article in World Psychiatry says psychiatry is in trouble and needs to move from reductionism to hermeneutics. He builds on the 'Bracken manfesto' paper (see previous post), as named by Peter Kinderman (eg. see another previous post), that the problem is the technological paradigm which dominates psychiatry. As Pat says, "Hermeneutics is based on the idea that the meaning of any particular experience can only be grasped through an understanding of the context (including the temporal context) in which a person lives and through which that particular experience has significance." Most medicine and surgery is concerned with the natural order, whilst psychiatry is mostly concerned with the human order.
Mario Maj in an editorial argues that the Bracken manifesto has gone too far in rejecting the technical aspects of care. He can't be as sceptical about the value of psychiatric medication or even that non-psychiatric medication could be just as ineffective (see previous post). He raises the spectres of the Italian reforms following the introduction of law 180 and the concept of the 'schizophrenogenic mother' to boost his argument of the dangers of a non-technical approach. However, evaluation of the influence of Franco Basaglia has been controversial. It is also obviously wrong and naive to blame families for causing schizophrenia. However, the problem with the reaction against the 'schizophrenogenic mother' idea is that it has undermined further legitimate family studies of schizophrenia. Maj also sees early intervention to reduce duration of untreated psychosis as a benefit of the technical approach without mentioning the critique of the early intervention approach (eg. see Jo Moncrieff's book The bitterest pills). Nor is it clear, as Maj suggests, that a non-technical understanding of psychiatric diagnosis necessarily leads to the abandonment of any attempt at classification (see previous post).
Still, it's good that there has been some mainstream response to the Bracken manifesto, rather than just ignoring it.