Psychiatrist Simon Wessely suggests that doctors in his field have a deeper appreciation for complexity than other medical professionals do:
Not for us the simplicities of some other parts of medicine. Here is a cancer – take it out. There is a bug – kill it. In psychiatry, the ability to tolerate uncertainty is an essential skill. Because we have to negotiate fuzzy boundaries – between eccentricity and autism, between sadness and clinical depression, between hearing voices and schizophrenia – and there will always be boundary disputes.
Far from backing away from such debates, my experience of psychiatry is that we relish them. We are not the only branch of medicine that argues about classification – so do tumor biologists – but the difference is that the issues that we face in classification are more readily understood by the general public. If there is a little bit of crisis, like argument and discussion it keeps us on our toes, alert to new developments, and is an antidote to complacency.
Update from a reader and neurologist:
I’m a bit behind on my Dish reading, but just saw the post that you referenced from Dr. Wessely, and really have to call complete and utter crap on it.
This is one of the most enduring tropes in medicine, where every specialty sees itself as special and more extraordinary than their peers in lesser specialties. While were all guilty of it from time to time, it’s rare that I’ve seen someone bold enough to put it to print (from the President of the Royal College of Psychiatrists no less!). It would be like me denigrating cardiology by likening the vascular system to something marginally more complex than the pump and plumbing for my pool.
Nothing in medicine is ever as clear cut. Furthermore, we all treat more than a disease; we treat a patient (and often the family issues/fallout arising out of the patient’s disease). And because patients are complex, individual creatures, management has to be tailored not just to the illness, but to them.
Even in cancer, it is not quite as simple as Dr. Wessely suggests. Take prostate cancer for example. Do we have to treat it? The majority are slow growing and aggressive intervention is not always warranted. Psychiatry does itself no favour by promoting exceptionalism.
The Dish 