Psychiatry

Psychiatry is the branch of medicine that diagnoses, treats, and studies mental illness and behavioral conditions. While all physicians will encounter patients with mental illnesses and any of them may treat it, psychiatrists specialize in these areas, being more extensively trained in the differential diagnosis (distinguishing various forms) and treatment of mental illness and are professionally required to keep up to date on the newest developments in the field of mental illness. Additionally psychologists, nurse practitioners, and social workers can provide psychiatric care though of these only the nurse practitioners may prescribe medication.

Opposition

Anti-psychiatry

Unlike most other areas of medicine, there is a politicised anti-psychiatry movement opposed to the practices of, and in some cases the existence of, psychiatry. Some opponents of psychiatry state that selective financing by large multinational drug companies of both high ranking professional psychiatrists, research and educational material has led the practice of psychiatry to be subversively, and in some cases inhumanely, misled.

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One of the chief complaints of the anti-psychiatry movement is that most mental illnesses lack a simple, biologically-based test. There are a number of people trained in the field who have stated that physical tests cannot distinguish between a normal person and a mentally ill person, though these criticisms tend to ignore the rising body of evidence from neuroimaging that identifies such illnesses as schizophrenia and major depression. At the same time, critics are right to contend that psychiatrists tend to rely upon theories of causation that are uncertain (e.g., the idea that dysregulation of dopamine causes schizophrenia stems from the proven fact that dopamine-regulating medications help people with psychotic hallucinations. This clinical fact does not, however, prove that schizophrenia is caused by altered dopamine regulation). Psychiatrists are aware of this problem, however, and point out that most medical illnesses lack clear theories of causation.

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There are also criticisms based on what is perceived as political motivations on the part of psychiatrists as opposed to objective scientific criteria. An example often cited is the inclusion and then the removal of homosexuality from the list of mental illnesses in the DSM. Thus, some critics contend a mental illness label such as schizophrenia has no etiology and is only a matter of opinion. If the addition or removal of mental illnesses from the DSM is politically based, then the DSM can not be held by all as an objective standard. However, it is possible to argue that even if the removal or addition of psychiatric conditions to/from the DSM has been politically motivated, the initial inclusion or exclusion may have been a result of politics, creating something of an equalization effect. Morever, many would hold it logically fallacious to argue all DSM diagnoses are categorically invalid simply because one or some may be politically motivated or otherwise invalid.

Related Topics:
Homosexuality - DSM - Schizophrenia - Logically fallacious

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Recent news articles and other columns have noted and commented on the creation and marketing of new diseases (as seen in this August 2005 article from Mother Jones magazine)http://www.motherjones.com/commentary/columns/2005/07/selling_sickness.html

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:From a pharmaceutical company's perspective, the big money can be made not only by selling drugs to the sick, but by selling drugs to the healthy, the people who don't even know that they need drugs yet. A recent Reuters Business Insight report, designed for drug company executives, suggested that the drug companies can reap billions by "creat new disease markets." That involves convincing people that "problems they may previously have accepted as, perhaps, an inconvenience"?such as, for instance, the distress that can accompany PMS?are in fact "worthy of medical intervention." In other words, nothing short of the medicalization of everyday troubles. Cheerfully, the report believes that drug companies are up to the task: "The coming years will bear greater witness to the corporate sponsored creation of disease."

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A specific example involves a repackaging of prozac, in order to prolong the market for the drug.http://www.motherjones.com/commentary/columns/2005/07/selling_sickness.html

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:In 1998, Lilly, one of the world's largest pharmaceutical companies, was on the verge of losing its patent on fluoxetine (more commonly known as Prozac) worth over $2 billion annually. However, if Lilly could find a new use for the drug, the patent could be extended. That year, Lilly helped fund a "roundtable" of researchers to gather in Washington D.C., along with staff from the Food and Drug Administration to discuss a scientifically controversial condition called "premenstrual dysphoric disorder" (PMDD), which had only recently, and after much controversy, been included in the appendix of the Diagnostic and Statistical Manual?the bible of psychiatric disorders?as a disorder "under evaluation." But the Lilly-funded researchers soon published an article in a small medical journal suggesting, falsely, that the debate was over and that PMDD could now be considered a "distinct clinical entity," distinct from the stress and tension that can accompany ordinary PMS.

