Robert C. Smith, MD, MACP - "Has Medicine Lost Its Mind?" - Marshall Chin, MD, MPH

Robert C. Smith, MD will discuss Has Medicine Lost Its Mind?: Why Our Mental Health System Is Failing Us and What Should Be Done to Cure It. He will be joined in conversation with Marshall Chin, MD, MPH. A Q&A and signing will follow the discussion. 

At the Co-op.

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About the Book: HAS MEDICINE LOST ITS MIND? reviews that the public does not understand how abysmal its mental health care is, that medicine refuses to improve it, or that it can direct its politicians to require change. The book details what Americans need to know to activate them to take control.

 First, even though mental illness is the most common health condition in the US, most do not know that only 25 percent of patients receive any care; compare this to 70 percent of physical disease patients receiving care.

Second, their compromised mental health care results from medicine failing to train enough mental health professionals (psychiatrists conduct only 12 percent of care) and providing almost no training for the primary care clinicians who, by default, conduct over 75 percent of mental health care. US citizens will be shocked to learn that only 2 percent of physicians’ training is devoted to mental health care. This points to the surprisingly unidentified solution to the mental health crisis: train the doctors who provide the care and train more mental health professionals.

Third, few understand why medicine would resist such obvious solutions. From the 16th and 17th centuries Scientific Revolution, the theory of the “mind-body split” has guided medicine—the mind, soul, and spirit the church’s domain, the physical body and its diseases from the neck down belonging to medicine. That made mental disorders and other mind issues, such as emotions, off base. Even though mental health care has long since been medicine’s responsibility, medicine has never shown interest in mental health and patients’ other psychological and social issues. Imbued with the mind-body duality, it sees no need to train physicians; as an afterthought, it trains a few psychiatrists. While guidance by the mind-body split led to massive physical health care advances in the last 75 years (life survival doubled), its exclusion of patients’ psychological and social lives now renders it obsolete for the country’s most common problem—mental illnesses.

Finally, the public does not realize that medicine flouts modern scientific principles. Only medicine, among all sciences, fails to follow modern scientific theory, a systems view of life. It requires that all parts of a problem and their interactions be considered rather than addressing just one aspect, as medicine does with its narrow disease focus. Worse yet, medicine repeatedly ignores the systems model proposed for it in the 1970s, the biopsychosocial model. This demonstrably superior, research-based model links the patient’s physical disease (biological) features with their psychological and social parts, fully integrating mental health care with medical care. Implementing the model would guarantee that patients access to, and quality of mental health matched that for physical disease care.

HAS MEDICINE LOST ITS MIND? then describes exactly how an informed populace can pressure medicine to change politically. And it shows exactly what to do, once politicians work with medicine to effect the necessary paradigm change.

About the Author: Robert C. Smith, MD, MACP is a University Distinguished Professor of Medicine and Psychiatry Emeritus at Michigan State University. With many publications, awards, and strong grant support, he has been involved in teaching and research in patient-centered communication and primary care mental health since 1985.

He and his colleagues defined the first evidence-based patient-centered interview, now published in a popular interviewing textbook, Smith’s Patient-Centered Interviewing: An Evidence-Based Method (4th edition, McGraw Hill, 2018). Dr. Smith’s group also identified the first evidence-based method to teach primary care clinicians to diagnose and treat mental health and substance use problems. Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting (McGraw Hill 2019) resulted. Educators use both books to teach medical, nursing, and other health care students in the USA and abroad.

Dr. Smith’s new trade book—Has Medicine Lost Its Mind?—will be published by Prometheus Books in March 2025. Fed up with medicine’s resistance to improving training in mental health care, Dr. Smith decided to take the problem to the public. The book addresses the poor state of mental health care in the US, why medicine ignores it, what needs to be done, and how to accomplish this politically. Details are available on his website: https://www.robertcsmithmd.com/.

About the Interlocutor: Marshall Chin, MD, MPH, Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics at the University of Chicago, is a practicing general internist and health services researcher who has dedicated his career to advancing health equity through interventions at individual, organizational, community, and policy levels. Dr. Chin received the Society of General Internal Medicine's 2024 Robert J. Glaser Award for outstanding contributions to research, education, leadership, and mentoring in generalism in medicine, and was elected to the National Academy of Medicine in 2017