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Comments and Controversies

The larger mosaic; Same goal different method

Vol. 11, No. 06 / June 2012

The larger mosaic

Dr. Nasrallah paints a frightening vision in his April editorial. There are many schools of thought in psychiatry, including biological, psychodynamic, cognitive behavioral, relational, and humanistic approaches. All of these reflect a piece of the larger mosaic that makes us human and contributes to our mental health. Psychiatry is the only medical specialty where well and broadly trained clinicians can treat patients on any or all of these levels in an integrated fashion.

The desire to redefine psychiatry as the treatment of strictly neurologically based conditions may work well for illness such as schizophrenia or bipolar I disorder, but it does a disservice to patients with anxiety, depression, trauma, etc., who can benefit from an integrative approach that may include medication and a neuroscience perspective but does not deny the healing power of approaches that work with the subjective side of mental life.

David Aftergood, MD
Private Practice
White Plains, NY

Same goal, different method

I agree with Dr. Nasrallah that psychiatry is ready for creative destruction. We differ in the best way to achieve that goal. It is not enough to revolutionize current diagnostic schemes or the disastrously dysfunctional mental health bureaucracy. My suggestion is to get psychiatry out of the pocket of pharmaceutical manufacturers who support academic psychiatry and its publications. The April 2012 issue of Current Psychiatry has 78 pages; one-half are drug advertising. If we want to revolutionize our profession I suggest we wean ourselves from our dependency on pharmaceutical manufacturers’ support, and advocate for the elimination of direct-to-consumer advertising.

Carl Hammerschlag, MD
Chief of Community Mental Health
Gesundheit! Institute
Phoenix, AZ

Dr. Nasrallah responds

I thank my colleagues for their comments on my editorial, whether supportive or dismissive. Editorials represent my opinion, sometimes critical, sometimes aspirational, but always intended to provoke healthy discourse with Current Psychiatry ’s readers. My intent in this editorial was to urge psychiatrists to continuously question what we do and whether we can practice our art differently, better, or in a more scientifically valid manner.

Regarding the issue of laboratory testing to confirm a clinical diagnosis—which many were hoping would be part of DSM-5—I have no doubt that this will become a reality in the not-too-distant future. Testing will include a mix of blood, cerebrospinal fluid, neurophysiological, or neuroimaging tests—structural, functional, spectroscopic, and diffusion tensor imaging MRI. If this sounds unlikely right now, that’s what most people thought about our ability to land on the moon a mere decade before it happened.

When it comes to the future of psychiatry, I uphold 1 mantra: yes we can and yes we will!

Henry A. Nasrallah, MD

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