Sir, – Dr Ciarán Crummey (Opinion Analysis, August 30th) recommends that psychiatry needs to be “reformed and humbled”. Much of his article is based on the premise that psychiatry, unlike other medical specialities, is entirely subjective and there are no scientifically validated tests for psychiatric disease. He maintains psychiatrists do not “operate to the same standards as cardiac surgeons or stroke specialists”.
As a cardiac surgeon, I only wish that cardiac surgery was as objective and mechanistic as Dr Crummey believes. In truth, in all medical specialities many key decisions have to be made in the absence of good scientific data to support them. The reason medicine is challenging is that frequently the “tests” Dr Crummey refers to give incomplete or conflicting results.
The heart is a relatively simple pump but even then our understanding is not complete. The brain is a complex organ with many and varied functions. Our understanding is largely due to the body of research in psychiatry carried out by such doctors as Dr Aiden Corvin (Irish Times, July 31st). Dr Crummey’s belief in “tests” shows a misunderstanding of the use of tests in medicine. He may be surprised to know that if he were to attend AE with appendicitis, the diagnosis would be principally made by speaking to the patient and the interpretation of the examination in much the same way as a psychiatrist interprets their patient’s story.
Unlike other medical patients, those with major disturbances in their thought processes may occasionally require doctors to act in their best interests and against their stated preferences. While safeguards are obviously vital in this process, it is a mistake to talk of “humbling” the group of healthcare professionals who have chosen this challenging area of medicine. It is also a mistake to view psychiatry as fundamentally different from other medical specialities. – Yours, etc,
Department of Cardiothoracic Surgery,
St James’s Hospital,