What makes a good psychiatrist|My essay solution

Posted: February 25th, 2023

Compare and contrast the attachments.  At a minimum, you should address the following  in your assignment

  1. Discuss at least two similarities and two differences between the perspectives expressed by the authors of each article.
  2. Discuss your own perspective on the material in the articles and how your views changed or did not change after reading the articles.
  3. In your future PMHNP practice, you will be using the DSM-5-TR to diagnose patients.  How will you apply what you learned from the articles when diagnosing and treating patients?

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  • Fully answer all of the prompts in detail.
  • Show evidence of scholarly analysis and synthesis of the materials.  Go beyond repeating the authors’ perspectives.What makes a good psychiatrist? What particular skills are needed to practice a ‘medicine of the mind’? Although it is impossible to answer such questions fully we believe that there is mounting evidence that good practice in psychiatry primarily involves engagement with the non-technical dimensions of our work such as relationships, meanings and values. Psychiatry has thus far been guided by a technological paradigm that, although not ignoring these aspects of our work, has kept them as secondary concerns. The dominance of this paradigm can be seen in the importance we have attached to classification systems, causal models of understanding mental distress and the framing of psychiatric care as a series of discrete interventions that can be analysed and measured independent of context.1

    In recent years this Journal has published a series of editorials arguing that the profession should adopt an even more technological and biomedical identity, and that psychiatrists should focus on their mastery of technology to allow progress in the development of brain research, genetics, pharmacology and neuroradiology.2–4 These resonate with calls in North America for psychiatry to become simply a ‘clinical neuroscience’.5

    However, the promise of therapeutic gains from the brain sciences always seems to be for the future, leading some to interrogate their contribution to advances in our field.6 Indeed, neuroscientists themselves have become more cautious about the value of reductionist approaches to understanding the nature of human thought, emotion and behaviour.7,8 Furthermore, there is ample evidence that anti-stigma campaigns based on biogenetic models of serious mental illness have been counterproductive.9

    The increasing focus on neuroscience has meant that other important developments in the provision of care and support for people with mental health problems over the course of the past century have been neglected. Historically, these have been driven mostly by non-technical changes that have fostered empowerment and social inclusion.10 It is generally agreed that the closure of the large Victorian asylums improved patients’ quality of life. But this was mainly the result of economic imperatives combined with a growing realisation of the negative effects of institutionalisation, rather than, as frequently suggested, a consequence of the introduction of new drugs.11,12 Other positive developments have resulted from the establishment of multidisciplinary, community- based care and the rise of the service user movement and

    voluntary sector supports. Many psychiatrists have worked hard to promote these developments but the increasing focus on technical and biomedical aspects of care have served to sideline such efforts.

    The technological paradigm

    Since its origins in the asylums of the 19th century,13 psychiatry has faced a fundamental question: can a medicine of the mind work with the same epistemology as a medicine of the tissues? Through the 19th and 20th centuries, psychiatry held fast to the idea that mental health problems are best understood through a biomedical idiom; that problems with feelings, thoughts, behaviours and relationships can be fully grasped with the same sort of scientific tools that we use to investigate problems with our livers and lungs. In more recent decades, models of cognitive psychology, such as ‘information processing’, have been developed that work with the same technical idiom.14 The ‘technological paradigm’ that now guides psychiatry incorporates these perspectives, works with a positivist orientation15 and involves the following assumptions.

    (a) Mental health problems arise from faulty mechanisms or processes of some sort, involving abnormal physiological or psychological events occurring within the individual.

    (b) These mechanisms or processes can be modelled in causal terms. They are not context-dependent.

    (c) Technological interventions are instrumental and can be designed and studied independently of relationships and values.

    In the technological paradigm, mental health problems can be mapped and categorised with the same causal logic used in the rest of medicine, and our interventions can be understood as a series of discrete treatments targeted at specific syndromes or symptoms. Relationships, meanings, values, cultural beliefs and practices are not ignored but become secondary in importance. This order of priorities is reflected in our understanding of the training needs of future psychiatrists, what gets published in journals, what topics are selected for analysis at conferences, the types of research that are promoted and how we conceptualise our relationship with the service user movem

SOLUTION

In contrast to the technological paradigm, we argue that the most important skills needed for good psychiatric practice are those that involve engagement with the non-technical dimensions of our work, particularly the development of relationships with patients that are characterised by respect, empathy and shared understanding. We suggest that these skills cannot be reduced to the application of a set of technical skills or algorithms, but involve the development of a set of interpersonal and reflective capacities that enable psychiatrists to enter into the subjective worlds of their patients.12

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