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Friday, 9 October 2009

Psychiatric Diagnosis -The corpse that wouldn't die

The criticisms of taxonomic systems in psychiatry and psychotherapy are not new - indeed Wittgenstein suggested that "The classifications made by philosophers and psychologists are like those that someone would give who tried to classify clouds by their shape" (PR #154).

Professor Ricahrd Bentall (whom I trained with in Liverpool many moons ago) has recently revisited the topic yet again in the Guardian (www.guardian.co.uk/commentisfree/2009/aug/31/psychiatry-psychosis-schizophrenia-drug-treatments). He points out that there is minimal genetic evidence supporting psychiatric diagnostic systems (compared with other fields of medicine) and that the advances that have occurred in other medical areas have noticeably failed to be replicated in psychiatry.

The flawed nature of the psychiatric diagnostic system has failed to lead to its disappearance however. Indeed, what strikes me as interesting is that despite the changing tide towards "talking therapies" a pharmaceutical classification system remains arguably more predominant than ever. Twenty years ago, criticisms of the psychiatric diagnostic system were rife as part of the tail end of the anti-psychiatry movement and within my own profession (clinical psychology). Today, such criticisms is notable by their rarity.

Why is it that such a heavily criticised model refuses to lie down and die ? The most common answer given (apart from the `the tradition one that drugs "work" , thus "proving" the validity of the diagnostic system) is that big Pharma and the medical profession are well financed and have a lot invested in maintaining the system. Jobs, careers and profits would be lost, if it wasn't so. This is true.

However, I'm struck by how this argument also applies to other professions as well. To obtain funding for research requires acceptance of the diagnostic system, to have a conversation with colleagues about a client
requires acceptance of the diagnostic system, to fail to do so would lead one to be seen as a "poor team player", to obtain promotion may well require an interest in particular diagnostic categories. In other words, there is no real alternative. If this really is the case I'm not sure I expect to see a proper burial of the system any time soon.

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