Bringing Psyche Back to Psychiatry
with Paul Minot MD
A critical review of modern psychiatry—proposing a neurodigital model of thought, mind, and memory
What’s Brought Me Here
I trained in psychiatry in the early 1980s, at the dawn of the current biological era of psychiatry. I was fortunate enough to receive psychotherapy training, but since my graduation in 1985 I’ve been practicing modern medication-oriented psychiatry. Over the past three decades I’ve seen revolutionary improvements in psychiatric medication, including the advent of atypical antipsychotics, SSRIs and other modern antidepressants, and anticonvulsant medications for mood stabilization. All these innovations occurred in an atmosphere of promise, driven by the belief that we were finally cracking the code of psychiatric dysfunction, improving lives and beating mental illness.
Forty years later, we’ve seen an explosion of psychiatric diagnoses and treatment. Numerous psychiatric terms have migrated into popular jargon, such as “bipolar”, “chemical imbalance”, “PTSD”, “ADD”, and “autistic spectrum”, as well as drug names like Prozac and Ritalin. With more people carrying psychiatric diagnoses and receiving treatment than we ever could have imagined, you would expect to see improved psychiatric health and decreased suicide. But the opposite has occurred. The percentage of Americans on psychiatric disability benefits more than doubled from 1987 to 2007. And from 1999 to 2018, in the midst of this Age of Prozac, the incidence of suicide in America has increased by 35%.
This shit is not working.
The promise of biological psychiatry was a reboot of DuPont’s familiar slogan from the last century, “Better Living Through Chemistry”. In both instances it rings hollow, and ironic in retrospect–but the pitch was unequivocally good for business. The biological movement opened the door to billions of dollars of investment from the pharmaceutical industry, for research and development of new psychiatric drugs by the academic centers of psychiatry. It’s been good for the insurance business as well, since the model justifies the curtailment of hospitalization, and limiting access to time-consuming psychotherapies.
My mission here is to confront the corrupted scientific reasoning that props up this biological model, and to promote a more eclectic model of treatment–one that acknowledges the existence of the mind as well as the brain, and engages our capacity for personal growth.
TMI
I grew up an only child and an Air Force brat. My Dad retired and we settled in Houston, where I easily transitioned to NASA brat for junior and senior high school. I majored in Biology and minored in Social Sciences at Rice University. I pursued both medical school and psychiatric residency at the University of Texas Health Science Center at San Antonio, completing my training in 1985. (Check out the podcast/article “My Insecure Profession” if you want to hear more about that experience.)
Soon afterward I spent 11 years working in Austin, mostly in community psychiatry. I subsequently spent four wonderful years practicing frontier psychiatry (it’s a thing) in the Big Bend area of Texas.
I’ve now been practicing psychiatry since 1985, and since 2001 have been employed by MaineGeneral Health, where I am Assistant Medical Director of Behavioral Health. I’m also an Assistant Clinical Professor of Psychiatry for Tufts University School of Medicine. Please note that my opinions are strictly my own.
My wife Aimee is a psychiatric nurse (as was my late mother), and together we have five wonderful children. I also have a backstory of playing bass in a number of Texas bands who recorded original music–most notably a stint with The Hates, proclaimed to be “Houston’s first and last punk band.”