Friday, December 29, 2017

Choosing the orthodox path in psychiatry

The latest Mad in America podcast includes an interview with Sir Robin Murray, who I have mentioned in previous posts (eg. Schizophrenia is not a neurodevelopment disease). Like him, I wanted to be a psychiatrist through reading Freud as a teenager. Similarly, we both got caught up in the 'anti-psychiatry' conflict and were interested in R.D. Laing. Murray opted for the orthodox view, whereas I gave up my medical training for 8 years and then returned to complete it to become a critical psychiatrist. I ended up having a different view of schizophrenia from him (eg. see my BMJ letter). And, I have spent my working life as a consultant as a full-time clinician, unlike Murray, who was an academic, only working part-time clinically.

Like Anthony Clare (eg. see previous post), Robin Murray took his position partly as a reaction to their understanding of Laing as blaming families for causing schizophrenia. This is actually a misunderstanding of his view, about which Laing complained repeatedly (eg. see extract from my book chapter).

As I said in a post on my personal blog, it's interesting to see Murray questioning the call he made when he started in psychiatry. But he hasn't completely given up his belief in the brain hypothesis of mental illness. For example, in the interview, he talks about dopamine being involved as the "final common pathway for psychosis".

Like him, I'm not encouraging psychiatrists "slagging each other off", but there is a genuine issue about the conceptual nature of mental illness. It's difficult for people, like Robin Murray, to accept that an organic basis is insufficient for understanding mental activity. He's taken this step of faith and to retract it and realise he's made a mistake would be like giving up a religion (see previous post). I'm not necessarily encouraging him to be a philosopher, but he does need to accept that there is a mind-body problem. Organisms as a whole are constantly maintaining their internal environment and cannot be explained mechanically (see another previous post). The activities of the mind cannot be derived completely from the laws of the physical world.

And, I do not want to be misunderstood. Of course I know that minds are enabled by brains. But this does not mean that minds are reducible to brains. To use a quote from Adolf Meyer that I have used before, "mental disorders show through the brain but not necessarily in the brain" [Meyer's emphasis].

Sunday, December 17, 2017

Is psychiatric diagnosis dead?

The title of the 2018 medical student essay prize established by the Faculty of General Adult and Community Psychiatry of the Royal College of Psychiatrists is 'Is diagnosis dead? Discuss.' It's good to see a Faculty of the College encouraging this debate.

Of course the hope of finding a neurobiological basis for psychiatric diagnosis should be dead, particularly following the failure of DSM-5 (eg. see previous post), but it isn't because the wish to find a physicalist basis for mental illness will never go away. And, psychiatric assessment has never just been about diagnosis and includes formulation (eg. see another previous post), which may well be more important than a single-word diagnosis (eg. see yet another previous post).