the demise of biological psychiatry?

[Bill Penson]

In the last few weeks, as the publication of DSM 5 grows near, there have been some unprecedented reactions to the new psychiatric bible. The 3 that stick out are

1. activity on twitter from US psychiatrists who have 'come out' and admitted that the biological theory of depression, for instance the serotonin hypothesis, is known by medics to have no evidence and is something that they tell patients because it seems to go down well and is found to be reassuring. What this means for the status of biological models and indeed so-called 'anti-depressant' drugs remains to be seen...but not for long...

2. the National Institute for Mental Health USA, the largest funder of mental health research globally, announced it is departing from the use of DSM 5 because of its lack of validity. NIMH wants a more scientific view of mental illness to prevail, and a few months back a pan-European agreement was made (I forget between who but 'they' were important) to put neurological research into mental illness as a greater priority.Will this herald a new era of biological determinism or perhaps confirm the lack of scientific rigour in current models?  Maybe, although...

3. Over this weekend the Clinical Psychology section of the British Psychological Society fired a shot across psychiatry's bows taking a stance that mental health problems are the result of complex psychological and social processes and that bio-psychiatry has little to offer. Is this opportunistic professional positioning given the DSM controversy or the time up on bio-psychiatry?

What remains to be seen is what the fall out will be. This is pure speculation but big pharma will still want a piece of the pie- would that be to the extent that it would re-brand again its drugs as an adjunct, switching the current emphasis, but remaining in the market? Will pharma court the psychologists as the psychiatrists lose their crown? It could be the start of the mental health version of 'Game of Thrones', except there is no fantasy element here, but rather real impact on real lives.

 

[julie gosling]

- of course talking and behavioural 'therapies' may hold their attractions - but will they commit to the sort of power- sharing partnerships that truly recognise accommodate and celebrate the truth of lived experience without trying to 'normalise' or control it? - my concern here is that one professional colonisation merely replaces another ....

[steve lyon]

Unfortunately, nothing ever is as black and white as we would like, and maybe that is why the biological model is often criticised as an attempt to simplify a complex situation. Wasn't this the reason why Laing attempted to get alongside and understand the world as the person experienced it, and that this would take some effort to appreciate? But then talking therapies isn't an alternative to a biological model - things can't be polarised like that; and the reason I say this is because neuroscience is moving at such a pace that it is providing fascinating and complex insights into how CBT and mindfulness approaches may impact on pathways in the brain. For those who are interested, I can suggest some reading that presents the evidence for this and I for one think its a case of "watch this space".

[Bill Penson]

Curiously I definitely don't like black and white as options, and that seems to be have been part of the problem. Any strategy(by that I refer to an epistemological orientation) that can accommodate nuance, hybrids, resistance, negotiation, difference will offer something far more helpful where help is desired. DSM and the like remove that from the frame and any flex is within the clinician's gift. The objections to biological psychiatry have been in part about the bio, but more often it is about the bio as a strategy of dominance, lacking scienticity. Interesting times...

[julie gosling]

All theories, knowledge and practice have their place  - of course - where would we be without them! But it is when their jostle for power displaces the person from the central focus, and power becomes an closed end in itself, rather than an enabling of services of empowerment and liberation to humanity.

[Jill Anderson]

Interesting article here: Delusions of Progress - Psychiatry's diagnostic manual - by Andrew Scull

http://lareviewofbooks.org/article.php?type=&id=1677&fullte...