On Rebranding Psychiatry

I saw a great post on PsiHub and just attempted to comment on Dr. Stephen Strakowski’s Medscape Post entitled “Does Psychiatry Need ‘Rebranding’?” It was approved although I’m posting a longer version of it here as well because it’s not accessible without registering (although it’s free).

I’m a retiring consultation-liaison (C-L) psychiatrist and have no financial relationships with the manufacturers of health care products. I’m biased toward the definition of psychiatry which acknowledges the link to general medicine.

I appreciate Dr. Strakowski’s contribution to psychiatry and to the issue of psychiatry’s rebranding, which sounds very much like the rebranding issue with which C-L Psychiatry has struggled for years. Just last month, the Academy of Psychosomatic Medicine (APM) formally announced their name change to the Academy of Consultation-Liaison Psychiatry (ACLP), which is the specialty’s own rebranding effort.

I remember the name change poll that the organization ran in the last couple of years. One other commenter here suggested we change the name of psychiatry to “NeuroPsychiatric Medicine” or “NeuroCognitive Medicine.”

The ACLP has struggled with this rebranding more than once over decades. The American Board of Psychiatry and Neurology (ABPN) and the American Board of Medical Specialties (ABMS) originally named our specialty Psychosomatic Medicine when they approved it in the early 2000s as one of the now 7 psychiatric specialties. Few of us who actually practiced C-L Psychiatry cared for the name, partly because of the “all in your head” pejorative associations.

Other names suggested have included Medical Psychiatry, Neuroscience Medicine, Med-Surg Psychiatry, General Hospital Psychiatry, Neuropsychiatry, Encephiatrics, Ergasiology, and Encephalopathology. Dr. Don R. Lipsitt, a C-L Psychiatrist, preferred the name C-L Psychiatry and wrote an excellent history of the rebranding path in his book, “Foundations of Consultation-Liaison Psychiatry: The Bumpy Road to Specialization.”

The effort to reintegrate mind and body has been going on in medicine for a long time. We have combined training programs in Internal Medicine-Psychiatry, Family Medicine-Psychiatry, and Neuropsychiatry.

There have been debates about combining Neurology and Psychiatry into a single specialty in order to better link mind and body. Dr. Ron Pies cast some doubt on this suggestion in his 2005 editorial, “Why Psychiatry and Neurology Cannot Simply Merge,” 2005. J Neuropsychiatry Clin Neurosci, 17(3): 304-309. Pies was the one who suggested the name “encephiatrics.” According to Pies,

“Still, we have other reasons to believe that the discourse of psychiatry differs fundamentally from that of neurology, notwithstanding the common substrate of these two disciplines (i.e., the human brain). The discourse of psychiatry, notwithstanding its burgeoning interest in neuroscience, remains grounded in human subjectivity and existential concerns. This applies not only to psychotherapy but to psychiatry as a whole. Psychiatry has always been, and essentially remains, a discourse of interlacing and multilayered meanings. Neurology is fundamentally a discourse of neuroanatomical and neurophysiological relationships.”

On the other hand, Schildkraut and colleagues have a different vision, described in “Integrating Neuroscience Knowledge and Neuropsychiatric Skills Into Psychiatry: The Way Forward.” Acad Med 91 (5): 650-656.

“Psychiatry has traditionally concerned itself with what is individual and personal—namely, life experiences and the construction of meaning. Brain function is also an important aspect of individuality. In this era of rapidly advancing scientific information about the brain, it is now possible for psychiatrists to integrate knowledge of neuroscience into their understanding of the whole person by asking, What person has this brain? How does this brain make this person unique? How does this brain make this disorder unique? What treatment will help this disorder in this person with this brain?”

I should mention the book by McHugh and Slavney: McHugh, P. R., MD, and P. R. Slavney, MD (1998). The Perspectives of Psychiatry, The Johns Hopkins University Press. They described other contributors to psychiatric illness in addition to the brain which allowed for other influences, leading to the perspectives: Disease Perspective, e.g., delirium, schizophrenia, bipolar disorder; Life Story; Behavior; and Dimensional. They are no less important and not mutually exclusive. 

I suspect rebranding will not be an easy task.

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