To concede, given the increased effectiveness of other therapies and this pressure on resource use, that psychodynamic and psychoanalytic thinking should not be part of residency training is short-sighted. A capitulation here means producing psychiatrists with limited approaches to the breadth of human psychology and the treatment of mental illness. A psychiatrist must be more than a human embodiment of DSM-IV or a walking therapies manual. A psychiatrist must bring to the appraisal and treatment of a psychiatric problem interest, understanding, and respect for the individuality of human beings. This means an empathic approach with knowledge of motivations and wishes, impulses and fantasies, defenses and resistance, transference and countertransference, and the various manifestations of unconscious mentality that characterize an individual s preoccupations, personality, and symptoms.
Many psychiatric illnesses benefit from combined biological and psychological treatments.
For depressed patients, a psychiatrist who can draw on psychodynamic understanding in addition to the standard psychiatric repertoire is best suited to handle the whole of an individual s suffering and dysfunction, while facilitating residual strengths and adaptive techniques. It is gratifying to see new treatments for conditions such as schizophrenia and manic-depressive disease, which in years past were approached, often unsuccessfully, with psychoanalytic interventions. Psychiatry, as a self-critical profession, constantly renews itself by concluding that disorders such as these are better treated by other methods. Still, there are some conditions, such as the personality disorders, for which no other treatment offers superior therapeutic efficacy. Though some regard personality disorders as a phenomenon undeserving of medical attention, this seems inappropriate given the suffering and dysfunction with which some of these disorders are associated.