatment-resistant or uncooperative patients.

Although our special skills are required to deal with such complicated cases, being restricted to only complex patients is a recipe for burnout.

We must maintain a broad base, with a mix of difficult and easy cases, and we must fight the tendency of "cream-skimming" by other professions. …

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