Different perspectives in psychiatry

George Dawson in a comment on my previous blog entry mentioned an article by McHugh & Slavney, which has just come out in NEJM (not sure how George seemed to know about it before it was published). I agree with the analysis of this paper. A full psychiatric assessment of a patient in terms of family and personal history is too often regarded as almost 'out of date' and unnecessary in psychiatric training these days.

I don't agree, however, with McHugh and Slavney's proposed solution. They say "No replacement of the criterion-driven diagnoses of the DSM would be acceptable". That's just the point and why the DSM system should be abandoned to help psychiatry to realise that full psychiatric assessment is essential to practice. They are also right in a way that "much turns on causation" but then I think this is where they get it wrong by including schizophrenia and panic disorder as brain diseases with delirium.