The question posed by the study–Are there psychiatric disorders that help precipitate a stroke?–is an important one. Psychiatrists and neurologists should be working together to either retrospectively or prospectively discover who has strokes.
It seems to me that we should be singling out those who develop arterial sclerosis or other vessel-blocking disorders, testing carotid arteries for blockages, or looking at those who have other evidence of vessel blockage for signs of imminent stroke, weakness, difficulty speaking, etc. Since I obviously am not impressed with the discovery that psychological distress may increase strokes, it means nothing to me. I wouldn't know whom to warn.
In the biopsychosocial world in which we live, a need for greater precision is needed. We analytic types often have been accused of imprecision, guesswork, and flawed theories, and we have, in fact, often lacked the necessary precision that is considered in the biomedical world to be scientific. But as I experience more and more of how the rest of medicine operates, I am amazed by how sloppy others can be in their science! Add to that the institutionalized rudeness of office staff, the lack of concern about the patient's time, and the habitual lack of feedback to the patient and/or the family, and you can begin to understand why I find the misuse of terms and the failure of accurate diagnosis so exasperating.
The use of the anomalous and meaningless word “distress” is obviously one of the nodal points that gets to me. It's worse if you are a physician, because the doctor will often answer my questions with “you know what to do.” If I knew, I wouldn't ask! I assume that he doesn't act the same way with nonphysician patients.
What I'm begging for in this column is a better recognition of the body of knowledge called psychiatry with all of its theories, diagnoses, and treatments. I have resented for decades the stigma against psychiatry practiced by nonpsychiatric physicians, which is passed on by residents to medical students. No matter how hard we fight to erase the stigma, we are stuck with chronic joking and gentle harassment by our colleagues. I believe that much of our thinking is incomprehensible to these men and women who appear to be offended that we seem to know something about how the human mind works and what makes people tick.
I have avoided using the word “castration” in my teaching and scientific talks for years, but today I saw a patient with the residents and students where it was absolutely appropriate. A 56-year-old man with depression and anxiety had severe chronic obstructive pulmonary disease, the result of smoking three packs of cigarettes a day for more than 40 years and drinking two cases of beer a day for decades. Now totally incapacitated, unhappily living with his daughter and son-in-law whom he despises, unable to get out of the house, work or “do” anything, he is depressed, largely because of his unfitness and the death of his wife. Also, he is reliving the death of his mother when he was 7 years old. Today, he is a shadow of his former self: a vibrant husband, father, and construction worker.
This patient is jumping out of his skin to rejoin the living but “doesn't have the energy” and can hardly breathe. Does the pulmonologist, who is recommending a lung transplant, care about any of this, or does he know that his treatment can actually help this man get his life back?
We in psychiatry have to resist glib and often unnecessary research in areas that do not further our work and might start whole new areas of thought that are of no practical use.
Both stroke and depression are important areas for our concern. Knowing the relationship between the two can be helpful to scores of patients. Let's make sure that we don't go along with “scientific” nonsense.