One-Trick Training?

After I received my 50-year distinguished fellow award at APA's 2004 annual meeting in May, there was time for thought on the flight back to New Mexico and my practice. APA has become a polarized organization, perhaps a reflection of the larger society, but it has tilted too far toward the advocacy of unsupported “biologic” diagnostic and treatment practices that corrode its efficacy and leadership.

We have trained a generation of psychiatrists who are “one-trick ponies,” with no arrows in their quiver after pharmacy and“ rational polypharmacy” fail their patients. Perhaps that is why we are so threatened now that New Mexico and Louisiana have granted prescription privileges to psychologists.

It is ironic that we are witnessing serious challenges to the scientific integrity of studies supporting the FDA approval of the SSRI class of antidepressants at a time when an unsilent majority of us go along with the pretense that this is evidence-based psychiatry. The editors of Lancet wrote in the April 4 issue that “selective reporting of favourable research should be unimaginable.”

It is too easy to fault the drug companies. There are too many of us whose integrity has been compromised by grant support or honoraria for the rest of us to be able to trust their advice. The late George Engel, M.D., whom many of us consider the primary advocate of the biopsychosocial approach, would consider current statements about neuro-bio-chemical-genetic causality of mental disorders regressive.

I consider myself fortunate to be able to continue to practice psychiatry now that I am retired from teaching and lucky that I received my award before the name of APA changes, perhaps to the American Bipolar Association.