While organizing the WPA section on Personalized Psychiatry some reflections come to my mind. In our daily clinical activity we think like personalized psychiatrists, and even in more general, we think in a personalized way. We have several experiences in a field, we see, for example, many patients, we read books, we discuss with collegues and we consequently build models. We create models for everything: patients, politics, cooking, training and so on. Personal experiences shapes our models and we use these models in our daily activities.
This is good, since it allows us to avoid loosing time in analyzing everything in details and helps us to use our success/error continuous experience to quicken decisions. We listen to our “somatic marker”, that physical sensation that tells us is a thing is good or bad.
The big risk of this way of proceeding is that, while models are becoming stronger with experience, we believe they represent the truth and, slowly in a subtle way, only experiences that confirm our models are considered and those who disconfirm it is somehow refused (it is not really the same thing, it something of different, there should be a mistake and so on): in this way our big ego and the transformation of experiential models in beliefs will bring us to lose critical thinking.
Science, as candle in the dark (Carl Sagan), keeps our mind open to changes and helps to disconfirm our models, improving the possibility to build new models more near reality. Scientific methodology and research allows us to test ideas and models, helps to develop critical thinking and makes us all humble remembering us that we are not gods.
We need to think like a scientist and to reach this goal we need to become scientists. Thus only doing scientific research, being involving is research activity will allow to became fully aware on the role of science for our never ending process of learning and the weakness of our cognitive ability to build models.
In psychiatry, since brain and mind are the most tough enigma that science is trying to disentangle, the distance between our experience as personalized psychiatrists and the what science is able to explain in still big, to many of us choose to follow our models and give up the effort to be continuously updates, being persuaded that research is understanding only a standard model of patients that is far away from real patients, unable to capture their complexity, the complexity of a human being. Unfortunately this is often true.
Personalized medicine, allowed to look for specific anti-cancer drugs for specific patients with a unique genetic background allowing a incredible improvement of clinical responses. The same street might be followed by personalized medicine in psychiatry. No more “mean” patients, no more standardized patients, but each person with a mental disorder will be considered within his genetics, his child experiences, his temperament, his psychophysiology, his cognitive style and more personal features as possible to build up and understand each person within his personal life. The promise of personalized psychiatry is to build a science that will disentangle individual complexity to find out the best personal therapy for each patient helping us to become better personalized psychiatrists.
Giampaolo Perna,, Section’s Chair