COMMENTARY

The Disappearing Patient

David J. Hellerstein, MD

Disclosures

August 10, 2007

Have you looked at psychiatry journals lately? They are full of multicolor MRI scans and complex genetic maps. Fantastic progress is being made in understanding the biology of mental disorders. However, actual human beings with mental disorders have practically disappeared from their pages.

Now look at the major medical journals. Along with cutting-edge science, they now include a substantial amount of the medical humanities -- first-person accounts of illness by patients and doctors. Essays, stories, even poems!

Why the discrepancy? After long delay, psychiatry has eagerly embraced the scientific model. It has largely thrown out the "soft" disciplines, including the humanities.

Concurrently, medicine has realized the limits of narrowly defined "scientific medicine." Twenty years ago, it became painfully clear that many doctors no longer listened to patients. The result has been an unprecedented flowering of the medical humanities.[1]

Psychiatry is teetering on the edge. Does it really want to become neuroradiology lite, and give up its traditional role of connecting patient experiences to social realities?

I believe psychiatry should reembrace the humanities -- not as a competitor to neuroscience, but as a way of expanding our understanding of these incredible new technologies. With dynamic brain imaging and epigenetics, we can explore the biological basis of subjectivity and individuality. Humanities approaches can illuminate these technologies.[2,3] In exploring these new universes, we need not be only technicians and scientists, but also artists!

In his Nobel Prize speech,[4] psychiatrist Eric Kandel called for renewed collaboration between science and the humanities, which, he says, "will not only improve our understanding of psychiatric and neurological disorders, but will also lead to a deeper understanding of ourselves."

My prescriptions:

 

  1. Include humanities with the science in psychiatric journals.;

  2. Encourage dialogue between humanists and psychiatric scientists; and

  3. Learn from the internists: Bring the stories back!

That's my opinion. I'm Dr. David Hellerstein, Associate Professor of Clinical Psychiatry at Columbia University in New York.

 


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