Just noting another article by another psychiatrist bemoaning that his field is "in crisis." I have been reading about this crisis in identical terms for most of the past twenty years. The crisis can be described in several different ways, viz: is psychiatry about the physiology of the brain or the state of the soul? is it another branch of pharmacology, or is treating mental problems different from treating infections? should we be finding ways to make therapy work better, or discarding it as mumbo-jumbo and looking to do everything with drugs and electric currents? are psychiatrists scientists or humanists, or perhaps priests?
Has anyone read a book or article lately by a psychiatrist who loves his or her work and thinks the field is in great shape?
Thirty years ago there was a raft of books by people very excited about the potential of new drugs like Prozac and lithium, certain that our growing knowledge of the brain would soon lead to miracle cures of mental problems. I'm not hearing very much along those lines these days. ("Anyone who thinks otherwise should remember the Decade of the Brain, which ended 15 years ago without yielding a significant clue about the underlying causes of psychiatric illnesses.") Certain drugs do help some people, but in my experience only those patients whose problems originate from simple physical causes -- e.g., a severe deficit of some pituitary hormone -- are ever cured by drugs.
Therapy also seems to help some people, but sometimes at the cost of making them insufferable bores who talk constantly about themselves. The whole point of therapy is to pay very close attention, at an almost obsessive level, to your own mind and how it works; but a humanistic psychologist might say instead that what people really need in life is to stop obsessing about their own minds and involve themselves more fully in the world. Anthropologists will tell you that this obsession with the mind of the individual is a western, modern thing, and that in most of the world people think about themselves much more as units in a family, a village, and a society. And that, furthermore, many of our psychological problems may be caused precisely by focusing too much on our own minds; why else would more Americans suffer from crippling anxiety than people living in war-torn states like Lebanon or Ukraine? Toss our ongoing fight about who should pay for health care into the mix, and you get a lot of misery and confusion. Because of doubts about the efficacy of therapy and fights over who should pay for it, the number of Americans receiving it has declined greatly in recent years.
All of this has left me, as my readers know, feeling detached and skeptical about psychiatry. I never know what advice to give anyone with psychological difficulties, since I am ambivalent about all the options. I have sometimes recommended therapy or drugs, although without any great conviction. In my heart I think that what would most help troubled people is more fulfilling lives, but that is of course a ridiculous thing to recommend to anyone, especially some one too depressed or anxious to take even a small step outside routine. I also think that our psychological difficulties point toward something very wrong with our society that I would like to fix. But since we evolved to live in small communities beset by shortages and threatened with violence, I am at a loss to suggest what sort of modern world might really be suitable for us. Except that we could all use more friends, stronger communities, more support in times of hardship, and a stronger sense that we are all in this together.