The Decline of Language – Based Psychiatry

Originally published by ThinkerMedia: on July 4, 2013

Report from the field: This personal chronicle of one doctor’s recent journeys into some corners of his profession, currently rarely noticed by most colleagues and the public, illuminates issues now in the news with grave implications for all our futures. Some solutions to the basic conflict between the need to create billable records and the delivery of competent language-based psychiatric care are offered, including development of IT systems.

In the popular mind, mental hospitals may be pictured as gracious rural spas where gentle platitudes and long rests restore people; or as snake pits filled with agitated, violent, cross-eyed, drooling people and deranged sadistic nurses with poor dentition and doctors with thick accents tugging patients into canvas straight jackets; or as callous, filthy insane asylums dispensing punitive electric shocks and bizarre mind-destroying destroying drugs. IMHO these images often mostly reflect common fears we all instinctively harbor about unlucky people with troubled minds and the hospitals where we hide them. We are also often creeped out by their strange caregivers and bearded humorless doctors, who must obviously also be somewhat odd themselves to actually choose to spend professional lives so close to them.

So OK, I am one of those doctors, well into my career, but there is absolutely nothing strange nor odd about me, and no beard, either. My recent journey into modern psych hospitals started like many today: I needed the income, so I was lucky to find several opportunities as an hourly temp. I was quickly placed in a succession of private Behavioral Health and public state hospitals, that sought psychiatrists. I also spent some months in a well-regarded outpatient family service agency. These seemingly agreeable settings and the locum tenens (temporary covering doctor) arrangements were new to me.

But I found my journey more novel and difficult to understand than I expected, with some realities as appalling as the popular stereotypes, yet with other aspects amazingly and wonderfully inspiring. The whole journey took me some time to sort out, but I can now begin to describe what I saw and what I did, much as a memoir, punctuated by personal comments in italics. My essay concludes with reflections and a personal note. Reader please note: From time to time, I may amend or edit this essay.


I made the following discoveries during recent immersive roles as a temporary substitute physician. In three adult inpatient units in hospitals in urban areas, I served several months for 10-40 hours weekly, taking over care already started by others or admitting new folks, and covering pediatrics, emergency rooms, drug rehab, medical consultation, and adolescent services nights and days. In a family agency, I spent about three hours a week as a child and adolescent psychiatrist. And so I came to care for hundreds of people of all ages, individuals, families, and staffs, and became intimately familiar with their experiences.

My professional standards are based on fortunately superb education and training, decades of successful and fulfilling psychiatric practice in many settings, including original widely cited published research, teaching and board certifications and many stints as a board examiner in adult and in child and adolescent psychiatry all over the US. I view patients as ordinary people doing their best to cope with neurobiological illnesses affecting their minds and dealing with the enormous stresses of being in a psychiatric facility (or currently,”Behavioral Health” unit, whatever that means) at the same time.

I set the bar pretty high because I believe doctors owe that to their patients. Giving poor care is an ultimate act of cruelty and disrespect when good care can reasonably be given. When it comes to compromising and shortcutting patient care because of selfish self interest, incompetence, or sloppiness, I am known to typically hold licensed professionals and institutions to non-negotiable standards, especially when they know or should know…


Article by Eitan ‘Dr. S®’ Schwarz, MD

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