Psychiatry on the Edge

Ronald William Pies, MD
SUNY Upstate Medical University, Syracuse, NY, US

Series: Psychiatry – Theory, Applications and Treatments
BISAC: PSY046000

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Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick

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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 empathically 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 stigmatized, 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 defense 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 emphasizes 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.” (Imprint: Nova)

Foreword
Cynthia M.A. Geppert, MD, PhD, MPH

Preface

Chapter 1 - The Philosophical and Scientific Foundations of Psychiatry (pp. 1-66)
Ronald William Pies, MD, Sairah Thommi and Nassir Ghaemi, MD, MPH

Chapter 2 - Psychiatric Diagnosis and the DSM Debates (pp. 67-102)

Chapter 3 - Grief, Depression, and the Bereavement Controversy (pp. 103-130)

Chapter 4 - Psychiatry in Crisis (pp. 131-162)

Chapter 5 - Psychiatry and Humane Values (pp. 163-186)

Author Contact Information

Index

"Dr. Ronald Pies latest book, Psychiatry on the Edge, is a masterful collection of his writings. In addition to having been editor of Psychiatric Times, Dr. Pies is a prolific scholar who has written about topics ranging from psychopharmacology, medical causes of psychiatric illnesses, ethics, Judaism, Buddhism, Stoicism, cognitive-behavior therapy, and poetry. In this volume, he explores how we can begin to understand what psychiatry is and what it is not. At a time when our field is under attack from many quarters, it is critically important to be able to discuss what it is that we do as psychiatrists in a non-defensive and intellectually rigorous manner. In order to do so it is helpful to critically view our field from different vantage points and prisms.

Dr. Pies engages the reader in a thoughtful review of relevant philosophy, drawing upon original source material. On a process level, we are taught about philosophic principles salient to our field. For those of us who never took philosophy (or who are a little rusty), we are treated to a highly educational and enjoyable overview. How best to learn about philosophy than to relate it to our own field and what better way to learn about psychiatry than to draw upon philosophy as a field of thought that is different than our usual intellectual framework! This book offers the reader an intellectual opportunity to learn (or relearn) philosophic principles and, by applying the basics of rational philosophic thought, be able to critically explore the very nature of psychiatry, including the many misunderstandings and negative polemic offered about our field in the popular press or when we are asked existential questions by our patients and others.

Dr. Pies is an exceptional author and scholar, able to draw upon many different topic areas and write in an enjoyable manner, which exemplifies such fantastic “synthetic thought.” This volume helps focus our attention on the central vexing issue our field faces: how do we embrace an evidence based, scientifically driven mindset while simultaneously maintaining the art of medicine, and the critical empathic connection with our patients, both of which are necessary for treating the hallmarks of disease – suffering and incapacity. Pies offers the concept of “polythetic pluralism,” which embraces the world of both medical science and the healing arts.

The essay “Can Psychiatry be Both a Medical Science and a Healing Art? The case for Polythetic Pluralism” should be read by all psychiatric providers. The book also goes a long way in debunking the belief that psychiatry is not scientifically based, reminding us that mental health signs and symptoms are as real as the headaches that a neurologist treats. The fact that mental phenomena are subjectively experienced does not detract from the validity of symptoms representing disease. As an example, affect and mood can be assessed in a reliable manner and can reflect valid distress and illness despite being subjectively experienced. Logical positivism is put in a safe perspective that does not allow it to crowd out the very meaning of psychiatric illness.

Dr. Pies is a very wise physician who shares his knowledge and insights with true generosity. In addition to learning about philosophic thinking, he shares insights into many topics including health care as a basic human right, psychiatrist participation in executions and interrogations, gun control, and internet ethics, to name a few. Each section left me with many new ideas and I was often awe inspired.

This is a thinking person’s collection, with much to learn, enjoy, and share with each other. Psychiatry on the Edge develops a dialog which helps us define who we are and what we do as psychiatrists, critical in understanding our field and sharing it with others. I highly recommend this contribution as the reader will be rewarded with much knowledge and many deep insights."
- Jeffrey S. Barkin MD, DFAPA, Portland, Maine, US

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