It had been an awkward pause. Professor Nick Craddock was addressing a lecture hall of students at the recent National Conference of Student Psychiatry Societies in Sheffield. Faced with numerous scenarios relating to mental health, we were to vote on whether a medical, psychological, or social approach best suited the predicament. For the scenario in question, most arms stayed still, uncertainty reigned. We were told, in no uncertain terms, “the correct answer, is medical.”
The hesitant abstention to this vote, part of a talk entitled, “The psychiatrist, a fully trained doctor,” might give encouragement to the respondents critical of Professor Craddock et al’s recent editorial in The Psychiatrist (formerly The Bulletin of the Royal College of Psychiatrists) that attempts to define the core attributes of a psychiatrist. Viewed by one consultant as “disconcertingly incomplete,” and by others as threatening “to take British psychiatry down the American cul-de sac,” their formulation of a specialty mainly concerned with the respectful certainties of biomedicine is considered dangerously simplistic. The bio-psycho-social model mantra was not easily relinquished and reduced to its component parts by the medical students attending the conference that morning.
Given the title of the talk, one question afterwards revealed how difficult it is to convince students that psychiatry is just another medical specialty: what to say to students interested in psychiatry but who worry about losing their medical skills and knowledge? This is one conundrum that is central to the stigma that sticks to psychiatry and its troubled relationship to the rest of medicine. It can be an uncomfortable one for students to negotiate in their choice of specialty. Professor Craddock’s genetic research into bipolar spectrum mood disorders and psychosis is an inspiring illustration of the place for hard bio-medical science in psychiatry research and served as a good back drop to his response. However, students already interested in psychiatry are arguably looking for more nuanced presentations of the strange place that psychiatrists must inhabit within medicine at the clinical coalface of mental health.
Psychiatry, I would hope, will always remain a little bit apart from the pack. To boost flagging recruitment, there is a relentless heralding of a new dawn in psychiatry courtesy of advances in neuroscience. This might be good for attracting more scientifically minded students still not sceptical of how this might meaningfully translate for people on psychiatry’s receiving end. However, the implication that the meteoric rise of neuroscience research will earn the specialty greater respect from its more biomedical brethren does the profession a disservice, as it undermines what makes psychiatry so unique and should be equal cause for celebration. This is its ability to challenge the epistemology of biological psychiatry and tolerate the ambiguity and uncertainty this creates. As Ikkos et al contend, “meaning cannot be reduced to molecules.”
The drip feed of “new brain scan shows…” headlines tells us little about what it means to be human other than our current predilection for neuroreductionism. For anyone in any doubt as to whether the current bling of neuroscience might one day lose some if its lustre, Siri Hustvedt’s “The Shaking Woman or A History of My Nerves” comes highly recommended. In charting her own journey around neurologists, psychiatrists, and psychoanalysts in a search for answers to her fits of shaking, she shares an encyclopaedic knowledge of these disciplines’ entangled histories. Having surveyed the shifting fashions in the battleground of ideas about the mind, brain, and selfhood, it leaves little doubt as to the need for humility from doctors when confronting another’s suffering.
A bit of uncertainty in the lecture hall seemed like the correct answer.
Jonny Martell is a medical student in London.