In anticipation of this first blog post, I have spent some time wondering how I arrived at this point in my career. I have practiced psychiatry for 30 years. My work has primarily been with people who are experiencing psychotic illnesses. I work in a fairly typical community mental health center in Vermont and I think most would consider my practice to be mainstream. I value the so-called medical model but most of all I value empiricism. I had no idea when I started in the field that it would be fraught with such controversy, and early in my career I had the idea that because I was a thoughtful and basically well intentioned person, I would be able to figure out the best thing to do, the best thing to recommend to my patients. I thought that due to my fundamental goodness and common sense I would win over any critics of my profession. I look at this now as a remarkably naive perspective.
I had a strong reaction to Robert Whitaker’s book, Anatomy of an Epidemic. I had already grown frustrated with many aspects of my profession, most notably the tendency for findings to be distorted in the pharmaceutical marketing process. I already agreed that the efficacy claims for certain classes of psychiatric medications, such as the antidepressants, were overstated. However, I believed that antipsychotic medications were helpful to many people. I certainly understood their many limitations but at the same time thought they were important components of the treatment of people with psychotic symptoms. His book, however, seemed extremely well documented and I could not easily dismiss his conclusions. I felt compelled to review the primary data to which he referred. In that process I began corresponding with Mr. Whitaker and talking to many colleagues about his book. I summarized my opinions about his book in an article published in Clinical Psychiatry News.
In this blog I will describe how I am evaluating my current practice and incorporating the conclusions I have drawn since reading Anatomy of an Epidemic. I will also try to explain the complexities of psychiatric diagnosis and treatment. When I read accounts about what psychiatry is or what psychiatrists do, regardless of whether from critics or advocates of my profession, I often do not find accurate reflections what I do or how I practice. I will write about the kinds of things I discuss with my patients as I explain my diagnostic formulations and treatment recommendations. This will be a forum to help me expand on topics that arise frequently in my practice. I will also discuss the process of redesigning the mental health care system in Vermont in the aftermath of the flooding and subsequent closure of our state hospital. I hope to address some of the most fraught areas in our field, particularly the use of involuntary treatments. This has been a part of my practice for most of my career. I have always felt the need to address this topic openly and honestly. I look forward to this process and I look forward to sharing it with readers and commentators.