Bringing Psyche Back to Psychiatry
with Paul Minot MD
We didn’t abandon the psyche because of scientific progress. We lost our mind because we wanted to, and because The Nine Commandments told us to.
How Psychiatry Lost Its Mind
Do you believe that your mind exists? Do you believe that the minds of other people exist as well? Of course we do. It’s common knowledge that every one of us has a brain–and a mind as well. But the mind’s existence is routinely ignored in the practice of modern psychiatry.
Our current mode of treatment–emphasizing neurobiological explanations and interventions to address emotional and behavioral problems–is frequently described as “mindless psychiatry.” It’s not meant to imply that my profession is stupid or crazy. Nearly all practicing psychiatrists are both intelligent, and perfectly sane. But modern psychiatry certainly seems to be mindless by design–driven by a belief system that willfully excludes the existence of the mind as a significant clinical entity. And it’s painfully obvious why we do so. It’s because of our history, our insecurity, our ignorance, and our corruption.
In 1808 a German medical professor named Johann Riel used Greek roots to coin the term “psychiatry,” which means “healing of the psyche.” The psyche itself is defined as “the human mind, soul, or spirit,” with no reference at all to the brain. Riel probably did so because he lived in a time when we had some grasp of the mind, but almost nothing was known about the functions of the brain. To this day psychiatry is defined as “a branch of medicine that is focused on mental, emotional, and behavioral disorders.” “Mental” is an adjective referring specifically to the mind–which in turn is defined in the Oxford dictionary as “the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought.” But you won’t find any reference to the mind in the vast majority of published psychiatric research.
The history of psychiatry reveals a discipline whose focus has repeatedly swung back and forth between the two poles of our bipartite target organ–inclusively referred to as the brain-mind. Our modern treatment model claims to be driven by science–which is by definition the study of nature. Our scientific understanding of the brain-mind is at this time limited to the anatomical and microanatomical features of the brain, and their associated physiological activities. What has escaped us is any credible explanation for the physiology of thought, and the composition of the mind.
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.”