Psychiatrists must take an active role in defining their identity, rather than allowing others to do so for them. Shahram Shaygani argues that our history can assist us in defining ourselves clearly in the future as the only profession in mental health capable of treating patients with a bio-psycho-socio-existential approach. At the same time, he cautions that our privilege to prescribe medication may pose a significant threat to our professional identity in the future.
As psychiatrists, we like to see ourselves as medical professionals who specialize in the diagnosis, treatment, and prevention of mental illness. We believe that we have training and abilities to assist patients with behavioural disturbances, relational difficulties, altered perceptions of reality, a lack of insight into their condition, and even violent behaviour. However, this self-perception is not necessarily shared by everyone involved in the field of mental health, whether they are patients, caregivers, or other professionals. We must acknowledge that there are many unanswered questions and uncertainties in our field. In our position as a scientifically oriented profession, we should be open to constructive criticism and listen carefully to it. Nonetheless, it is also necessary to address the unjust, misleading, and conspiratorial portrayals of psychiatry. Rather than allowing others to define who we are, we must take an active role in defining ourselves.
Looking back
Those who are ignorant of their own history risk losing their footing in the future. Therefore, it's imperative for young psychiatrists to cast a retrospective eye on their own professional heritage. Several factors justify the importance of such an introspective journey. As noted by Norwegian psychiatrist Per Vaglum (Valglum, 2009), history provides us with heroes and heroines—figures to admire and emulate. Moreover, such reflection allows us to appreciate the depth, dynamism, and inherent meaningfulness of psychiatry as a field. We come to recognize that we are standing on the shoulders of giants, and also acknowledge the privilege inherent in choosing this career path. Our past not only offers a window to learn from our predecessors but also grants us the opportunity to learn from our own mistakes.
From a historical perspective, our heroes and heroines attempted to understand mental disorders through four distinct approaches: biological, psychological, socio-cultural, and existential.
Looking forward
I strongly believe that psychiatrists' entire identity stems from this bio-psycho-social-existential understanding of mental illness. Psychiatrists are the only specialists in mental health who are authorized to prescribe medications. However, if this becomes the sole role of psychiatrists, it may mark the beginning of the decline of our profession. I believe that the privilege of prescribing medications will also pose the most significant threat to our profession in the future. Naturally, we should provide effective psychopharmacological treatment to our patients. However, we should always continue to offer medical psychotherapy, practice social psychiatry, and engage in profound existential conversations with our patients and their families when needed. As experienced psychiatrists, we bear a significant responsibility to convey this message to our younger colleagues who will become future psychiatrists. However, this is the message we should send clearly to all professionals working in the mental health field, as well as leadership in psychiatric units, health policymakers, the media, and anyone interested in the well-being of those experiencing mental health challenges. □
Reference by request
Vaglum, P. (2009). Hva er en psykiater? Tidsskr Nor Legeforen 2009 129: 478-80. doi: 10.4045/tidsskr.09.0351