FACING THE UNSEEN

A psychiatrist’s life in the medical trenches, attempting to bring the study of the mind to general practice.

“Psychiatrists…are on the margins,” writes Tweedy, author of Black Man in a White Coat. Much of medicine is quantifiable, but psychiatry is situated “primarily in the descriptive realm anchored in clinical experience and research.” This subjective element has pushed the practice to the edges, with the result, writes the author, that patients with mental health issues, substance use disorders, and the like are often hard-pressed to find adequate treatment: “When a system marginalizes mental health, defining it as something alien and less important than physical health, patients pay the price.” Patients sometimes do so willingly, refusing to take insulin to treat diabetes, thinking about suicide, and the like; Tweedy’s narrative is punctuated by anecdotes telling as much. More often, however, the problem is systemic: Although all doctors learn about depression, anxiety disorders, substance abuse (or misuse, in Tweedy’s formulation), their education is shallow. The result is that “patients bring to their primary care providers and other medical specialists every form of overlapping mental and physical distress, and these doctors too often don’t recognize the mental health issues or don’t know how to begin treating them.” Fortunately, writes the author, a doctrinal shift is building, with doctors and patients alike increasingly inclined to examine mental health issues. That, in turn, comes at some emotional cost to doctors, already overburdened in a deeply flawed system of health care delivery. Tweedy is no exception; as he writes, “Becoming a doctor hadn’t made me better at dealing with sickness and death; if anything, the lessons from medical school, internship year, and early psychiatry training framed them as things to fear.”

A charged, earnest argument for relaxing the distinction between body and mind in the treatment of both.