After studying medicine for six years at university, newly fledged doctors have to work under supervision in a training hospital for at least a year before at last being registered as doctors. Then they can start another four or five or more years training to become general practitioners (GPs) or hospital specialists.
Those who train in psychiatry cannot help but see profound differences between their new specialty, psychiatry, and everything they have known about medicine before, all they have been taught and learned about how to diagnose and treat diseases of the heart, the lungs, liver, brain, stomach, joints, and so on, and how to look after women going through pregnancy and labour and then their new born babies. The patients have been able to cope with the usual anxiety and stress of being in hospital or at the GP’s surgery. Doctors and patients have a rapport with mutual respect. Care for those in need is inherent in human nature. As much as anyone else, doctors care for fellow humans who are feeble, sick or injured and have specialised skills for this.
When the anthropologist, Margaret Mead, was asked by a student what was the earliest record of civilisation, she said it was a human skeleton 30,000 years old. One of the thigh bones was fractured and had healed, which would only have been possible if the living individual had been looked after and cared for for at least three months – the time it takes for a broken thigh bone to heal. Thirty thousand years ago, anybody with a fractured leg would have died if not cared for.
The world of psychiatry is profoundly different. The very ideas of diagnosis and treatment are completely different from those doctors have learned and trained in in all other areas of medicine.
The patient’s history is important. If the patient has recently returned from the tropics this could be a clue and might help to diagnose his present illness; the doctor can do tests for malaria or for some other tropical disease. When someone is short of breath going up the stairs and has swollen ankles and needs three pillows in bed the doctor will suspect heart failure and can do suitable tests to confirm it.
In psychiatry the patient’s history might give a clue to why someone has recently started to hallucinate and become agitated and aggressive when he had never been like that before, but after he has been smoking a lot of marijuana recently. Possible clues like this are more subtle than a person’s history in medicine. Many people smoke a lot of marijuana and do not suffer while anybody who has heart failure will be ill. Many people who do not smoke any marijuana or take any other mind-altering drugs start to hallucinate and become agitated and aggressive. Nothing in their past gives a clue.
Millions of people suffer in these ways not because they have been taking any recreational drug but because they have been taking prescribed psychiatric drugs.
People with infections or heart disease, liver disease, disease of the gut or nervous system, including disease of the brain, have changes that can be detected by examination of the body and/or by laboratory tests, X-Rays, scans, and so on. Diagnosis depends on it and the diagnosis tells us what the prognosis is and determines the treatment.
None of this is found in psychiatry. The patient’s history might be suggestive but not much more than that. Examining the patient cannot find anything wrong in the body. The mind is like a black box that we can see what goes into it and what comes out but have no idea of what happens inside. Nothing can be found to account for why we all suffer emotionally, except to understand that because we have senses we are bound to feel pain and suffer from time to time.
We have no medical or scientific explanation for depression or anxiety or eating disorders or lack of attention or over activity, or restlessness, or aggression, and so the list goes on to include all human behaviour and all human suffering. But we do know that all such ways of suffering occur and as far as we know they have done for as long as there have been human beings.