Reducing Reductionism: Reclaiming Psychiatry
Wesley Sowers, M.D., president, American
Association of Community Psychiatrists
Despite the growth in our understanding of the mechanics of
the human brain, the scope of psychiatry has actually been
growing smaller in recent years. Our systems have evolved in
ways that constrict the range of our practice and the growth of
our skills. Our programs for training psychiatrists have too
often acquiesced to this system, and young psychiatrists are
increasingly ill prepared to assume the clinical leadership
roles that have traditionally been ours. The emphasis on
neurobiology and pharmacology has limited exposure to and
proficiency in rehabilitation, the psychotherapies, group
dynamics, clinical administration, and supervision. Too often
we hear service users complain that their doctor talks only
about medication and does not seem to have time to really get
to know them. The growing use of complex polypharmaceutical
interventions that highly functional people would have
difficulty adhering to makes us wonder whether many
psychiatrists have become uncomfortable applying the basic
skills of empathic communication and whether they are at a loss
for what to suggest to manage uncomfortable circumstances,
apart from a new medication.
From the shadow of these developments a new movement has emerged
that has become a powerful force in moving the future direction
of service development to consumer- and family-driven service
systems. Recovery for persons with mental health and substance
use disorders is a powerful idea that promises hope,
self-respect, independence, affiliation, personal growth, and
empowerment. In this light, it will no longer be acceptable for
psychiatrists to simply be caretakers, more concerned with
stabilization and maintenance than with reclaiming lives. The
principles of recovery, in conjunction with knowledge of
theories of change and motivational techniques, provide
powerful tools for psychiatrists to help guide clients toward
their desired goals. The recovery approach enhances clinical
practice by providing a basis for hope and trust and a
structure for communication and therapeutic alliance that is
applicable even within the constraints of present systems of
care.
It is time for us to reclaim psychiatry and tend to our own
recovery. We have an opportunity to put excitement back into
what we do, to return to moral treatment perspectives, and to
celebrate rather than commiserate with our colleagues. Toward
that end, a group has formed to create a new agenda for
psychiatric training and continuing education. The Coalition of
Psychiatrists for Recovery invites all like-minded
professionals to join a network that promotes the grassroots
change of our systems and the education of future
psychiatrists. Persons interested in joining this network
should contact us (sowerswe@ccbh.com).
Related Article:
- June 2005: This Month's Highlights
Psychiatr.
Serv. 2005 56: 641. [Full
Text]
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