Medscape letter to a medical student about psychiatry

[daisybell]

http://www.medscape.com/viewarticle/873762
This is an interesting read - very popular and lots of comments.
The author is very critical of the DSM...

'Psychiatry is the least medical of medical branches. Some celebrate this fact, others rue it; some deny it; many refuse to come to terms with it. It's acceptable in a way, if by "medicine" we mean biological aspects of physical diagnosis and treatment, because psychiatry deals sometimes with the mostly physical and sometimes with the mostly psychological.

But psychiatry is medical, in the sense of dealing with diseases (whether mental health professionals want to admit this reality or not). The problem with that medical aspect of psychiatry is that the field is ambivalent about it. The diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders(DSM) are created as social constructions, as preferences of the profession—not solely, or even primarily, as scientifically based definitions. For two decades, our profession has bound itself to these social constructions and pretended that they were scientific facts. This has been proven a lie, but we are unwilling to admit our self-deception.'

 

[alex3619]

The above except is basically some of the things I have been saying. There is more to it of course, you cannot assess what is happening without also assessing what is happening in academia, to the sciences, and the rise of bureaucratic bodies that dictate what doctors can and can not do. Its also tied to failings in medical education and continuing education. Evidence based medicine can be led down false paths as well, since many who follow it do not understand it, and many who write EBM papers don't understand it either. Its become a sham, but it does not have to be; just like psychiatry. Yet until there is a strong move to fix the issues then the problems will remain, and patients will receive unhelpful or even dangerous treatment far more often then should be the case.

 

[alex3619]

I often wondered why progress was so slow. It took me two decades to realize that besides the conflicting ideologies of our field, there was the current ideology of the DSM, which is inherently unscientific. The DSM was and is a social construction, as I said, created by the profession for its own social purposes. When we make up our phenotypes for social, economic, and professional purposes, why should genetics, biology, neuroimaging, pharmacology, and even psychotherapies correlate with it?

The problem psychiatrists have is they need to help people in a broken system. Psychiatry is broken from the ground up. Its not that we do not need psychiatrists, its that we need psychiatry to abandon the nonscience and embrace strong science. This is not easy. The brain is about the hardest thing science has ever tackled.