Psychiatry is presently not as ostracized as it once used to be, confined to asylums.
Now a days you may even find psychiatrists invited to public functions.
A welcome change but likely to be short lived.
Why?
Read on – #stigma has always been a huge problem for psychiatry.
We got mental health away from Shamans but managed to get stigma in the process.
Persons with mental illness were always feared and hated. Hence confined to asylum, away from sanitized life of people. Anything perceived as threatening (mentally ill, free thinking women, disenfranchised minorities, political opponents, sexual minorities) was labelled as “madness/character flaw/unsoundness” etc and sent to asylum to spend rest of their life. Psychiatrists worked in such places. Looking after those who were unwanted by the world. They made sense of this madness.
As medicine progressed, neurological basis were discovered and most importantly, prescriptions could be written to achieve “cure”. History of psychiatry shows that as soon as something is discovered to be –
1. Treatable by talk therapy (depression, anxiety, relationship issues, etc.)
2. “neurodevelopmental” to be treated with some medicines but largely support (autism, ADHD, intellectual retardation)
3. Effectively treatable with medicines (epilepsy, movement disorders)
It is moved to mainstream medicine and treated by psychologists, pediatricians and physicians/neurologists. Stigma continues to work strongly in society but MORE PROMINENTLY among medical doctors.
They are afraid of serious mental illnesses that involve losing “sanity”.
That means – Schizophrenia, Any psychosis, Bipolar disorder.
In India almost no non-psychiatrist doctor knows about “Phenomenology” and “mental status examination”. So they think psychiatrists just talk with people and give labels.
As we develop more effective medical and non-medical therapies for various ills of brain and mind,
psychiatry is headed back to asylum, its birthplace. A psychiatrist is trained in “bio-psycho-social” model to look after all aspects of mind-brain-body-self-others complex.
We are gradually handing over care of mentally ill to part-specialists because it is less stigmatizing (though not necessarily any cheaper or better). This leaves care of only seriously ill to psychiatrists and psychiatric nurses.
Sometimes in asylums, sometimes in community (not necessarily integrated with society).
“Mindless psychiatry” and “brainless psychology” is often rightly criticized. Now we have entered era of “narrative based mental health”
Where does it stand as science? How does it serve society? Is getting rid of multidimensional model specialists a really good idea?
Are we throwing away baby with bathwater?
I leave you to think and comment on this rapidly turning tide of twenty first century mental health.