Leo Sher, M.D.

Today, we publish an interview with an eminent European psychiatrist, Dr. Zoltan Rihmer.

Zoltan Rihmer, M.D., Ph.D., D.Sc. is Professor of Psychiatry at the Department of Psychiatry and Psychotherapy, Semmelweis University and at the National Institute for Psychiatry and Addictions, Budapest, Hungary. His main clinical and research interest is clinical, biological and psycho-social aspects of mood and anxiety disorders and prediction and prevention of suicide. Professor Rihmer is a member of many Hungarian and international scientific organizations, and the recipient of several Hungarian and international scientific awards.

Leo Sher: What is the most important problem in contemporary psychiatry?

Zoltan Rihmer: Unfortunately, there is a big gap between our present theoretical knowledge and the everyday practice, because the former is not reflected enough in treating patients. An example for this is the fact that the rate of patients with prior medical contact among suicide victims is still too high. Psychiatrists should combine their best and most recent psychopathological knowledge with the results of rating-scale based papers on treatment-response studies. It is not enough for someone to know the DSM/ICD diagnostic criteria; up-to date psychopathology knowledge should also be used for implementing diagnostic criteria successfully.

Leo Sher: What needs to be done to reduce suicide rates around the world?

Zoltan Rihmer: As about 90% of suicide victims and attempters have at least one (mostly untreated) current major mental disorder, health-care system is crucial in suicide prevention which is much more than to explore the acute suicidal intention. As more than half of suicide victims die by their first suicidal act, using the clinically explorable psychiatric and psycho-social suicide risk factors it is possible to identify the “potentially suicidal person” before the first alarming symptoms and to manage the patient accordingly all over his/her life. However, this ideal target needs a well-developed and widely available healthcare and social system everywhere in the world, but unfortunately, we are very far away from this.

Leo Sher: How do you see the future of psychiatry? 

Zoltan Rihmer: If the community trust in psychiatry will further decrease in the future, psychiatry could not keep its positive role in the society. Since not only the health-care workers are responsible for mental health of the population, leaders of the society should also provide appropriate financial and emotional support for healthcare and social welfare systems. Ironically, the future of psychiatry is a black box for me, therefore I see it as dark and black. I am worried about it. This is my Black Box Warning.