Amrish Kumar , Vrish Dhwaj Ashwlayan , Mansi Verma
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Journal : International Journal of Medical, Pharmacy and Drug Research(IJMPD)
Psychiatric symptoms are very frequent in medical practice, up to 40% of the people that have physical problems present anxiety or depressive symptoms associated to physical illness. Due to this, psychiatric liaison is an important part of hospital attention and many people usually have psychiatric drugs associated to other treatments. In the second half of the last century, many clinicians mostly psychoanalytically oriented-have opposed the use of psychoactive drugs for the treatment of mental illness, particularly in the course of psychotherapy, arguing that they suppress conflicts and states of mind considered essential for the understanding of suffering. Furthermore, psychoactive drugs were supposed to have a negative influence on psychotherapy by making it less effective. In reality, in 1974 research demonstrated that integrated therapy (i.e. combined use of medication and psychotherapy) is not harmful to the patient, but is actually useful. However, the conflict between pharmacotherapy and psychotherapy had already made a great disservice to patients, sometimes delaying the required drug treatment (e.g. the importance of duration of untreated psychosis for the prognosis of schizophrenia) or other avoiding effective psychological interventions that could lead to a better quality of life and reduce the risk of suicide. This may be the case when considering dialectical behaviour therapy (DBT) or exposure and response prevention (ERP) techniques in cognitive behavioural therapy (CBT) for borderline personality disorder (BPD) and obsessive compulsive disorder (OCD), respectively. Unfortunately, today, despite a much-vaunted integration of treatments, on the one hand we often deal with reductionist attitudes that judge psychotherapy as irrelevant and consider drug therapy alone sufficient for treatment. On the other hand, we deal with extreme psychological assumptions that consider psychiatric illness as a social problem and treatable solely and only – through psychosocial interventions, including psychotherapy. Over time, psychiatry seems to move from a “brainlessness” approach to a “mindlessness” one. In fact, before the introduction of psychoactive drugs the psychiatrist’s attention was almost exclusively on unconscious and intrapsychic conflicts supposed to affect the mind (as separate from the brain). After 1956, attention moved to neurotransmitters and other aspects of the brain, consequently with an extensive use of drugs and less interest for the exploration of the life stories of patients, and focused on symptoms. Therefore, a biological model of mental illness prevailed, causing an important crisis for psychotherapy. In my opinion, the cause of this crisis is simple: psychiatry reductionists, using data from scientific research, support the biological causes of psychiatric illness (e.g. excess dopamine, serotonin deficiency, etc.), and therefore were supposed to be able to say when, how and why a treatment protocol is effective, describing the mechanisms of action, therapeutic effects, limitations and side effects.