The physical location, of thought, mood, and behavior, is the brain. We don’t like to biopsy that organ without extremely good reason. The consistency of the brain is something like Jell-O — not easy to use an x-ray to see where it’s broken. Using brain scans, however, we now can distinguish between the brain of a person with depression and a person who is not depressed — and make many, many other such observations. Those observations correlate with what we learn by interviewing a patient and observing his or her behaviors.
5. Do psychiatrists want to label everybody as sick so as to fill our practices?
There is a shortage of psychiatrists. I don’t know any psychiatrists with time on their hands. Our incomes are at the lower end of the medical totem pole, along with family medicine and pediatrics, which makes it difficult to repay the over $100,000 in student loans we have, on average, but we make a good living.
6. Is there a scientific basis for psychiatric treatment?
The New England Journal of Medicine some years ago published a paper demonstrating that far fewer than half the treatments used for cardiovascular diseases are supported by good scientific evidence. Psychiatric treatments work about as well as other medical treatments (1).
7. How can talking to someone cure a real disease?
Well, it can. It can also help cancer patients to live longer; it can lessen the pain of diseases and procedures. We see the same changes on brain images whether a person’s depression is relieved by psychotherapy or medication.
8. Do psychiatric medications turn people into ‘zombies,’ or change their personalities?
Any medication can cause ill effects in some people, especially if they take too large a dose. Are psychiatric medications ‘brain-altering’? A person who recovers from depression, post-traumatic stress disorder, or obsessive-compulsive disorder can seem to have a changed personality — a healthy one. People treated for schizophrenia can use their brains to make contributions to society and have fulfilling lives because their brains are no longer cluttered with hallucinations and delusions.
Prejudice against psychiatry, psychiatric patients, and psychiatrists goes back millennia. It’s hard enough to have a painful and possibly disabling disorder, or to treat one, without suffering from stigma as well. The brain is not only the most complicated organ of the body — it’s one of the most complicated entities in the universe. So psychiatric problems don’t have simple answers. Just like our colleagues in other branches of medicine, no more and no less, there is much more that we don’t know than that we do know. Like our medical colleagues, we’ll keep relieving the suffering of people who are ill, and we’ll keep doing research to understand and treat them ever better.
[Sources: Stotland, Nada Logan, MD Presidential address. Am J Psychiatry 2009: 166:1101-1104. The Huffington Post June 20, 2014. Photo: en.wickipedia.org]