How psychiatrists think

Photo by Flickr user Felipe Ven√¢ncio. Click for sourceAn article just published in Advances in Psychiatric Treatment called ‘How Psychiatrists Think’ discusses how mental health physicians are susceptible to cognitive biases and how it’s possible to reduce the chance of error.

The article was inspired by a Jerome Groopman book we discussed in 2007 called How Doctors Think in which he tackles cognitive errors in medicine but omitted psychiatrists because he felt their thinking process were too complex.

Two psychiatrists, Niall Crumlish and Brendan D. Kelly, decided to take this as a challenge and wrote an article that applied the cognitive science of ‘heuristics‘ to psychiatric reasoning.

Heuristics are mental short-cuts we make to deal with everyday reasoning, and work made famous by Nobel-prize winning psychologist Daniel Kahneman has shown that these short cuts often lead us astray.

For example, the availability heuristic is where we judge likelihood on how easily something comes to mind – perhaps nudging psychiatrists towards incorrectly diagnosing a rare disorder if they’ve just been to a recent discussion on it.

The authors make the point that although they discuss how general reasoning biases applies equally to psychiatric decision-making, almost no experimental work has been done specifically on psychiatrists, meaning we’re still not exactly sure whether there are any speciality-specific mental errors that might regularly crop up.

However, they do note that there’s good evidence that being aware of these biases helps people overcome them.

Their article is a brief guide to some of the most common cognitive biases in us all, with an interesting insight into psychiatric thinking.

Link to ‘How psychiatrists think’.
Link to DOI entry for same.

2 thoughts on “How psychiatrists think”

  1. Great Post ! Paul McHugh’s book, “The Mind has Mountains” covers some of this topic and other historical biases in psychiatry too.

  2. I read a shorter article by Groopman on how doctors think. He pointed out that if a doctor had just seen or heard about a rare disease he would tend to mistakenly see it in another case. Groopman didn’t include psychiatrists because he felt their processes were more complex.
    It seems to me to be quite obvious that psychiatrists are just as subject to distortion and mistakes, probably more that other doctors. To take an example I know well, Freud and the Oedipus Complex. Freud was absolutely convinced of the murderous hatred sons held toward fathers. In his life, he was threatened by defectors and saw betrayal everywhere, a self-fulfilling perception. He cast his brilliant disciple, Viktor Tausk as Oedipus the potential fatherkiller–once he’d done that,it was easy to misinterpret anything Tausk did. I built my novel Vienna Triangle around the tragedy brought on by this kind of thinking. But I think similar things must go on all the time in a profession where theory is so bitterly fought over and key tenants acted out by its practioners.
    I’ve written about this in my blog
    if you’d like to respond.

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