Study Diseases or Cases?

From 1 Boring Old Man:

In another Residency in Psychiatry in the mid-1970s, there was a different way of learning. There were lectures and lots of articles, but they came from reading lists, and some were pretty old - "classics." There were lots of conferences where a Staff Psychiatrist interviewed a patient or supervisions where we presented our own cases. It was more about single cases rather than single diseases. I spent a lot more time in the library reading books rather than reading this month’s journals. It seemed like we stayed on the trailing edge instead of jumping at new things like in Internal Medicine. It fit better with the way I naturally think and I liked it.

Though I'm not a medical doctor, this reminded me of my graduate school training.  Yes, we read books and articles about "conditions," but for the most part we used this material to learn about different theoretical approaches to understanding and treating people without comparing them to diagnostic templates based upon symptoms.  And keeping up with the leading edge was far less important than developing depth in areas where depth already existed in the literature.

We spent maybe two classes (not courses, classes) in graduate school going through the DSM III and we didn't have to memorize any of it.  The classes were merely intended to familiarize us with the DSM.  At this point, I only have a pocket DSM IV-TR.  Rarely do I open it.

Away from the books and articles, the actual clinical training focused intensely on single cases.  We spent a great deal of time learning to listen, formulate and intervene without concern for diagnostic categories. The format for single-case presentations varied with the supervisor, but I learned from all of them.

There is much more to 1BOM's post than what I quoted above.  It's a good read for anyone interested in the radical transformation of psychiatry since the 1960s.  You can check it out here.

Comments

[Novalis]

It brings up the interesting question of whether psychology is closer to the sciences or humanities. Science and technology are cumulative. Cardiology is objectively better than the cardiology of fifty years ago.

The arts and philosophy do not "improve," they merely grow in extent and complexity over time.

Obviously psychotherapy is not a monolithic entity, but one can ask whether psychotherapy as practiced today is objectively better than that practiced fifty years ago. (I don't know the answer).

[Dr X]

All valid points. When we're talking about cognitive-behavioral therapy, I think we can identify more effective treatments that have emerged--the cognitive component itself, for example, but in the other major schools, the growth often looks more like growth in philosophy and the arts.

Testing is more science-y, but still, the 'facts' are soft, having to do with correlations and predictions that are thought to represent certain mental constructs.

[Heisenberg's Eyes]

Medicine and Psychology are way out of my league, but I like the TV medical series, HOUSE. I suppose I like the idea of the diagnostic sleuth; the medical maverick whose own neuroses and addiction seem to drive his improbable genius. I know---it is only TV fiction. But the anti-hero, Gregory House, appears to thrive on enigmas. Cases propel his unorthodoxy, not the diseases themselves. He is a fictional oddball---do these oddballs exist in the real world? I have heard they do, but have never met one---yet.