Scientific American MIND – July-August, 2019, Volume 30, Number 4

OBSERVATIONS

Psychiatry’s

Inevitable Hubris

Can clinicians help their patients

even in the absence of certainty?

I

t’s 3 P.M. on a Saturday in March, and I’m work-

ing at Silver Hill Hospital. As the on-duty doctor,

my job is to admit new patients and to work

with the other staff to make sure that everything

goes smoothly.

I’m about to see a young patient I’ll call Adrian.* I

glance in the glass-paned waiting room and notice

Adrian sitting on the sofa. Their parents are also in

the room (I’m using gender-neutral names and pro-

nouns for the patients in this essay, as the author’s

note at the bottom explains), standing with con-

cerned looks on their faces.

A few minutes later, I meet with Adrian, who

turns out to be a pleasant college student. They’ve

been feeling anxious and depressed and, in addi-

tion to worsening paranoid thoughts, is thinking

about suicide.

Each patient is uniquely complex. I have never

seen two identical patients: even within the same

family, even among twins, patients are unique. Each

patient’s history and symptoms, brain and genes,

hopes and fears differ, which is one reason why

psychiatry is so difficult.

I need to figure out how to help Adrian. To do

this, I need to reduce their complexity into some-

thing cognitively manageable, into something I can

understand. The way I (and all clinicians) do this is

to look for patterns: common symptoms and trends

that help me understand what’s going on and sug-

gest a type of treatment.

A previous clinician had diagnosed Adrian with

bipolar disorder, which means that the clinician had

seen a particular pattern of symptoms and, accord-

ingly, had begun them on a specific medication

regimen. I sense a similar pattern as we discuss

periods of mania and depression and, more recent-

ly, suicidality. We finish our conversation and return

to the waiting room.

Adrian’s parents are now sitting on the couch.

The mother smiles, while the father looks deep in

thought, staring out the window.

I ask them if they have any questions and Adri- GETTY IMAGES

Daniel Barron is a resident psychiatrist at Yale

University. As a member of Yale's neuroscience

research training program, he is helping to develop

biomarkers for brain disease.

Opinion