Friday, January 09, 2026

Will psychiatry ever change?

As Diana and Nikolas Rose wrote in their 2023 Psychological Medicine article (see previous post), psychiatrists tend to see themselves as 

exponents of highly effective, neurobiological based, targeted treatment of brain disorders, like their peers in other biomedical specialities. The leaders of the psychiatric establishment are likely to resist … a reconfiguration of their profession [by giving up such a claim].

This is despite the fact that psychiatric disorders are not dependent on biological pathology, whereas physical diseases are. A purely biological account of primary mental disorder is not possible, but psychiatrists keep hoping one will be found.

It’s depressing to see how much psychiatry is prepared to cling to its outdated understanding of mental illness, which it actually promotes as a major advance, misleading people that there has been real progress (see eg. recent post). As I’ve commonly said (see eg. my editorial), the essential position of critical/relational psychiatry is that functional mental illness should not be reduced to brain disease. Although, of course, all mental disorders involve cerebral processes, despite what psychiatry says, neuroscience is not moving us towards having a biological and genetic understanding of primary mental disorders (see eg. previous post).