Saturday, December 3, 2011

Psychosomatic Medicine and Psychiatry

All medicine and surgery is "psychosomatic".  Yet politics and law and people's attitudes remain in the dark ages or simply there are alot more stupid people than intelligent ones.  No one wants to be told "it's all in your heads".
Yet that's essentially what I do, in a way, daily. I say that 'illness' is in your mind. I'm a hypnotist. I've hypnotized people so they forgot their illness and I 've hypnotized people so they had illness they didn't. I've hypnotized people and their pain has gone and I've hypnotized people and they have experienced pain.
I assisted a neurosurgeon and as we probed different parts of a patients brain they experienced pain, the absence of pain, ticks and the absence of ticks, smells and the absenece of smells.
Phantom limb syndrome is the experience of the limb that is missing.
Now face it, without a mind, and especially without a brain, experience is radically diminished.
Schizophrenia is a disese of the mind without any clearly reproducible evidence of 'body' damage.  In contrast I have patients who have existing brain tumors whose thoughts and behaviours are no different than any others.  A big wad of cancer tissue doesn't change their identity but one day a person with schizophrenia  wakes up and believes some one has stolen their identity and the identity of their familes.  One disease is bodily profound yet makes little waves in the patients life while an innapparent switch is changed in anothers and their whole life is relatively lost.
The head bone is connected to the toe bone and vice versa.
Further, psychiatrists and somatic doctors have an uneasy relationship.  The somatic doctors are really happy to pass off all the unknown mechanism disorders to the psychiatrists. After they have depleted all their millions and millions of dollars worth of tests they project their own gross inadequacy by denouncing the patient as 'invalid' in their strictly physical sense and hence 'psycho'.
Ideally as a psychiatrist and medical specialist I'd feel respected if I was consulted early on obvious connundrums but increasingly I'm stigmatized as badly as my patients.  No one wants to deal with the mentally ill or their caregivers.  We're too 'unknown'.
As a result we're desperately as psychiatrists trying to establish a physical basis for the illness of our patients to validate ourselves and them before our colleagues and society who would rather us all  be put back in asylums than allowed to walk among 'regular' people.  Indeed the stupidest of the lot, the ignorant bullies, deny any problem, deny mental illness, close asylums and put everyone who doesn't agree with them in jails.  Jails are simple places for simple minds.  Many a genius has known such confines.
Yet every time we prove a mental illness has a physical cause up jumps a physical doctor who wants to steal it from the realm of psychiatry.  Hypothryroidism was one of the last psychiatric conditions to be taken by the Endocrinologists. The Rheumatologists nabbed fibromyalgia , what we called 'somatic depression', when it seemed  there were consistent trigger points and some reason to believe it wasn't just a 'factitious disorder'.
Yet the fact is, all medicine began in psychiatry. As psychiatrists we're the oldest aspect of physicians and as physician psychiatrists were the original  witch doctors and healers. We dealt with the 'possessed' and the 'evil' and we were there when we found that so much of what was once thought to be 'malingering' and a product of 'masturbation' per se was found instead to be a virus or bacteria or a brain injury.  Neurologists are the greatest theives among our colleagues, happy to steal anything that isn't nailed to the floor of psychiatry. They even have 'behavioural neurologists' who are neuropsychiatrists by a different name.
So should we continue to lose our patients to these 'press gangs' of regular doctors or point out that most of the illness they treat with great sanctification is a product of the deviant thoughts and behaivour of their patients.  Heart disease patients are commonly alcoholics, workaholics or food aholics.
As an addiction psychiatrist I'm fully aware that most of the disease seen by family physicians is really in my territory.
It's no surprise there's a shortage of psychiatrists.  We've more psychiatrists than ever before but our colleagues have recognised that while they were pilfering our individual cases their whole fields of medicine have slipped under the umbrella of psychiatry.  Family physicians are desperately playing catch up to learn psychiatry in order to treat diabetes and asthma with any degree of success.
Everything is biopsychosocial and even the surgeon must admit his work is in the realm of the psychosomatic.
Psychiatric interventions follow diagnosis and psychiatrists have long been the end resort of diagnosis so have well documented skills in this domain. We're also therapists, psychopharmacologists and interventionists.
I just regret they disarmed me.  I liked that when I began in surgery I carried a knife and did so in family practice as well.  In psychiatry they gave me a choice, if you don't give up your knife we won't give you the keys.
I went with the keys.  Still some days I miss the knife.

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