What's killing psychiatry?

Part 7

by Lisa Birk

Practitioners I've spoken to say that in a decade, or two at the most, psychiatry as we know it will be extinct.

The ranks of traditional practitioners are dwindling, and managed care has changed the focus of psychiatric training from individual evolution to quick fixes. "The residents know psychotherapy intellectually but hardly ever see a patient for more than a year," says Cecilia Mikalac, a psychiatrist who leads an annual seminar at UMass Medical School.

Sam Holden puts it a different way: "It's as if a surgeon-in-training saw part of the surgery -- opening up the patient, seeing the tumor -- but left before learning how to take it out," he says. "Would you want that surgeon to operate on you?"

We are living through a paradigm shift in our understanding of human beings and how they work, perhaps as great -- and as disorienting -- as the publication of Darwin's Origin of Species. If Darwin's theory of evolution made us feel less divine, perhaps the new drugs, the reduction of the brain to a series of chemical functions, make us feel less human.

Few would choose to go back to the days before Clozaril, when an anti-schizophrenic drug gave patients tics and contortions and Parkinson's-like shaking. But what if the patient had the benefit of the powerful new drugs, complemented by the skilled and artful practice of traditional psychotherapy? Thanks to the collision of managed care and psychiatry-by-prescription, we may never know.

Back to part 6

Lisa Birk is a freelance writer living in Cambridge.