[di meliora]

Dr. Pies, in another Psychiatric Times essay, takes on this question and introduces a concept he calls "Polythetic Pluralism." http://www.psychiatrictimes.com/blog.../10168/1973626

Before talking about polythetic pluralism, Dr. Pies tells us:

When I was a first-year resident, a revered supervisor of mine made the statement—half-facetiously—that “in psychiatry, you can do biology in the morning and theology in the afternoon!” That remarkable claim not only intrigued and inspired me—it also became a kind of North Star in my own professional orientation, for the next 30 years. But amidst the intense and sometimes internecine conflicts that rage around and within psychiatry today, I think it is time to reexamine my supervisor’s observation. At the very least, it may be useful to use it as a kind of lens, through which recent arguments about psychiatry may be viewed.

Those who are curious may read the essay to learn what Dr. Pies intends polythetic pluralism to mean. Pies concludes:

In my view, psychiatry should not aim to be a “physical science” or a “natural science”—but neither should it confine itself, in Cartesian fashion, to being a “mental science.” Psychiatry ought to be both a medical science and a healing art—and must find a way to embrace and meld elements of both. Psychiatry should be a medical science in so far as it studies conditions of health and disease; adheres to the best available controlled evidence; and uses the tools of “objective” medical practice, such as laboratory studies and brain imaging. At the same time, psychiatry should be a healing art, in so far as it concerns itself with the intimate subjectivity and “inner world” of the patient. There is no incompatibility or conflict between these complementary realms: “molecules” and “motives” are simply two lenses through which we view one and the same human condition.

What I am describing is akin to what Ghaemi20 describes as the “biological existentialism” of Karl Jaspers. And—although some physicians may chafe at this—the model I am proposing is also close in spirit to the “nursing model” described above: ie, “a holistic . . . assessment of all dimensions of the person (physical, emotional, mental, and spiritual) that assumes multiple causes for the problems experienced by the patient.” However, as Kontos commented to me (personal communication, October 12, 2011), this putative “nursing” model really represents the qualities found in all good physicians, independent of any theoretical “model” of medical care and treatment.

Albert Einstein once observed, “The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.” In order for psychiatry to escape the “fly bottle” in which it now finds itself, we must bring together the intuitive and the rational mind. And we must do this not in service of a theory or ideology, but in the service of reducing suffering and enhancing the quality of life for our patients.

Would it not be wonderful if all arbitrary boundaries currently invoked in health care were removed to allow what Dr. Pies envisions to occur?

[Gus1234U]

sadly, it has been my experience that Pdocs, more than any other specialization, have abandoned the Prime Directive: Do Good, but First, Do No Harm. helping a person suffering from brain disorders is a delicate and often slow process, requiring the five axes of support: physical, emotional, cognitive, spiritual, and integrated long term coordination. without those there is at best often only a short term shoring up of unreliable abilities and relapse. such is what i have seen and read, and known. i only hope my experiences are not repeated endlessly with others.

[DespondentDaisy]

Yes, I totally agree with that. The main problem it seems is that the majority of society still doesnt see much validity in psychology and dont realize or understand that medications are viable technique in the healing process along with talk therapy and that not all conditions need medication, though I don't think all conditions can go without it either. If the medical field could come together and collectively continue research and understanding about the elements involved in mental illnesses I believe a lot of good would come from it.

[DespondentDaisy]

Originally Posted by Gus1234U

sadly, it has been my experience that Pdocs, more than any other specialization, have abandoned the Prime Directive: Do Good, but First, Do No Harm. helping a person suffering from brain disorders is a delicate and often slow process, requiring the five axes of support: physical, emotional, cognitive, spiritual, and integrated long term coordination. without those there is at best often only a short term shoring up of unreliable abilities and relapse. such is what i have seen and read, and known. i only hope my experiences are not repeated endlessly with others.

Ah, but that is the doctoral oath, not a psychiatrist or therapist oath, sadly. Good point though, it should be included in their training as well. I think though it's not because people in the profession have the assumption that they're all there to do good and that nothing they do can do any wrong. . . Well, not everyone, but I think from what I've heard some people in the psychiatrist field don't quite empathize with their patients as much as they could. Staying unattached is one thing, being totally clinical is another.

[Open Eyes]

Many of todays psychiatrists do not spend enough time with thier patients, they have a prescription pad, a pen and perks that many patients are truely not aware of yet. When I was with one therapist he told me that he had two psychiatrists that he worked with and both were very abrupt in their diagnosis and spent only about 10 to 15 minutes with a patient. He described one psychiatrist as also working with a big pharmacutical company and was paid more by that company than their regular patient practice. I think that NO psychiatrist seeing patients should be allowed to also work for and get paid by any pharmacutical company whatsoever.

In the past 10 years alone, even in the past five years we have learned so much more about the human brain than ever before. But there is still so much we do not know. Yes one can add oil to a car if the oil gauge is low, but what about changing the filter or maybe there is a leak somewhere and often adding oil only buys a short amount of time and truely doesn't address the real problem behind that low oil gauge. Ofcourse an engine is not the same as a human brain, we know more about engines than we ever knew about the human brain. However, I have used that example just to show that perhaps just spending a few minutes with a patient and prescibing the newest drug is a real concern to me.

I agree with Gus, there is more to be considered that cannot possibly be considered without a psychiatrist truely getting to know the patient. More than just considering the newest drug on the market. For me, my experiences with psychiatrists did not leave me feeling any real comfort.

There are some very good points made here in these posts. I truely think that a patient's past and current environment and medical history has to truely be considered before prescribing medication on a try this and let's see if it helps basis. I find it very troubling when it comes to medication, I honestly don't know who to trust. And working with a therapist is extremely important and a patient must be diabnosed correctly. I will never forget my stay in a psychward and meeting patients that were on 5 medications and truely did not know if they felt any improvement or were in fact worse than before, that really frightened me. I truely felt like I was in a lab rat atmosphere.

Open Eyes