As a forensic psychiatrist, I have testified in courtrooms, at depositions, legal hearings, and inquests. I’ve been cross-examined by attorneys whose agenda was to discredit my testimony or demean psychiatry as a medical specialty. Two criticisms frequently leveled at psychiatry are: 1) Psychiatry has not changed significantly for the last sixty years and, 2) Psychiatry is the least scientific of all medical specialties.
These beliefs are not true.
Over the last few decades, psychiatry as a medical specialty has changed dramatically.
Over the last sixty years, more advances have been made in understanding and treating mental illness than in all the centuries during which human beings have populated the earth. Even newer developments will change nearly everything about psychiatric treatment. Psychiatry as a medical specialty is on the cusp of profound scientific breakthroughs, and the specialty has entered the realm of neuroscience. With the latest developments, psychiatry can no longer be viewed strictly as a social science or the handmaiden of medicine.
Beginning in the late 1980s, effective medications were developed, including potent antipsychotic remedies, effective antidepressants, anti-anxiety medications, and mood stabilizers. These medications have transformed formerly untreatable conditions such as phobias, panic disorder, PTSD, and depression. The latest generation of SSRI and SNRI medications effectively smother symptoms of these disorders and have changed the landscape of clinical practice. New mood stabilizers have made bipolar disorder eminently treatable, and people so afflicted can lead normal lives. The latest neuroleptic medications have few side effects and suffocate symptoms of schizophrenia.
Innovative treatments have evolved, including light therapy, transcranial magnetic stimulation, sophisticated neuroimaging, and much more advanced techniques for administering electroconvulsive therapy.
More innovations are on the way.
Psychiatry is now on the cusp of revolutionary new developments. These include the potential for gene therapy and the discovery of new biological markers for many illnesses. Neurobiological markers for schizophrenia, bipolar disorder, and other major psychiatric conditions have been discovered. These advances implicate specific brain pathways and chemical neurotransmitters as playing crucial roles in various forms of psychopathology. Neuroimaging of the brain has evolved whereby specific structural abnormalities are observed and monitored for psychiatric illnesses.
Certain predictive drug-related biomarkers will soon be used to indicate whether one specific medication or another will be most effective for an individual. There will be no more trial-and-error treatment for depression or schizophrenia.
In the not-too-distant future, biomarkers will make it possible to prevent the onset of mental illness and will be used to individually tailor treatments for those already affected. Within our lifetimes, a simple blood test to determine a person’s genome will be used in gene therapy. Imagine this: A blood sample drawn from an infant will be able to determine a minute genetic variation responsible for the onset of a specific psychiatric disorder later in life. Altering that genetic configuration will allow physicians to eradicate that psychopathology either before it arises or after it has achieved expression.
And, these new developments do not discount the benefits patients derive from supportive counseling or insight-oriented psychotherapy. In fact, for psychotherapy to be effective, it must work through biological mechanisms. Many neuroimaging studies have demonstrated that psychotherapy itself affects demonstrable brain changes, impacting certain brain areas as profoundly as medication, electroconvulsive therapy, and deep brain stimulation.
The integration of psychiatry with neuroscience, biochemistry and genetics has already begun. This development will have a profound impact on human suffering and well-being far into the future.
Mark Rubinstein is a psychiatrist and author of Bedlam’s Door: True Tales of Madness and Hope.
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