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Comments and Controversies

Missed progress

Vol. 10, No. 08 / August 2011

I, too, am concerned with the lack of recent progress in psychiatry. Nevertheless, Dr. Nasrallah is missing some of the progress he downplays (“A skeptical view of ‘progress’ in psychiatry,” From the Editor, Current Psychiatry, June 2011, p. 18-19). For instance, the discovery of chlorpromazine brought about concomitant serious side effects and homelessness, but many patients gained a life in society, which allowed some to become peer specialists, helping others with mental illness. Sure, insurance hassles for state hospitalization did not exist and hospitalization stays today often are much too short, but 40 years ago, state mental hospitals were so-called “snake pits” of overcrowding with excrement on the floor, and precious little treatment. Yes, in psychiatry we have more legal constraints, but in part this is a reflection of past coercive and unneeded hospitalizations.

I agree funding reductions have broken public mental health systems, but psychiatrists generally have preferred private practice with mentally healthier patients and sat quietly while other disciplines took over psychotherapies. I also don’t like the term “behavioral health,” but behavior can be measured, and we have precious few ways to measure progress and outcomes in psychiatry. Maybe pharmaceutical companies are abandoning drug development because they have been unsuccessful in developing novel medications in the last few decades, instead benefitting from serendipitous discoveries such as chlorpromazine. We may need new approaches to biologic treatments to progress any further, but this should not be surprising, given how difficult it is to access and study the brain

Steven Moffic, MD
Professor of Psychiatry
Medical College of Wisconsin
Milwaukee, WI

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