Vivian Rakoff, the chair of the University of Toronto’s Department of Psychiatry during the 1980s and one of the legends of Canadian psychiatry, used to say that psychiatry was both a science and an art, and the essence was to balance the two. More than four decades later, his words ring as true as ever.
So begins Dr. Paul Garfinkel in the chapter “Science and Care” of his newly released autobiography, A Life in Psychiatry: Looking out, Looking in.
It has the feel of a bad movie.
When the BBC goes to interview psychiatrist Dr. Egip Bolsane in his native Chad, they find a man in a small office with a small wooden desk. Dr. Bolsane speaks enthusiastically about his work, wiping sweat from his forehead (he can’t afford an air conditioner) as he talks about the challenges of practice in a country where mental illness is often confused with possession.
When was the last time you recommended exercise to one of your depressed patients?
Too often, we tend to be too selective with our patients, choosing to talk up the drugs, and choosing not to talk about the other things that can help.
It’s a problem not confined to clinicians: 2014 seems to be the Year of the Obscure Depression Treatment. The American Journal of Psychiatry has published papers on ketamine and NSAIDs. The New York Times ran an op ed suggesting that mushrooms may be the future of treatment (citing the British Journal of Psychiatry, no less).
And with such attention-grabbing remedies, exercise seems so much less dazzling.
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