I deeply appreciate Ann-Louise Silver's letter to the New York Times (May 30, 2006, D4) making a plea for the value of ongoing dialogue in the treatment of severe mental illness centering on emotional realities and lived experience:

To the Editor: “A Career That Has Mirrored Psychiatry’s Twisting Path” (May 23) nicely depicts my friend and colleague, Tom McGlashan, from Chestnut Lodge. I’ll never forget his Lodge Symposium pronouncement about the “grand Experiment” there: “The data are in; the experiment failed.”

Bud did his results warrant this depiction? Granted, two-thirds of the patients were no better off. But one-third were significantly improved, and one-third of these showed no signs of psychosis. They recovered.

They had careers; many were raising their families successfully. On arrival they were among the world’s sickest patients.

The Lodge shifted to relying on medications. These agents so dulled my patients’ emotions that they couldn’t fully commit to work or relationships. While we wait for answers from science, shouldn’t we still meet regularly with these bereft and lonely people, reaching out to them even if only one in three shows clear improvement or recovery?”

She is in line with a recent call by psychiatric-geneticist Kendler (2005). Kendler, in an article published in the American Journal of Psychiatry delineating a philosophical structure for psychiatry, underscored the importance of attending to subjective, first-person experiences. He noted:

“Our central goal as a medical discipline is the alleviation of the human suffering that results from dysfunctional alterations in certain domains of first-person, subjective experience...The clinical work of psychiatry constantly requires us to assess and interpret the first-person reports of our patients...While we want to take advantage of the many advances in the neurosciences and molecular biology, this cannot be done at the expense of abandoning our grounding in the world of human mental suffering” (pp.433-434).

Gabbard and Freedman (2006), in a recent editorial published in the American Journal of Psychiatry (G. O. Gabbard & R. Freedman Am J Psychiatry 163:2, pp. 182-184), referred to Harvard social psychiatrist Leon Eisenberg’s cautionary comments on the growing neurogenetic and neurobiological reductionism in our field. They noted:

“These directions recall Leon Eisenberg’s prediction that when the ultimate neurobiological treatment for schizophrenia is someday devised and everyone is marveling over the results on the computer monitor, there may be only one psychiatrist left who will remember to ask the patient, ‘How do you feel’ (p. 183).

Brian Koehler
New York University