Posted by alexandra_k on August 24, 2013, at 20:17:03
In reply to Re: And the toyotas they drove in on!, posted by Christ_empowered on August 24, 2013, at 12:35:45
I was reading something just the other day lamenting how American (DSM and pharmacology based) psychiatry is taking over the world. Training p-docs in Europe used to have to read the great (phenomenology) European theorists. But they don't, now.
Part of the problem is that there is a concern to ground psychiatry in the medical / biological sciences and the way to do that is to focus on the neurobiological / pharmaceutical aspects. Because the distinctive feature of psychiatry (as a specialist field of medicine) is the prescription of psychiatric medications.
Psychologists / counselors have talk therapy too, you see. Social workers / education concern themselves with environment.
Why (government, health insurer) pay a psychiatrist (2x as much? more?) to give talk therapy (where there is limited evidence of efficacy - not least because it is impossible to run randomized double blind control trials on this form of treatment which makes it such that it will *always* seem scientifically inferior to medication)?
I have been watching some stuff on surgery and I got the impression that they were presenting it as something of 'the glory days are over'. Now... Mostly... Partly because of litigation... And precedent too, of course... I got the impression that things are fairly ritualized. Routine. Mundane. Minimization of error.
The 'real stuff' goes on in developing nations. War zones etc. Where you have to think on your feet a bit more. Improvise. Where you do the best you can under high pressure conditions... Perhaps where things move too quickly for you to have to write a book of paperwork on every operation you perform. Less accountability. I expect that is it. You can take a risk and if you fail it won't be broadcast all over the place till some committee says you aren't allowed to try that again because it is too risky. Probably not ground breaking insofar as you are reinventing the wheel with cheaper inferior components... But a personal journey of improvement in skill to be sure... And I guess you see a lot of stuff that you wouldn't get to see in more developed nations.
Psychiatry... To practice the way you *want* to practice... Well... You have to make a living / sell your services, I suppose. So there is certainly a bit of that... You would need to step outside the system in some way to be less accountable to it... But then there is a fine line between having a license to practice or... Needing to set up shop someplace different like Australia hahaha. I don't know.
I used to think psychoanalysis was the way, really. Well... For people like me (whatever that means). And that it was an art more than a science (and psychoanalysis did not do itself any favors in appealing to cognitive psychology to validate the unconscious etc). Some interesting things are happening with developmental neuro-biology and aspects of psychoanalysis, however. Schore and others... I think the science does (should) constrain the art, but there is an art to the narration / phenomenology to be sure. And that this is an important part of it. And... Perhaps... That less stupid people are better at assisting with this... And that psychiatrists tend to be less stupid (as a group on average) than the other 'allied health' fields. Not least because the former is more competitive (and thus the curriculum can move at a faster pace and the examinations can be more demanding than) alternatives. Perhaps. That medical doctors have a solid foundation in the physical sciences. Which teaches a way of thinking.
It is a bit of a shame that the current psychiatry curriculum isn't intentionally trying to attract the more literary types. It would be an interesting way to market it as appealing to a different niche of clinician and might perhaps alter its image from something along the lines of 'second rate neurology'. There is an interesting double aspect to psychiatry (there always has been). The complexity should be a feature. Not a farce.
Used to have to train as a psychiatrist before you got to train as an analyst. Not so anymore. They opened their doors. The broader they open them the more dumbasses they attract... Though, I suppose, it tends to be more literary people attracted to that kind of thing, anyway. But then the concern is that they literally have dual masks - the psychoanalytic involving the suspension of critical thinking that is usually a feature of science. Or at least the medical doctors among them get to have dual masks. Since the education and social work and (mostly but not always) psychology curriculum don't often succeed in teaching the critical way of thinking that is a feature of science.
- philosophy of science and the limits of science (the sorts of questions, explanations) anyone???? the meeting of fact and value?
poster:alexandra_k
thread:1049427
URL: http://www.dr-bob.org/babble/20130730/msgs/1049636.html