December 14, 2014 : 647



Psychiatry is the branch of medicine concerned with mental disorders. To become a psychiatrist you first study to be a medical doctor. However the practice of psychiatry struggles to fit within the scientific rigour of a medical model.

The “bible” of psychiatric diagnosis is the Diagnostic Services Manual, or DSM for short. This is published by the American Psychiatric Association and is now in its fifth edition. The majority of diagnostic criteria in the DSM are called “disorders”, however unlike most medical diseases they are not validated by biological criteria. Despite this, these diagnoses purport to represent, and take the form of, medical diseases. They are “top-down” classifications of a subjective nature based on observation of symptoms.

Psychiatry has been strongly influenced by, and leans heavily on, the effects of a number of psychoactive drugs, euphemistically called “medication”. The manufacturers of these medications like to distinguish between their utility  and their side-effects, however this is a largely artificial distinction, and it would be more accurate to say some side-effects are useful, and have been marketed as the prime action of the drug, while other side-effects have been described as such by the manufacturers.

The availability of these medications has transformed mental health care across the world. Long-term inpatient care of the mentally unwell has almost disappeared as it is prohibitively expensive compared with the cost of medicatiing. The medicated patients have been transferred into the care of the community, often under-funded, and this has placed an enormous burden on some communities. There is almost no “asylum” available for the most desperately ill, where a patient can be carefully attended to and the causes of their suffering understood.

Some medications are more focussed in terms of their action than others. Some are more “dirty” and hit-and-miss, having one effect at one dose and something quite different at a higher dose. Many psychiatrists have become extremely skilled in administering a cocktail of drugs that manage their patient’s symptoms and relieve their immediate suffering. This has saved many lives.

However psychiatry understands and treats symptoms as the disease. To justify this it tries to make links between the psychopharmacology and structure of the brain through neuroscience, but so far studies have been unconvincing.

Psychiatry does not understand symptoms as someone’s best attempt to manage a distturbance within them. In treating symptoms as the disease it risks making the sufferer more unwell even though their symptoms may not be so pressing.

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