Is there a debate about the future of psychiatry?

All in the Mind broadcast a programme that included a debate between Nick Craddock and Pat Bracken. It suggested there was a fierce debate within psychiatry about the very future of the profession.

I think the origin of this so-called debate is supposed to be an article by Craddock et al entitled "A wake-up call for British psychiatry". It has been portrayed as a biomedical reaction to the policy of New Ways of Working.

I think the issues are more complex (see my e-letter). There has been a deprofessionalisation of services in the sense of an undermining of professional expertise. New Ways of Working encouraged a fragmentation of services and, in fact, Department of Health policy now seems to have moved on to focusing on the "creative, capable workforce" and not so much about the structure of services.

The question is whether there is really a debate about the conceptual basis of psychiatry. Pat has always tended to argue that postpsychiatry is not another model (eg. see Openmind article). I may have misunderstood the implication of Pat's point but I do think there should be a debate about whether psychiatry has a biomedical or truly biopsychosocial foundation. "Biopsychosocial" may not be the best term as it has been used to mean an eclectic, atheoretical position. But I think critical psychiatry is clear that psychiatry can be practiced without postulating brain pathology as the basis for mental illness. That is a debate worth having but I haven't seen much engagement in it.