I was thinking of writing about the future of Psychiatry. Surprisingly, Ajeesh has raised this issue in his reply to the post on "Many face of love". (It should have been Many faces). He writes that Psyhcology and psychiatry may be taken over by neurology in future. I have heard the same arguments from many other doctors, mostly neurologists and internal medicine specialists. Theoretically it sounds natural as neurology is THE medical speciality dealing with brain. But there are a few issues in practice.
The incidence of major psychiatric disorders are much higher compared to the pure 'neurological' disorders.The most common neurological condition is epilepsy. This is being treated by psychiatrists, internists, pediatricians and the GP without much problem. The skill sets needed to practice hard core neurology is different from those needed to practise psychiatry. In neurology things are more concrete and precise. In the field of mental health, most of the disorder are still vague and abstract. Enormous verbal skills are needed to listen to the patient, and offer psychological treatments. A neurologist may consider all this including the time spent for establishment of rapport as a waste. Of course, a neurologist or any other doctor with the right inclination can practice psychiatry well. Psychiatrists will outnumber neurologists in most countries.
I view things in a different light. The psychotic disorders need mostly drugs, some education about how to handle the illness (for the patient) and education about how to handle the patient (for the relative). To some extent this can be done by any willing doctor with reasonable expertise in psycho pharmacology, if there is a good social worker to help him with the education part. Usually most doctors are uncomfortable with these patients as they are prone to violence and cause disruption in their respectable consultation rooms. This is why they avoid seeing such patients.
The most common mental disorders belong to the category of neurotic disorders (anxiety, somatization and minor depressions). Here more intensive psychotherapy is needed. Hence a mental health professional is needed. My view is that these disorders are best handled by a good G P with adequate training.
If psychiatry is going to be taken over by another speciality, I wish this will be by the speciality of General Practice. This is more beneficial for the persons with the most common forms of mental illnesses. They can approach the GP without fear of stigma. If the GP has some training and is willing to spend some time, he can manage such cases properly. Thus a G P who is willing, can be trained to manage most mental illnesses and reduce the stigma. Only the most difficult cases and those with multiple diagnoses, need to be send to Psychiatrists. In fact this is true of most specialities. A good G P with adequate training can at least rule out serious conditions and refer only those cases needing real specialist care. It is sad that the speciality of G P is not developed in our country. I do not know why this is so. But I am sure this is one important step towards reducing health care costs. The general practitioners should outnumber the total of all the specialists together in a country.
I hope at least some of my friends and colleagues will respond to my arguments.

http://www.psychiatryforpublic.blogspot.com/