Reflections on a hot afternoon

Our system has too many subsystems, each of which functions fairly autonomously inside self generated boundaries which are far enough away from the other fiefdoms that patients “fall”in the gaps.

Psychiatrists seem to be drawn to unusual, and unproven treatments. Always justified by criticisms of treatments that (despite many weaknesses) on balance do good more often than harm. Psychedelics as treatments were proposed and implemented by RD Laing and others, with dubious benefits for most. Scholarly papers propose their use now on the basis of unproven theories about the causes of symptoms. 

One type of symptom, what is termed psychotic, has become a disorder in, what seems to me, a rush to avoid diagnosing actual illness.  Powerful drugs (which do help in severe illnesses like schizophrenia) are being given to young people with symptoms, in the belief that doing so may prevent them from “developing” schizophrenia. Probably a third do not need medication. 

I feel lucky to work with young doctors, nurses, trainee psychiatrists, and patients who have real thirst to “know”. Together, perhaps, we can avoid some of the mistakes of the past by using the knowledge gained from those and from the successes.