In many ways, it is "the best of times and the worst of times" for
the field of psychiatry. New discoveries in neuroscience are
leading us to a better understanding of several major disorders,
such as schizophrenia and bipolar disorder. New and effective
treatments are gradually emerging for these conditions, sometimes
combining medication with brief, targeted forms of psychotherapy.
And, psychiatrists are increasingly aware of the role of culture
and spiritual values in working emphatically with patients. At the
same time, psychiatry is being challenged from several quarters,
with both its diagnostic system and treatment methods, the subject
of great controversy. Mental illness itself continues to be
misunderstood or stigmatised, and those who treat psychiatric
disorders have been subject to harsh criticism and hostility.
Economic pressures have encroached on psychiatry's ability to
provide psychotherapy for many patients, and the "biopsychosocial
model" of treatment has been undermined. For all these reasons,
psychiatry finds itself "on the edge" -- the edge of both great
promise and equally great peril. In this collection of essays drawn
from his many years writing for Psychiatric Times, Ronald W Pies,
MD, defends psychiatry against its detractors, while also
acknowledging the profession's shortcomings and challenges. He
provides a robust defence of both the science and the art of
psychiatric treatment, while moving beyond the symptom-based, DSM
approach to diagnosis. Dr Pies takes on the positivist critics who
insist that only bodily disease is "real", and emphasises that both
psychiatry and general medicine identify disease states by the
presence of substantial suffering and incapacity. He also espouses
a broad-based, humanistic approach to the care of the patient,
drawing on several philosophical and spiritual traditions. Finally,
Pies argues that psychiatry cannot be viewed apart from the system
of ethical values that underlie medical practice in general, and
offers some caveats regarding the misuse of psychiatric expertise
for non-medical purposes. Unifying all these essays is the teaching
of the 12th century physician and sage, Maimonides, who said, "The
physician does not treat a disease; but rather, the diseased
person."
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