Limits to Psychiatry and Limitations of Psychiatrists
Sekhar, K., Indian Journal of Psychological Medicine
Byline: K. Sekhar
Psychiatry as a clinical discipline has made rapid strides during the last three to four decades. Advances in the field of psychoparmacology, and genetics have contributed to better treatment options and enhanced the quality of life for the mentally ill. However, simultaneously, there is a perception that psychiatry needs to do a lot more to the suffering population at large.
At times, it is believed that a psychiatrist has the capacity to give panacea for the innumerable problems that exist in the society. Not a day passes without some "EMMINENT PSYCHIATRIST" giving his "VALUABLE OPINION", "PSYCHOLOGICAL EXPLANATION" and advice for a whole range of problems in society including terrorism, kidnappings, murders, earthquakes, tsunamis and what not, in the electronic and print media. I think the time has come when we should ask ourselves in the words of late Dr. Ravinder Lal Kapur "Are we overdoing psychiatry?" Let us remind ourselves that a psychiatrist is not an expert in the whole conduct of life. Unless we understand the "LIMITS OF PSYCHIATRY" and "THE LIMITATIONS OF THE PSYCHIATRIST" in the current scenario, the day will not be far off when a lay person thinks that we talk too much and deliver too little.
Scope of Psychiatry
"Psychiatry is that medical specialty which deals with behavioral changes arising out of pathology either in the brain or other systems in the body". This is too simplistic a way of defining and it does not include the various other behavioral maladaptations occurring due to psychosocial factors.
It is a known fact that mental disorders are more diverse than bodily disorders in their presentation. When we look at the various psychiatric diagnoses, dementias, organic psychoses, schizophrenia, bipolar disorders, paranoid psychoses, obsessive compulsive disorder, anxiety states, depression and addictions can be termed as disorders and given a disease status while one tends to see more variability and conceptual confusion when the labels Hysteria, Stress reactions, Adjustment disorders, Conduct disorders and Psychopathy as disease, as they appear to be more of problems of routine daily living.
Psychiatry is about managing mental illnesses and not human suffering of any cause. As Pridmore points out, "Psychiatrists are now expected to assist (up to and including hospitalization) when individuals have social difficulties and are distressed following relationship breakdowns".
Do Psychiatry or, for that matter psychiatrists have any tools to address or remedy the social causes? Psychiatry can manage "difficult" individuals when the difficulty is because of a mental illness. The general public, unfortunately, including other specialists have a poor understanding of psychiatry and hence try sending all their "difficult" people to the door of a psychiatrist. By magnanimously accepting these challenges, are we diluting our own role as medical specialists? When such "difficult" people creep into diagnostic classifications and get a label attached to them, there is bound to be a vast difference in the perception of psychiatry by the Lay public, Governments and Judiciary, and Human Rights activists etc. It is but natural that this type of overinclusiveness can lead to defective planning and policies and improper priorities in the delivery of mental health care. The tardy and ineffective implementation of MHA in India and almost total non-implementation of the National Mental Health Program born 25 years ago are examples of defective planning and implementation. We do not have a proper program or funding for the mentally ill and allocate precious budget for areas remotely related to psychiatry.
Some argue that there is no future for psychiatry. The reductionists' point of view is that psychiatric disorders can be reduced to either neurological dysfunctions or psychosocial problems of living. While the former can be taken care of by neurologists, the latter are the concern of social scientists. …