I recently attended a psychiatric conference, which offered a chance for me to reconnect with others in my profession, and to catch up on some of the latest research. During one of the initial sessions, the presenter (a psychiatrist) projected this slide summarizing his definition of a physician:

“A physician is
-An expert at a particular set of skills
(History, examination, differential diagnosis)
-The custodian of a body of knowledge
-An advocate for the patient”

A sub context of the presentation, was that psychiatry, in the past, had been overly concerned with therapeutic issues, as there had been relatively little known about actual (biological) causes of mental illness.

I have to admit feeling very disappointed as I heard that definition. As a result of our training, we do have expertise in a certain set of skills, and carry a certain unique body of knowledge and experience which differentiates us from our peers in mental health. But I think we miss the mark entirely if we do not place firmly in the center of our definition the role of healer.

I know in my own case, my desire to become a physician was all about being able to help people who were ill in the most effective manner possible. And for me, especially as a psychiatrist, the “how” is just as important as the “what”. How people perceive me, how I relate to them, can make all the difference in a patient’s outcome, and I don’t believe the above definition captures that.

Interpersonal therapeutics are extremely important for psychological healing, and will always remain so, despite whatever advances we may make in genetic or molecular neuropsychiatry or neurobiology. There are a number of trends in modern psychiatric training and practice that are troubling to me, and that of minimizing interpersonal therapeutics (psychotherapy), in favor of diagnostic classification and over-reliance on pharmacology, are big ones.

The riddle of how to best help a patient become more adaptive to their environment, and at peace with themselves, is not going to be solved by relying on biomedical knowledge.  I think it is a great loss for psychiatry if we lose sight of the humanistic side of our art, in favor of a cold scientific model.