Sunday, June 01, 2014

Psychiatry for a new generation

Maybe because I am approaching pension age, I have been thinking about the impact of critical psychiatry on practice. There seems to be little shift in mainstream biomedical bias, which tends to ignore any challenge to its approach. I seem to have been wasting my time trying to get critical psychiatry's message across.

In a previous post, I mentioned Aubrey Lewis, who influenced the generation of professors that I saw retire. I think there's now less passion for thinking about the basis of psychiatry, which he encouraged. That passion has been diverted into promoting neuroscience as the solution to mental illness (eg. see previous post). Trainees are supposed to get excited about discovering the scientific cause of mental illness rather than be interested in the conceptual foundations of psychiatry. I think this is a recipe for disillusionment as fulfillment of this wish is unobtainable.

Of course, psychiatry has always held out the hope that the biological basis of mental illness will be uncovered. However, at times, it seems to have been more open to recognising the uncertainty of human action. For example, Adolf Meyer (see previous post) and George Engel (see conference presentation) encouraged a patient-centred approach to psychiatry. These days, however, a full personal assessment of a patient is almost seen as out of date in psychiatry (see another previous post). Do trainees even know who Adolf Meyer and George Engel were?

So, how can younger mental health professionals be interested in critical psychiatry? They need to be reassured about its legitimacy and not have their careers blighted because they express an interest. Critical psychiatry is not anti-psychiatry, in the sense that it denies the reality of mental illness. It may be almost unbelievable that mental illness is not associated with neuropathology, considering the research effort put into trying to find just that association. But, in fact, the neurobiology of mental illness may be no different from that of our "normal" behaviour (see my article).

I haven't seen any debate about these issues on the Early career psychiatry webpage at Psychiatric Times.

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