Filler-An article

What is Psychiatry?

Thoughts, emotions, cognitions and perceptions are the basic substrate of the experience of being ‘human’ as we know it. These enable us to interact with others and live our lives in rich and rewarding ways. These also mould our behavior which is a reflection of the above. However, the demands of being a member of society invariably impress upon an individual to conform to certain limits on behavior. This is essential because deviance beyond certain limits carries in it seeds of decay and downfall of that society. Therefore, individuals who have deviated in behavioral terms from the norm of a particular society have always attracted attention and in the absence of knowledge, alarm and indignation as well.

Until a few centuries ago, all such deviance was explained as a result of forces such as demonic possession. This was because unlike most other illnesses, mental illness did not manifest in any physical handicap and observers were not able to understand why a person behaved the way he or she did. As a result, depending upon the thought prevailing at that time such people were either eliminated as being evil or later on segregated for life from the society. Except for a few exceptions, such was the case in most parts of the world. It took courage from a few enlightened people like Pinel who advocated a moral and humane treatment for such people, the reason being mainly an aversion to the horrible conditions that existed in the asylums of the 18^th century Europe.

However, as other branches of medicine such as neurology became established, similar concepts were extended to the study of those individuals who presented with nothing more than deviant behavior and abnormalities in thought, perception, emotion and cognition. It started to be recognized that mental illness existed and the study of such conditions was a part of medicine and not all in the ‘mind’ as Descartian dichotomy implied. It was only in Germany in the 19^th century, that such study became a clinical discipline. The term “Psychiatry” was termed by Johann Christian Reil in 1808 and was derived from the Greek “psyche” (soul) and “iatros” (doctor). The clinicians started to be called “psychiatrists”. Similar movements also started in other parts of the world. It is important to realize the paradigm shift that occurred at this time. Psychiatry as a clinical discipline exists only on the premise that mental illness ‘exists’, and it took close to 2000 years of recorded human history for that realization to come about. This truly was a momentous step.

However, efforts at finding out the physical basis of the symptoms of mental illness continued to be futile and in such a scenario, clinicians such as Freud and Jung are credited with giving a theoretical basis of understanding into the causes of mental illnesses. Such a step was extremely significant as science works on observation but cannot hope to progress without a hypothesis into its reasons. These theories held sway for most part of the last century until increasing dissatisfaction with these and increasing knowledge into the biological basis of behavior gave a new impetus and direction to psychiatric research and this phase continues until the present time.

Even in the present day, even though it is evident from various lines of research that mental illnesses have a basis in the dysregulation in the functions of the brain, a direct one-to-one relationship between specific abnormalities and specific mental illnesses has not been found. As a result and to avoid confusion, psychiatric diagnoses are made on the basis of agreed upon combinations of symptoms that are considered to be syndromes because of factors such as natural history, treatment response etc. this system driven by nosology has so far stood psychiatry in good stead and has given impetus to research and given psychiatry a scientific temper. It is regularly updated and takes into account cultural variations as well. It also acknowledges that much remains to be found out, and that the final word about mental illnesses has not yet been said.

As is evident, like all branches of medicine, psychiatry too is a science and an art. It is constantly shaped by new knowledge and new discoveries. But at the very basic level, it deals with prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. Its primary goal is the relief of mental suffering associated with symptoms of disorder and improvement of mental well-being.

Because psychiatry deals with problems in behavior and with people who cannot often make proper choices, a robust series of checks and ethical practices have been devised so that human rights are not infringed upon and the psychiatrist does not take undue advantage of the privileges that are bestowed upon him or her. As psychiatry is intimately related to the individual who as an organism is a member of the bigger system of society, the study of psychiatry has also fostered a close relationship with other disciplines such as sociology and psychology.

Psychiatry has flourished as a discipline and a profession because it has been able to fulfill a felt need of society. With growing demands from various quarters, psychiatry has split up into many subspecialties and many psychiatrists are specializing in one or the other. These include:

• Child and adolescent psychiatry
• Adult psychiatry
• Psychiatry of Old Age (Psychogeriatrics)
• Learning disability
• Behavioral medicine
• Consultation-liaison psychiatry
• Emergency psychiatry
• Addiction psychiatry
• Forensic psychiatry

Some psychiatric practitioners specialize in helping certain age groups; child and adolescent psychiatrists work with children and teenagers in addressing psychological problems. Those who work with the elderly are called geriatric psychiatrists, or in the UK and Australia, psychogeriatricians. Those who practice psychiatry in the workplace are called industrial psychiatrists in the US (occupational psychology is the name used for the most similar discipline in the UK). Psychiatrists working in the courtroom and reporting to the judge and jury (in both criminal and civil court cases) are called forensic psychiatrists, who also treat mentally disordered offenders and other patients whose condition is such that they have to be treated in secure units.

Consultation-liaison psychiatrists in particular have done yeoman service to the cause of mental problems afflicting those treated in general medicine and surgical settings. Research in these areas has led to improved outcomes in a vast variety of patients, and has also led to an increased understanding into psychiatric pathology.

Treatment of mental illnesses no longer involves being shut up in mental hospitals for months and years on end. Most patients can now be treated on out-patient basis with a combination or singly by psychotropic medications and psychotherapy. Occasionally, in-patient treatment is required, but is mostly for weeks rather than months. It is in very rare cases that long-term institutionalization is required. Results of treatment are mostly favorable, and the contribution of social support networks is invaluable.

Psychiatry today is at an exciting stage in its history and development. Everyday, new discoveries enable us to gain new insights. New drugs and new modalities of treatment enable patients to enjoy ever better outcomes and better quality of life. The burden of mental illnesses on societies everywhere is enormous, and the psychiatrist and other allied workers remain committed to the cause of alleviation of the misery caused by these.