“Medical school is the wrong place to train psychiatrists,” writes Daniel Carlat in his new book, Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations About a Profession in Crisis. In place of the sort of education that makes psychiatrists fifteen-minutes-per-patient pill dispensers, and gives them little in the way of slower, psychotherapeutic skills, he proposes something like a “doctor of mental health” program: Perhaps “two years of combined medical and psychological courses, followed by three years of psychiatric residency.”
An ego- and money-driven need to be the equal of other MD’s will, as Carlat knows, probably keep this from happening any time soon; indeed, a need to feel that one’s clinical activity has the same empirical warrant as a heart surgeon’s will also keep the pills flowing.
Yet I lost track of the number of times Carlat, in the course of this book, cautions the reader that
new diagnoses are based on votes of committees of psychiatrists, rather than neurobiological testing. Because diagnosis in psychiatry is more art than science, the field is vulnerable to ‘disease-mongering,’ the expansion of disease definitions in order to pump up the market for medication treatment.