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:Lilly has not said what role it played in turning the "roundtable" into a journal article, but by 1999, the article helped convince the FDA to approve the use of fluoxetine to treat PMDD?and extended the patent until 2007. Lilly simply repackaged the drug in lavender pill-form, renamed it Serafem, and began marketing it to women. Never mind that independent researchers questioned whether PMDD even existed as a condition. Never mind that Europe's drug regulators raised serious questions about PMDD and criticized Lilly's clinical trials that purported to show the benefits of Serafem. Never mind that even the industry-friendly FDA was appalled at Lilly's television ads, with their too-vague tagline: "Think it's PMS? It could be PMDD." Undaunted, Lilly continued its advertising barrage, trying to convince women who thought they were experiencing regular PMS-related distress that, actually, they might well have a serious disorder that required heavy medication. Soon thereafter, both Pfizer and GSK got their own anti-depressants approved for treating PMDD. For all intents and purposes, the "debate" over whether PMDD was a disorder?let alone requiring medication with serious side-effects?was over. Industry money had carried the day.

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Also, some people criticize the psychiatric profession for treatments that transition into and out of usage. An example is electroconvulsive therapy (ECT), which the psychiatric profession considered a barbarous practice during the 1970s and 1980s, only to be revived recently as a treatment for clinical depression. (Psychiatrists point out that ECT as practiced today bears little to no resemblance to horror stories from the past or popular depictions such as in One Flew Over the Cookoo?s Nest, and remains the most effective treatment for some severe cases.)

Related Topics:
Electroconvulsive therapy - Barbarous - Clinical depression

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A few prominent critics of psychology and mental illness in general include Thomas Szasz, the author of "The Myth of Mental Illness", who founded an organization in 1969 together with the Church of Scientology (though soon afterwards he disavowed further association with them) called the Citizens Commission on Human Rights (CCHR), Peter Breggin, the author of Prozac Backlash, as well as other books criticizing the use of psychiatric drugs, Elliott Valenstein, Douglas C. Smith, Bruce Levine, and David Keirsey. In the United States and some other countries, Scientologists have been among the most vocal and prominent opponents of psychiatry in recent decades; members believe that psychiatry is a corrupt profession and present scientology as an alternative. Many are highly skeptical of the motives of Scientologists and the accuracy of the information they supply.

Related Topics:
Thomas Szasz - Church of Scientology - Citizens Commission on Human Rights - Peter Breggin - Prozac - Elliott Valenstein - Douglas C. Smith - Bruce Levine - David Keirsey - Scientologists

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Despite criticism of psychiatry, the specialty is accepted as a core part of medical education in all medical schools in the U.S. and most around the world. Medical students typically spend four to six weeks studying psychiatry in addition to other medical specialties such as internal medicine and pediatrics.

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Other criticisms

Others, probably a considerably larger number than those who oppose psychiatry altogether, still have problems with a number of aspects of the profession as practiced today. Many believe that psychiatrists have an incentive and tendency to over-diagnose disorders and to prescribe medication in cases where it is not necessary (or in some cases even when medically contraindicated.) Many critics question the current DSM diagnostic labels, finding some or all labels arbitrary, vague, and/or lacking in firm biological basis, leading some to describe them as pseudoscientific.

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Drug companies spend large amounts of money marketing psychiatric drugs. There is evidence this leads some psychiatrists to prescribe advertised drugs instead of more appropriate, better, or cheaper drugs (or prescribing them when drugs are not needed at all). The training and techniques of psychiatrists can vary substantially, according to critics, and patients often have to switch psychiatrists a few times before they find one they are satisfied with. Critics also contend training is unduly influenced by the drug industry.

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Misdiagnosis (one common example, unipolar depression instead of bipolar depression) remains a problem in some cases, prolonging the suffering for those patients. Also, different individuals respond differently to a given psychiatric drug; this can lead to some patients experiencing a prolonged trial-and-error process.

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