Everyone who has watched Idol knows that there are some individuals who think they are good singers, gods gift to music. They have probably been told by relatives and teachers (who are obviously tone-deaf) that they are great. They have been surrounded by individuals who are worse singers than them and therefore never realized that they don’t sound that good. They try out for Idol and they make Idol fun. We laugh at their expense and feel shame together with them. It is fascinating for us to see the crash site because their inner image collided with reality, the reality being three judges who aren’t afraid to tell them they are completely worthless at singing.
Psychiatry, much like an idol contestant is told it is something it is not and slowly crashes when facing reality each time it is faced with a suicide.
On September 1oth 2009, The National Suicide Prevention agency of Sweden (NASP) held their annual “suicide preventive days” where loved ones of those who have died of suicide or reside within the psychiatric system hold lectures about their experiences together with experienced scientist within the field and the representatives of the psychiatric community. Open dialog, heated debates when professionals meet the public and their questions and frustration.
I sat in the back, observing this phenomenon, this contestant called psychiatry being subjected to cruel comments and asked to perform a reality check from the ultimate judges, those who have lost their loved ones. This time, I did not laugh at the contestant, I only felt guilt and shame. But there was a remarkable flaw, which made me think about why psychiatry fails in this area, why it is the “self-fooled” contestant. Psychiatry, much like the idol contestant that fails, is told it is something it is not, it is told that the patients are just like any other patients and that it is a hospital.
And the paradoxical thing is, it is the same judges that are carrying out the brutal judgment that are encouraging that view. How are they doing that one might ask. It is quite simple. They are comparing the care of a psychiatric patient with a cancer patient.
“Why does psychiatry fail, if they can have functioning rules at oncology, why not have functioning systems in psychiatry” Relative 1
“If a cancer patient would be treated like a psychiatric patients are treated, nobody would accept that. Psychiatric patients are ignored and mistreated” Realtive 2
“There are routines at hospitals to stop the spread of infections by hygiene and sterilizing environment, psychiatry should have the same mental hygiene reforms” Public Spectator 1
No wonder psychiatry fails in front of the judges, in front of the patients and when it meets reality. There is a deep philosophical question that nobody asked and it is: what is psychiatry and what role does it play. Unlike an oncologists, a psychiatrist can’t see an anxiety attack or a suicidal thought on an x-ray. Oncologist can inject chemo and watch cancer cells die. At an infection clinic, viral tests can be preformed, viruses can be detected through technology, quick and simple. Even if neurobiology of suicide is becoming more and more established, extracting spinal fluid or pushing a suicidal patient in an MRI isn’t very realistic or time and cost effective. And even if new technology arose, neurochemistry more accessible, what about the day a patient arrives, CSF 5-HIAA above 92,5 nmol/l, serotonin, dopamine, cortisol etc all within reasonable levels and still the patient is suicidal and reports suicidal thoughts and attempts suicide. What about the day we can see a suicidal thought, but the patient ensures that he/she is fine. Can a doctor let them go, who is the one feeling the thought, the man or the machine? Which one is to decide if the suicidal risk is high or low? Disregard the patient, go on the biology, is that the future? A psychiatrist is the only doctor on this planet who can prescribe medication that has a high percentage of side effects, relatively undetermend effect and all that without taking any biological tests. When all you have to go on are scales, DSM and other diagnostic manuals, no wonder there is a conflict.
Psychiatry is told it is just like a hospital, with patients with biological problems. But it is the only hospital that can have 20 patient diagnosed with the same illness or disorder e.g. suicide risk/attempt or ideation and none have the same symptoms or patterns besides the act of self harm in some way. It’s not an easy reality to work in. It is the only hospital where the doctor rarely sees the disease, where the disease is symbolized by a hallucination. How do you inject a hallucination. An oncologist can see a tumor, it can see it progress or regress. Psychiatrists can hope that their patients progress or regress, patients can say they’re fine and go home to die. A cancer patient can’t, there are more precise ways to determine recovery.
It is the deep philosophical question, raised by Descartes, but it manifests the dilemma so beautifully in psychiatry; An institution devoted for treating the problems of the mind, has to follow the protocol of the institution devoted to treating the body.
No wonder psychiatry is a bad contestant. It operates under the structure of something it is not.
Psychiatry would be given the advice from Paula Abdul to “go home, practice and come back next year”.
Psychiatry is not a lost cause. It has potential and if only it would reflect over what its strengths are, weaknesses and its staff have a philosophical or a psychoanalytic discussion once in a while, it would progress in the right direction. Next year, NASPs annual “suicide preventive day” will be in September again. Let us hope that psychiatry as a contestant will meet the jury and move on to the next round.
Sometimes, time is all that is needed.