Choosing a Specialty: A Letter to a Medical Student


In this letter to a medical student considering pursuing psychiatry as a specialty, psychiatrist Nassir Ghaemi cautions that unlike other medical specialties, psychiatry can pose ethical dilemmas, and any efforts to reform the field will be met with resistance.

“The diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) are created as social constructions, as preferences of the profession—not solely, or even primarily, as scientifically based definitions. For two decades, our profession has bound itself to these social constructions and pretended that they were scientific facts. This has been proven a lie, but we are unwilling to admit our self-deception.”

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    (Psychiatrist, Professor Nassir Ghaemi).

    Not however, plagued and suffering on any level comparable with those whom psychiatry has so terribly abused and injured, or killed with the most toxic drugs ever used by the medical profession.

    Radovan Karadzic was a psychiatrist in Sarajevo.

    At the Hague, he described himself as:

    “I’m a mild, tolerant, understanding man”.

    “Instead of being accused, I should have been rewarded for the good things I have done”.

    Self deception perhaps?

  2. mwatkin55,

    I am compelled by your important questions, and believe that the involvement of medical students with integrity and idealism -(as yet not bought out by the Pharmaceutical Industry) – is vital to address the failed paradigm of psychiatry and to maintain integrity in our profession.

    Science is dependent on those who have the courage and insight to ask the pertinent question, and the commitment to challenge the vested interests that perpetuate patient deceptions and cause patient harms .

    I need to give this more thought.

    Might a start be made by developing a medical student insistence that all those who lecture and teach you clinically are required to reveal ALL their financial conflicts of interest with drug companies.?

    A more realistic assessment of the value (or otherwise) of their teaching would protect you from marketing masquerading as medicine.
    This marketing influence is most devastating to patients, their families and loved ones with regard to the perpetuation of the falsehood that psychotropic drugs, used for years or for a lifetime, are “safe and effective:.

    A second thought is to commit to Sir William Osler’s clinical philosophy – including : –

    “Listen to your patient, he is telling you the diagnosis”.

    In my experience, psychiatry no longer listens to, nor believes their patients or their families.

    Real change might best be achieved via the integrity, idealism and intellect of a medical student movement.

    The establishment resistance would be immense.

    TRM 123. Retired Consutant Physician.

  3. Strongly agree Steve.

    How can our future doctors be trained ethically and without bias, if their lecturers, mentors and clinical teachers have financial dependency on pharmaceutical companies?

    Such financial conflicts negate Primum Non Nocere – First Do No Harm.

    How many medical students are aware that such bias may be detrimental to the quality and integrity of their training, and that such adverse influences may negatively impact the future safety of their patients?

    TRM 123. Retired Consultant Physician.