What The Heck Is Physiatry?
Most people have heard of psychiatry. But my first and great love is physiatrics, often abbreviated PM&R–spelled out that’s physical medicine and rehabilitation. It’s a fairly new specialty, borne out of the need to care for and rehabilitate soldiers from the Great War of their injuries, including complex facial reconstruction. Physiatrists also took care of children with polio, spastics–an outdated term for someone with cerebral palsy–and today take care of many kinds of people including adults with post-polio syndrome, sufferers of long-COVID syndrome, TBIs, acute musculoskeletal injuries as in sports medicine or dance, spinal cord injuries, and various kinds of strokes.
Where do Physiatrics and Shrinking Heads Differ?
Unlike psychiatry, physiatry does not have a history of deliberately causing disabilities via invasive neurosurgeries like lobotomies, or driving gay men to suicide by pathologizing male homosexuality and “treating” it via chemical castration, which may have contributed to convicted homosexual and computer scientist Alan Turing‘s development of a severe depression and finally suicide by cyanide poisoning. Dr. Turing is responsible for the science that developed the imitation game, which is the same technology that powers the myriad kinds of CAPTCHAs online, with varying degrees of accessibility for low-vision, blind and deaf-blind persons.
Another proposed treatment for male homosexuals back in the day, according to UK publication Attitude, was to lobotomize them.
I suppose a third option was to have gay men individually destroyed with their own Dionysian riots, as in Tennessee Williams‘s 1958 one-act play Suddenly, Last Summer from Garden District. Because even if it does bring his cousin by marriage Catharine Holly a traumatic shock and subsequent institutionalization, the truth will out–after a long, poetic retelling of the murder in the final scenes after injection of a sedative and a fine example of prolonged-exposure therapy. I won’t tell you the ending; you can watch either Elizabeth Taylor (1959) or Natasha Richardson (1993) play the role of one of the greatest tortured Tennessee Williams heroines on stage. Better still, you can read the entire play if you will–it’s only eighty-eight pages!
Lest you think male homosexuals bore the entirety of medicalized and systemic societal homophobia throughout the twentieth century, fear not, my sisters who are sapphic–including the one in my family who is eighteen months younger than I and who got married to the best wife for her life on 7/20 of 2019 (before the pandemic ruined everything, and at nightfall!)–lesbians were institutionalized too, and you can hear or read the transcript of a wonderful 2022 Fresh Air interview between Terry Gross and Hugh Ryan about the House of D, a prison for women near the Stonewall Inn, a gay bar in NYC, New York.
Where Do Psychiatry and Physiatry Intersect?
There’s an excellent episode of This American Life called “The Thing I’m Getting Over” that tells the stories of a physiatric patient and a psychiatric patient. The first patient has a spinal cord injury; the second has an eating disorder. And of course, any patient can have both a physical and psychiatric disability!
Why Make Physiatry a Required Clerkship? Why Take PM&R in Medical School?
At some point, every physician will come to meet a disabled person in clinical practice. They may be walking independently with orthotics; they may have an amputation; they may have had a stroke. They may be living with cerebral palsy or spina bifida. A physician cannot effectively meet the needs of people with disabilities and improve our quality of life and social determinants of health without exposure.
PM&R is the specialty of dreamers. Physiatrists meet patients in a time of trauma or acute pain, and they work to restore function. But it really is the long game, PM&R. If you’re not willing to look at each patient and see what could be in six months, a year, two years, five years–it’s not the specialty for you. But it is my first and great love, and it has so much to teach family and internal medicine.
What is Psychiatry?
Psychiatrists are therapists who are also physicians. Dr. Tracey Marks explains the difference between the two. Psychedelics-assisted therapies are the next wave of psychotherapy, and Dr. Tracey Marks has a playlist on the different applications of psychedelics. Today, psychiatrists treat all kinds of syndromes–and every syndrome is treatable, including psychopathy. For more on my thoughts on psychopathy, see this video.