Biomedical Cooptation of the Psychosocial Care and Support Continuum for Severely Distressed Persons

In this issue of Ethical Human Sciences and Services, Lehrman describes his vision, focusing on continuity of care, of a mental health care system for psychosis. His main argument is that the same psychiatrist should treat an individual patient whatever the settings (hospital, community) that the patient shifts through, and that the psychiatrist is the key treating professional and as such should manage and direct care over the continuum. While continuity of psychiatric care is desirable and indeed noncontroversial and feasible, psychiatric services are not central to the care continuum, and its psychiatric control will lead to an even more biomedical orientation in patient care. This would undermine another key aspect of Lehrman's vision: a mental health system focused upon the whole person in interaction with the environment. The history of psychiatry shows that, as a medical specialty, psychiatry will inevitably focus upon the brain rather than the person. Psychiatric care could serve as adjunct to appropriate supports, services, and treatment, but if it determines them, they will merely become a downplayed accessory of biomedical (i.e., psychotropic drug) treatment.