Leo Sher, M.D.

Today, we publish an interview with an eminent European psychiatrist, Dr. Amanda Rodríguez Urrutia.

Amanda Rodríguez Urrutia, M.D., Ph.D. is Senior Psychiatrist, Psychiatry Department, Vall d’Hebron University Hospital, Principal Investigator, Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute, and Associate Professor, Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain.

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

Amanda Rodríguez Urrutia: In my view, the main challenges for psychiatry today are twofold: re-establishing the limits of clinical psychiatry and symptomatic integration into complex models. For the first problem, we must re-establish the basis of what psychiatry is, abandoning the medicalisation of everyday problems and the psychiatrization of life. It must be remembered that the psychiatrist is the expert in the diagnosis and treatment of psychopathology, not a “mental health expert,” which is a diffuse concept that escapes from what should be our job as doctors. In the second challenge, we must establish a new model that integrates symptoms with certain aetiologies while integrating the psychological, the social and the spiritual in complex models as an embodied mind. Biological simplification does not give the vision that a 21st century medicine should have, one that incorporates the exposome and the spiritual sphere (as advocated by some third-generation therapies).

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

Amanda Rodríguez Urrutia: I see the psychiatry of the future as a specialty based on a complex model, capable of simultaneously incorporating all spheres that comprise the human being (biological, psychological, social, and spiritual), understanding that psychopathological symptoms are the product of all these interrelated areas. To achieve this, we should abandon the current statistical classification system, and we should build a model that can construct a system based on symptoms and etiological correlates in the body (not just the brain) while simultaneously integrating them into a context. Dualism, as in the rest of medicine, should be eliminated from psychiatry, understanding that psychopathology is the product of a sick body, not just a brain one. For this great challenge, we must integrate other experts such as mathematicians, biophysicians, computer scientists, philosophers, etc., who can transcend current simplistic models.

Leo Sher: What needs to be done to reduce the lack of resources in psychiatry?

Amanda Rodríguez Urrutia: In a society with difficulties in setting limits, psychiatry needs to clearly define its necessary limits. Once established, the resources of other healthcare professionals, for example in emergency settings (e.g., social work, nursing, or psychology), must be increased to meet societies ever-increasing demand for mental health care, and psychiatrists must focus on strictly psychopathological issues. This means that psychiatrists must address the disorder, making the system more efficient. This could also reduce the exhaustion and burnout of psychiatrists, who are forced to address aspects of “mental health” or social problems that are beyond their medical training and capacity to resolve.