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Letters to the Editor |

When Psychiatry Is Not Psychiatry

Arch Gen Psychiatry. 1998;55(2):182-183. doi:.
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In "Managed Care and the Future of Psychiatry" (1997;54:201-204), Detre and McDonald suggest that psychiatry and neurology merge to create a new specialty. Their narrowly neurobiological approach suggests that the wolves of ideology are now cloaking themselves in the benign sheepskin of managed care.1 The new practitioner would be called a "clinical neuroscientist," whose skills would not include psychotherapy.

Indeed, in their polemic, Detre and McDonald dismiss out of hand so much of what currently defines psychiatry—communicative, diagnostic, and therapeutic skills—that we scarcely recognize our field in this brave new world of managed care. No wonder we would be called clinical neuroscientists: we would no longer be psychiatrists. This approach seems more a product of than an answer to managed care. And even the captains of managed care, although equating a psychiatrist to be something akin to an internist plus a social worker, have rarely, if ever, been so thoroughly disparaging of our specialty. We share the reservations voiced by Olson, Weissman, Gottlieb, and Sharfstein in their commentaries.

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