Isn’t it strange that the profession having the most to do with the mind—psyche lives, after all, in the name psychiatry—has come to so resolutely avoid the whole messy business of thinking?
I once saw a psychiatrist who had patients fill out a checklist before each (brief) appointment, rating things like depressed mood and sleep on a scale of one to five. No matter what answers I gave, we rarely discussed them. Our most in-depth chat lay in the virtues of different pharmacies.
I have only seen one psychiatrist in my life who took an interest in discussing mental content—the why and the how of depression, anxiety, delusion. She, Mary, helped me immensely, but I had to move away from her city. I’ve never found another doctor like her.
Somehow our mind care has come to treat states like despair or delusion as if they have nothing to do with our consciousness. I have an erratic heartbeat. If my thoughts go too far in a neurodiverse direction, they become in the eyes of medicine as meaningless as that organ’s skipped beats.
Sam Kriss, who wrote a review of psychiatry’s diagnostic manual the DSM, described the diagnostic process like this: “It’s not just that [patients’] thought processes don’t matter, it’s as if they don’t exist.”
Patients typically have brief visits, checklists—verbal or literal—with broad terms like “down, depressed, or hopeless” (as if these are the same thing). And, typically, receive a prescription.
In her memoir On the Trail of the Morning........© Psychology Today