An article that appeared in Psychology Today online (12/09/2019) discusses the ways in which the mental health professions have gone in a direction that undermines their ability to help patients. In particular, the article sites the increase in the application of the medical model to mental health issues and the resultant dependence on pharmaceuticals as a dominant remedy to all mental health complaints.
In a recent article in the New England Journal of Medicine, Gardner and Kleinman make a point that parallels what I’ve been saying for a long time. Modern medicine is so anchored in the reductionistic disease model that it has neglected mental health care, most manifest by its failure to train the primary care physicians who provide 85 percent of it; psychiatrists provide only 15 percent of all mental health care.
Gardner and Kleinman present parallel material describing a similar reductionistic process within psychiatry itself. Even though psychiatry does address the problem of mental illness, it has forsaken its earlier successes for a unidimensional interest in the biological basis of mental disorders.
Let’s begin by recalling the profound advances made by psychiatry beginning at the turn of the last century. At that point, the rest of medicine had completely divested itself of the psychosocial aspects of its patients in favor of an isolated focus on physical diseases. But psychiatry was the exception.
While many of Sigmund Freud’s ideas have been modified or discarded as neuroscience has matured, his articulation of the subconscious and its impact was a monumentally important derivative of his work that guides us to this day.1 It helped us understand the key role of emotions in the everyday life of patients. Additionally, his concept of listening carefully to the patient and facilitating the flow of conversation persists today in the burgeoning field of patient-centered interviewing, albeit one now located largely outside psychiatry.1 Central to this broad-based psychiatry was establishing a trusting physician-patient relationship and understanding patients in their psychological and social dimensions in addition to their physical disease problems.