Wednesday, December 17, 2008


Macbeth: Canst thou not minister to a mind diseased;
Pluck from the memory of a rooted sorrow;
Raze out the written troubles of the brain;
And with some sweet oblivious antidote
Cleanse the stuff'd bosom of that perilous stuff
Which weighs upon the heart?

Doctor: Therein the patient
Must minister to himself.

Macbeth needed a psychiatric referral and not a brush-off; we know how he turned out (well, psychiatry was a bit green in 1600).

1. Nassir Ghaemi, M.D., a prominent name in academic psychiatry, writes a thoughtful blog at Psychology Today. In his last few posts he has started to explore the issues stemming from the recent well-known scandals of psychiatric research and pharmaceutical companies. As one would expect, the reality is neither one of money undermining everything of value in the profession nor one of open, public-spirited firms working for nothing but the common good. I still need to write my post on this topic (yes, avoidance has its uses).

2. Courtesy of Arts & Letters Daily, I see that Paul McHugh, M.D. has written a useful conceptual and historical review of the concept of hysteria, a famous shapeshifter in both psychiatry and medicine (hysterics are as likely, if not more so, to visit non-psychiatrist physicians as psychiatrists). Basically, hysteria results from the intersection of individual vulnerability and suggestibility with the prevailing winds of groupthink at any time pertaining to what constitutes legitimate illness or illness behavior.

3. Have you nursed a lifelong dream to work in a state psychiatric hospital? If so, it is commendable, because good people are definitely needed. However, before signing up you might want to look at this hair-raising account of life as a social worker in a hospital in a state located somewhere between Virginia and South Carolina. Did you think that snake pit, cuckoo's nest, etc. were safely of the 1950's and 1960's? Think again. If you're going to become seriously mentally ill, be sure to arrange excellent insurance beforehand.

This account is not typical, fortunately, arising as it does from regrettable adventures in mental health care reform. It is amazing that forty years after the great deinstitutionalization of the 1960's (the effort to move the teeming masses of then-much-larger state psychiatric hospitals into outpatient community programs), we still can't get this right, apparently through lack of funding and organizational mismanagement.

And this occurs in a nation that, before the recent economic plunge at any rate, was apparently the most prosperous in both absolute and relative terms in the history of the world. Mental health care reform appears to be where good intentions go to die. Is the economy booming? Then mental health can spare some funding. Is the economy tanking? Then mental health is going to have to tolerate some cuts. What was that about a society being judged by how it treats the most vulnerable?


Anonymous said...

On hysteria:
So doctors could in fact be guilty of exacerbating the symptoms of patients' diseases by asking leading questions? After all, the very fact that a query was posited implants the idea that there's reason for concern, and depending on the degree of suggestibility, the patient reacts consciously (by manufacturing or exaggerating evidence for the perceived problem), and unconsciously by manifesting the perceived interpretation of the doctor's questioning. This makes all illness, in part, hysterical; because if a doctor were to downplay and trivialise a patient's illness, they wouldn't have that extra input for creative morbid interpretation.

Hysteria is like the placebo effect in reverse.

Does treating a mental patient as sane ameliorate their symptoms?
You can easily make someone believe they're mad by planting enough evidence to support the diagnosis, and then have enough people to confirm the view.

Novalis said...

I think this certainly does happen, although these days what comes out of the mouths of doctors is dwarfed by direct-to-consumer advertising and other general media trends concerning illness (e.g. "cyberchondria," or self-diagnosis via Internet medical sites).