Winter 2012
Letters to the Editor

The DSM-5 represents the “medicalization” of psychology, but problems with the mind doesn’t fit into easy categories

Patients First
Prof. Edward Shorter’s views expressed in “Mind Games” (Autumn 2011) emphasize the medicalization of psychiatry, but fail to recognize how mental-health professionals promote positive outcomes through listening to patients. As a nurse practitioner on a psychiatry team in a busy urban hospital, I believe it is important for patient care to consider both the traditional biomedical model as well as a contemporary holistic framework.

Health is influenced by biological, psychological and social factors: a patient is a person, and not simply a product of a diagnostic label. Prof. Shorter’s stance mistakenly overlooks the contributions of psychotherapy made by psychiatrists. Research has demonstrated that major depression is more effectively treated with a combination of medication and psychotherapy than with only one of these interventions. Psychiatrists, nurses, nurse practitioners and allied health professionals with specialized training in psychotherapy are well positioned to promote mental-health patients’ outcomes. Moving away from a “cure-only” paradigm will enhance the care of our patients, and, more importantly, their ability to achieve more accessible and effective mental-health treatment.

Brock Cooper
MN 2010, Toronto

The Poetry of Mood

Prof. Edward Shorter’s views on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) are spot-on. When I was taking the Licentiate of the Medical Council of Canada, as a clinical fellow at the Banting and Best Institute in 1985, I learned the DSM classifications like everyone else.

Now, after many years of clinical practice, I tend not to think in terms of the 265 psychiatric disorders, but of something closer to poetry. I find poetry, with its resonances and implied meanings and moods, more nearly captures a patient’s condition.

Sad: the heart sighs as the head
has its way.
Mad: the head shakes as the
heart holds sway.
Bad: the conscience crumbles
as vice turns to folly.
Glad: the voice sings – but too
loud and too jolly!

Graham J.C. Smelt
Yorkshire, England

Good Thinking

David Naylor’s “President’s Message” is the first page I read in every issue of U of T Magazine. His most recent message – particularly one sentence in the last paragraph – succinctly defines what a university education should impart to every student: “We can . . . provide an environment that helps our students learn to think more effectively – not just in their time with us, but for the rest of their lives.”

Thank you, President Naylor, for this clear statement of purpose for a university. Teaching students effective thinking – prior to taking action – will bring dramatic results as they apply their talents to solving such important issues as global warming and unsustainable population growth. Making this a strategic thrust of the university’s teaching will no doubt make U of T the world’s number 1 institution of higher learning.

Richard M. Clarke
BASc 1954, Westport, Connecticut

Who’s Watching?
I admire the work being done by PhD criminology student Alexandra Lysova, who is studying the extent to which men and women initiate domestic violence (“Always the Victim?” Autumn 2011). But I am puzzled by the article’s final sentence: “Lysova hopes that once this is better understood, more can be done – by psychologists, police officers and intimate partners themselves – to avert intimate partner violence in the first place.”

While it’s reasonable to suppose that adult men and women who hurt each other might benefit by becoming more self-aware about why they do so, it is hard to see how psychologists and police – outside of actually living in disturbed households – can play any meaningful role in a process that plays out in private. In Orwell’s 1984, every house has a surveillance camera that can never be switched off, but none of us lives in a novel – or would want to.

Geoff Rytell
BEd 1975 OISE, Toronto

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