Psychiatry 2.0 NEW!

Psychiatry 2.0: Experiencing psychiatry’s new challenges together

Helen M. Farrell, MD

“It is beyond a doubt that all our knowledge establishing a start-up company for health begins with experience.” care, working on policy reform, and innovat- - Immanuel Kant ing new approaches to achieve social justice.

edicine, a highly experiential pro- fession, is constantly evolving. The A history of challenge and change Mconsistency of change and the psy- Developing variables and expectations in Helen M. Farrell, MD chiatrist’s inherent wonder offers a paradox- this Millennial Age makes it an exciting time Department Editor ical sense of comfort and conundrum. for psychiatrists to explore, adapt, and lead As students, we look to our predecessors, into the future. Fortunately, the field has had associations, and peers to master concepts ample practice with challenge and changes. both concrete and abstract. And once we Social constructs of how individuals with achieve competence at understanding mech- mental illness were treated altered with anisms, applying biopsychosocial formula- William Battie, an English physician whose tions, and effectively teaching what we’ve 1758 Treatise on Madness called for treat- learned—everything changes! ments to be utilized on rich and poor men- We journey through a new era of medi- tal patients alike in asylums.1 Remember the cine together. With burgeoning technology, days of chaining patients to bedposts on psy- intense politics, and confounding social chiatric wards? Of course not! Such archaic media, we are undergoing new applica- practices thankfully disappeared, due in tions, hurdles to health care, and personal large part to French physician Philippe exposure to extremes that have never been Pinel. Patient care has evolved to encompass experienced before. The landscape of psychi- empathy, rights, and dignity.2 atric practice is changing. Its transformation German physician Johann Christian Reil, inherently challenges our existing practices who coined the term “psychiatry” more than and standards. 200 years ago, asserted that mental illness It wasn’t too long ago that classroom fod- should be treated by the most highly quali- 3 DO YOU HAVE der included how to deal with seeing your fied physicians. Such thinking seems obvi- A QUESTION OR patient at a cocktail party. Contemporary ous in 2018, but before Reil, the mental and CONCERN ABOUT discussions are more likely to address the physical states were seen as unrelated. THE FUTURE OF PSYCHIATRY? patient who follows you on Twitter (and Modern psychiatry has certainly come ? whom you follow back). Long ago are the a long way.4 We recognize mental health as ▶ Contact Dr. Farrell at days of educating students through a didac- being essential to overall health. Medications [email protected] tic model. Learning now occurs in collab- ▶ Include your name, address, Dr. Farrell is Lecturer, Harvard Medical School, and Psychiatrist, and practice location orative group settings with a focus on the Beth Israel Deaconess Medical Center, Boston, Massachusetts. practical and hands-on experience. Budding Disclosure psychiatrists are interested these days in The author reports no financial relationships with any company Current Psychiatry whose products are mentioned in this article or with manufacturers 38 March 2018 talking about setting up their own apps, of competing products. Psychiatry 2.0

have evolved beyond lithium, chlorproma- better yet, capitalizing on our knowledge, zine, and fluoxetine. We now have quar- experience, and hopes: What else can we do? terly injectable antipsychotics and pills that The essential interaction between mental, patients can swallow and actually be moni- chemical, and physical domains has given tored by their clinicians!4 rise to psychiatry and its many subspecial- The American Psychiatric Association ties. Among them is forensic psychiatry, (APA) has published multiple iterations which deals with the overlap of mental of the Diagnostic and Statistical Manual health and legal matters.6 of Mental Disorders since its inception in While often recognized for its relation 1968.5 And with those revisions have come to criminology, forensic psychiatry encom- changes that most contemporary colleagues passes the entirety of legal mental health could only describe as self-evident—such as matters.7 These are things that the daily prac- the declassification of homosexuality as a titioner faces on a routine basis. Clinical Point mental disorder in 1973. My mentor, Dr. Douglas Mossman, author Despite these advances and the advent of Current Psychiatry’s Malpractice The transformation of the Mental Health Parity Act of 2008, Rx department, passed away on January of psychiatry experience has shown us that some things 4, 2018. Dr. Mossman emphasized to his inherently have seen little progress. Reil, who saw a trainees that above all else, understanding challenges our nexus between mental and physical health, forensic matters simply makes one a better existing practices launched an anti-stigma campaign more psychiatrist. Legal matters and psychiatry and standards than 200 years ago. This begs a question go hand-in-hand. Involuntary hospital- to colleagues: How far have we come? Or ization, Health Insurance Portability and Psychiatry 2.0

