Who should do psychiatry?
A mature and sensible anaesthetist (she was a physiologist before training to be a medic) believes that psychiatry is just very complicated neurology. If you're a proponent of biomedical psychiatry it becomes quite a compelling argument.
A psychiatrist who taught me when I was a junior doctor believes that many psychiatric conditions, like severe depression, are too serious to leave to psychiatrists to treat. Although truly biopsychsocial in outlook, the "bio" bit was important enough for him to feel that "social psychiatrists" focussing on psychosocial problems were mistreating many of their patients by ignoring pathological neuroendocrine biological processes. "In 10 years time," he said, "physicians will be the ones treating depression, not psychiatrists . . . it's too serious a condition for us to play with."
Taking this views on, who should treat them? Their points both suggest that "sitting down and talking about it" is wrong and a more active management is warranted. And in many ways they're right.
We know that depression is bad.
The consequences of depression are serious. We know research shows that being stressed for protracted periods of time is damaging since the hormones released aren't meant to be sustained at high levels for any length of time. A "fight or flight" response is great if a lion is chasing you but to have surges of catecholamines like adrenaline is, we know, neurotoxic.
This means each and every day that someone's being there, fraught and frazzled, stressed and depressed, they're poisoning their brain and killing off brain cells. Much badness.
The original comments referred to this, meaning that patients deserved prompt and effective treatment to address the neuroendocrine elements of their distress. They felt that depression was too serious an illness for "social psychiatry" to treat and physicians (or maybe neurologists) should be treating such folk. My mentor said this over 10 years ago; his vision hasn't come to pass.
I think this is a good thing.
I believe that good mental health services can address the biochemical elements of illness expediently but, critically, can generate a holistic and cohesive careplan that's broader (and better) than simply getting the right drugs prescribed at the right time.