Letters to the Editor
Re: 2002—Defining the 21st Century II
Dear Editor:
Your remarks were timely. Yes, it is important that psychiatrists be trained as generalists, and it is hoped that some choose further training. As in internal medicine or surgery, psychiatrists in subspecialties must work as generalists when on call. In child psychiatry, there is the added factor that, when children comment on one’s advanced age, it may be time to shift to more adult work.
I agree with your view about the increasingly noxious influence of the pharmaceutical industry—much as I may have enjoyed the odd free dinner while only too often suffering the speaker. It may be instructive to read Healy’s Creation of Psychopharmacology (1). We don’t reiterate often enough that none of our drugs are curative; however, they usually make life easier for patients and psychotherapy, which brings me to the deplorable state of the latter. Far too few graduates have a solid training in this art. Too many do not know their psychopathology; instead, they throw medication at the patient, and they want “shared care,” which, while often effective, at times only serves the purpose of arriving at a DSM-IV cookbook diagnosis, leaving the psycho- dynamics or the need for psychological support untouched.
I have met few psychiatrists, who, after having received their training during the last 12 years, could correctly define transference and, more important, counter- transference. The keynote speaker at the last Ontario Psychiatric Association meeting had not heard about Bowlby until 1988! I have seen too many patients who, for years or decades, were tried on every conceivable drug (try to get the list from a hospital 40 overdoses later!), but no one had dealt with their anger or helped them to find other solutions than an overdose or slashing. A whole body of psychodynamics soon will be forgotten.
It is time for our postgraduate directors to reconsider their programs and choose their residents more carefully. We need more reentry places. Interestingly, a teacher at an unnamed university recently described the brightest and most knowledgeable product as a “disturber”—yes, it can be challenging to be asked awkward questions by a thinking student. I am delighted that a few intelligent and empathetic physicians choose psychiatry and become outstanding in this specialty, despite the poor pay, rather than choosing a specialty for lifestyle or subsidy reasons, as I learned at another university when giving a seminar.
Psychiatry should be the brain of medicine. Is it the stigma that patients still experience, or is it because of our own prevalent inadequacy that we, too, are stigmatized?
Reference
1. Healy D. The creation of psychopharmacology. Harvard (MA); Harvard Univeristy Press; 2002.
Ruth Kajander, MD, FRCPC
Thunder Bay, Ontario
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