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Psychiatry, science and humility (or lack thereof)

Mark Komrad's one-sided portrayal of psychiatry is as misleading as the Hollywood productions he criticizes ("Fiction does a disservice to psychiatry," Oct. 23). In this mental health utopia, "modern psychiatric medication" and "state of the art treatment" such as electroconvulsive therapy are "remarkably effective" and concerns about side effects are "exaggerated." To be sure, many people are helped by mental health services. But pretending that significant risks and limitations don't exist shifts the blame for treatment failures elsewhere — most often on the patient. Thus, people "lack insight," are "treatment resistant" or "non-compliant." Worse, lawmakers rely on this psychiatric fiction to pass ever-expanding involuntary treatment laws.

Fortunately, Dr. Thomas Insel, director of the National Institute on Mental Health, is injecting much-needed doses of reality into conversations about the state of psychiatric treatment. Often blunt in his critiques, he recently called on his profession to atone for its lack of humility, stating that "so much of mental health care is based on faith and intuition, not science and evidence." Dr. Insel summarized his observations that psychiatry lags far behind the rest of medicine as a "humbling realization [that] we still lack biomarkers to identify who should get which treatment" and "still lack effective treatments for many aspects of mental illness."

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Whether NIMH is able to achieve Dr. Insel's goal to move psychiatry beyond what he calls its current state of "religion" and into the world of science remains to be seen. In the meantime, simply heeding his call for humility and honesty would be a stunning achievement.

Laura Cain, Baltimore

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The writer is an attorney with the Maryland Disability Law Center.

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