Saturday, September 6, 2008

Annals of Risible Results

Theodore Sturgeon is quoted as declaring that "Ninety percent of everything is crap." That sounds about right with respect to a number of things, and of nothing is it more true than psychiatric research. Nothing demonstrates the pre-scientific nature of psychiatry better than the clinical irrelevance of the great majority of studies published even in the top journals. Until we achieve at least a basic understanding of the great issues of the mind--mood, memory, consciousness--we spend our time on pointless epidemiology (if all you have is a tape measure, then measure everything in sight), irrelevant biological minutiae, or far-fetched speculation (the latter is my metier actually). Psychiatry is a singular medical specialty inasmuch as virtually no published research has any specific implications for everyday clinical work.

Two of the top journals this month illustrate this once again. Archives of General Psychiatry, as usual, is so aridly biological, and so remote from clinical reality, that no real pretense of relevance is even attempted. The American Journal of Psychiatry, once again confirming the obvious, features studies on the relationship or lack thereof between parental depression and the psychopathology of children. To the surprise of no one, the studies suggest that the children of depressed mothers are more likely to have problems themselves. To some surprise, they also suggest that paternal depression has no impact. But the problem is that none of the results achieved should change anything we ought to be doing already. To consider the status and well-being of parents in the course of evaluating a child (and vice versa) should be common sense. And should anyone take the claim about fathers so seriously as to leave them out of the family evaluation? Of course not.

This is not to say that psychiatric research is irrelevant, period. It is largely irrelevant to today's clinicians, but it may be quite relevant to other researchers, who in several decades perhaps, will in fact produce clinically relevant research (just as studies, and treatments, developed decades ago continue to guide practice today). Scientifically, a psychiatrist today may be on par with an internist or surgeon practicing a century ago.

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