Wednesday, June 15, 2011

Is Psychiatry Like Acupuncture?

As I've discussed a few times here, this is the worst of times for antidepressants and other psychiatric medications; considering questionable efficacy and likely side effects, their popular esteem is at a low ebb. This makes them...a great deal like various alternative medicine treatments that remain highly popular and widely used (and paid for) despite the disdain of evidence-based medical critics.

In The Atlantic David H. Freedman discusses the persistent popularity of alternative medicine and its unlikely cohabitation with conventional research even at the Mayo Clinic and other hallowed institutions. He points out that while medicine made its reputation in the first half of the twentieth century with the significant (if not complete) conquest of infectious disease, its efforts to extend its domain to the kinds of chronic diseases that plague us today (diabetes, heart disease, cancer, Alzheimer's disease) have been frankly disappointing. What, exactly, has medicine done for us lately?

Psychotherapy and psychiatric medication have been targets of critical and cultural derision on the part of many for decades, yet millions of patients seem to derive some kind of healing experience from the pill or the couch, as the case (and the personal inclination) may be. The same could be said of the masses flocking to chiropractors, homeopaths, and, yes, acupuncturists in defiance of the conventional medical wisdom. We spend years in medical school learning about physiology, when practically speaking, healing arguably has more to do with constructing a healing ritual than with one's board scores. The "chemical imbalance," absurdly oversimplified though we hold it to be, may be like the acupuncturist's "lines of force," a necessary if fictional semantic scaffold on which to mount a clinical encounter. The shaman lives!


The Alienist said...

The main problem of the double-blind, randomized, controlled trial is the fact that the physician and patient are given a tool (the drug or other intervention) but not allowed to use it correctly. If I prescribe an antidepressant, I know this tool, how to use it, and how it fits into my patient's life. In a drug trial, I am given some object (it could be a valuable tool or a useless piece of junk) and told to try and help someone with it.

In some ways, this is like trying to get hammers approved for construction by blindfolding workers, randomly distributing tools, and telling them to build a house! You are unlikely to find the constructive powers of hammers in this way, but you will likely see their destructive capabilities.

Novalis said...

Yes, another way of saying it is that in the face of suffering, physicians are forced to be pragmatists, compelled to jerry-rig with whatever happens to be at hand...