To the Editor:
We commend the efforts of Reynolds and colleagues1 to achieve “the reintegration of undergraduate and graduate medical education in psychiatry and neurology under the rubric of clinical neuroscience.” As supervisors and teachers of psychiatry residents, we also agree with those authors that “psychiatry is grounded in clinical neuroscience” and that our residents need a “deeper understanding of genetics, pathophysiology, functional neuroanatomy and neuropsychopharmacology.”
However, we believe psychiatry is grounded in much more than clinical neuroscience, and that Reynolds and colleagues have given short shrift to the philosophical, social, psychological, and humanistic foundations of psychiatry. Indeed, though we proceed from different premises than do Healy and Mangin,2 we agree with their comment that psychiatry “need[s] more, rather than less, philosophy and psychology within the discipline.”
One of us (R.P.) has coined the term encephiatrics to encompass a broad-based, pluralistic discipline that incorporates not only the clinical neurosciences but also elements of philosophy, literature, and the world’s spiritual traditions.3 We do not regard these substantive disciplines as mere elective “frills” in psychiatric education; rather, we believe that residents in psychiatry should be exposed to the humanities and social sciences as an integral and required part of their training. Indeed, the psychiatry residency program at SUNY Upstate Medical University is now developing a “humanities track” for residents who wish to concentrate their studies in this area. We also believe that fostering competency in providing cognitive-behavioral, interpersonal, psychodynamic, and other forms of “talk therapy” must remain a central focus in a resident’s education, so that all aspects of a patient’s illness may be addressed comprehensively and compassionately. In our view, these points were not adequately stressed by Reynolds and colleagues.
Ghaemi4 argued that the pluralism of psychiatrist and philosopher Karl Jaspers “has still failed to be adequately appreciated by the psychiatric profession.” We fully agree. To put it in clinical terms, “The clinician who can instantiate the neurobiology of serotonin in the context of the existential dilemma of the patient … has a far better chance of preventing suicide than one who is entrapped in a solitary paradigm.”5
Ronald Pies, MD
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, and Tufts University School of Medicine, Boston, Massachusetts; (firstname.lastname@example.org).
Cynthia M.A. Geppert, MD, PhD, MPH
Department of Psychiatry and Religious Studies Program, University of New Mexico, Albuquerque, New Mexico.
1. Reynolds CF, Lewis DA, Detre T, Schatzberg AF, Kupfer DJ. The future of psychiatry as clinical neuroscience. Acad Med. 2009;84:446–450.
2. Healy D, Mangin D. The once and future psychiatry. Acad Med. 2009;84:418–420.
3. Pies R. Why psychiatry and neurology cannot simply merge. J Neuropsychiatry Clin Neurosci. 2005;17:304–309.
4. Ghaemi SN. Existence and pluralism: The rediscovery of Karl Jaspers. Psychopathology. 2007;40:74–82.
5. Geppert C. Why psychiatrists should read the humanities. Psychiatr Times. 2008;24:10.