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Psychiatry

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Psychiatry will continue to change rapidly from the impact of technological advances. These changes are often a double edged sword with both beneficial and destructive potential. The increased use of computers has contributed not only to brain imaging and new drug development, but also to the centralized information systems of managed care.

The convergence of the new mental health capability at the same time as the managed care crisis has created a crossroads for Psychiatry. On one path, physicians and patients remain united to maintain leadership to improve both mental fitness and social responsibility. On the other path, physicians and patients defer the leadership of health care to business interests. The result of this second path would be physicians who are reduced to health care technicians and patients who have lost many of their civil rights.

To expand upon these points, we are in the last year of the "Decade of the Brain." Imaging technology has given us a window into the brain which helps us understand the anatomy and physiology of mental processes. New theoretical views, such as Darwinian Medicine and the role of infectious disease in mental illness are changing the manner in which we view health and disease. A number of new psychoactive medications have been released which have helped improve the mental health of the masses.

These new treatments have improved the lives of millions and prevented countless suicides and homicides. Approximately 70 new psychiatric medications are in the research pipeline with a promise of even greater benefit in the future.

Psychiatry is increasingly recognized as the most complex and challenging field of medicine. The profession is assuming a leadership role in medical ethics, social responsibility, health care delivery, and forensic issues. The release of Viagra in the past year has contributed to an expanding role beyond "protection from harm" to the broader responsibility to enhance of the quality of life. Not everyone enthusiastically welcomes all of these changes. Some show cautious optimism to these new developments. The old stigma is gradually becoming less powerful as we explain brain functioning and human behavior more effectively.

However, power struggles persist as a significant obstacle to prevent access. A great experiment was recently imposed upon medicine. Economic interests were allowed to have an imbalance of power in the hopes this would decrease inflation while preserving the quality of health care. This experiment is best described with the phrase-"managed care."

Although some costs were temporarily reduced, the true cost was a reduction of ethics, freedom, access, privacy, and quality of care. Clearly the experiment has failed. Although much more covert, it reminds us of other abuses-Nazi medicine (the first to implement managed care) and the labeling of political dissidents as being insane in Communist Russia. The managed care experiment has emphasized a valuable lesson-the health care system which has protected us cannot be taken for granted.

The managed care failure has drawn the attention of the media, caused moral outrage, and awoken the social conscience of many. Physicians and patients are responding in a unified effort to protect the integrity of the physician patient relationship and to plan more viable health care delivery systems. Those who gain from managed care continue to white wash the inherent deficiencies while thousands die and millions suffer. Although in the short run, managed care will continue to grow, eventually it will collapse from the weight of it's structure of greed and deception. Now is the time to develop better options for health care delivery. The plan which I currently endorse is the Medical Savings and Responsibility Account. It protects the core components of ethics, freedom, access, privacy, and quality of care while improving cost effectiveness.

In summary, our new technology has created a crossroads with the best of time for mental health treatment capability, and the worst of time for public access to genuine mental health care. Ethical judgment and proactive advocacy shall help greater numbers benefit from new scientific advances.