Psychiatrists, people very remote from medicine.
Popular, amongst doctors
Jeff Lieberman is pretty enlightened for a psychiatrist. He correctly dispenses with witch remedies for schizophrenia.[1] Usually, in the US medical profession, disparaging the colleagues in words like "your previous physician was an idiot" means the end of the career. Even if it were so, American physician must use oblique phrases like "In view of the lack of progress, I would recommend a different course of action". Obviously, not so among the psychiatric profession. He describes the doctors who treated some of his patients in the most diminutive terms.
His book is a paean for clozapine. The problem with it, as with all antipsychotic medications, is their terrible side effects. Lieberman spends only a couple of paragraphs out of 300+ page book on this subject. Yet, reticence to use psychopharmacology has little to do with lack of medical enlightenment as Lieberman suggests. These are terrible side effects of antipsychotics, which cause many people to disconnect treatment or avoid it altogether. They include extreme forms of akathisia and fatigue so severe that patients contemplate suicide. Not because of a mystical "suicide ideation" but because of a quite real helplessness. And this not to mention a weight gain, interactions with numerous other drugs, sometimes lethal as with MAOI antidepressants, ticks, convulsions, incurable tardive dyskinesia and numerous other adverse effects.
Why the book uses long-outdated definitions of schizophrenia from DSM-II and DSM-III in its appendices is a mystery.
[1] Lieberman's vituperations against Freud are totally misplaced. Would we dismiss Galileo because he did not have a clue of the Second and Third laws of Newton (he invented the First law himself) not to speak of Quantum Mechanics? Galileo even did not fully appreciate the laws of Kepler, his younger contemporary. His epigraph to the chapter about Freud saying that Freud was a medical novelist is quite accurate but misguided. In Freud's times there was no possibility to help psychiatric patients but also no scientific analyses available for diagnostics and, consequently, no clinically-based language. Indeed, Freudianism failed miserably as a therapeutic method. Yet, as an integrative theory of personality it is pretty much the foundation of all the modern approaches.
No comments:
Post a Comment