Accountability Act violations, licensure about where the field is going, and how it boards, telepsychiatry, guardianship, and will likely change. In its quarterly publica- informed consent are just a few areas that tion, Psychiatry 2.0 will explore a diverse psychiatrists interface with routinely. range of topics, including technology, social media, stigma, social justice, and politics. A new department for a new era The world is changing very rapidly, and we face new dilemmas in the midst of trying In memoriam: to uphold our duties to patients and the Douglas Mossman, MD profession. There are emerging domains In my role as Department Editor, I find myself that psychiatrists will experience for the already reflecting on the experience, wisdom, Clinical Point first time—leaving us with more questions compassion, encouragement, and legacy than direction. And that is the impetus for of Dr. Mossman. A distinguished psychia- Psychiatry 2.0 will this new department, Psychiatry 2.0. trist, gifted musician, and inspiring mentor explore technology, The ever-evolving Internet opens doors and academician, Dr. Mossman embodied social media, stigma, for psychiatrists to access and educate a knowledge, creativity, and devotion. social justice, and larger audience. It also provides a tool for Among Dr. Mossman’s many accolades, politics psychiatrists to keep a web-based pres- including more than 180 authored publica- ence, something essential for competitive tions, he was recipient of the Guttmacher business practices to stay relevant. We Award (2008, the APA) and Golden Apple are languishing in a political climate that (2017, the American Academy of Psychiatry challenges our sense of duty to the public, and Law). Dr. Mossman was further known which often is in contrast with the ethical to many as a mentor and friend. He was principles of our association. Technology generous with his experiences as a highly also poses problems, whether it’s track- accomplished physician and thoughtful in ing our patients through the pills they his teachings and publications, leaving an ingest, following them on an app, or rely- enduring legacy. ing on data from wearable devices in lieu Remembering Dr. Mossman’s sage voice of a patient’s report. All of this suggests a and articulate writings will be essential to potential for progress as well as problems. moving forward in this modern age of psy- The goal of Psychiatry 2.0 is to expe- chiatry, as we experience new dilemmas rience new challenges together. As and opportunities. Department Editor, I will cover an array of cutting-edge and controversial top- References 1. Morris A. William Battie’s Treatise on Madness (1758) and ics. Continuing with Dr. Mossman’s John Monro’s remarks on Dr Battie’s Treatise (1758). Br J teachings—that forensic understanding Psychiatry. 2008;192(4):257. 2. Scull A. Moral treatment reconsidered. Social order/ enhances the clinical practice—this depart- mental disorder: Anglo-American psychiatry in historical perspective. Berkeley, CA: University of California Press; ment will routinely combine evidence- 1986;81-95. based information with legal concepts. 3. Marneros A. Psychiatry’s 200th birthday. Br J Psychiatry. Each article in Psychiatry 2.0 will be 2008;193(1):1-3. Discuss this article at 4. Cade JF. Lithium salts in the treatment of psychotic www.facebook.com/ divided into 3 parts, focusing on a clini- excitement. Med J Aust. 1949;2(10):349-352. CurrentPsychiatry cian’s dilemma, a duty, and a discus- 5. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Publishing; sion. The dilemma will be relatable to the 2013. clinician in everyday practice. A practi- 6. Gold LH. Rediscovering forensic psychiatry. The American Psychiatric Publishing Textbook of Forensic Psychiatry. cal and evidence-based approach will be Simon RI, Gold LH, eds. Washington, DC: American taken to expound upon our duty as physi- Psychiatric Publishing; 2004;3-36. Current Psychiatry 7. Gutheil TG. The history of forensic psychiatry. J Am Acad 40 March 2018 cians. And finally, there will be discussion Psychiatry Law. 2005;33(2):259-262.