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Contemporary Psychiatry

December 17, 2006

The Contemporary Moment: Psychiatry and its Critics Pt 1

Today, psychiatry is once again dominated by the biological perspective. There is full investment in the notion that psychiatric illnesses are biological diseases resulting from irregular brain function with specific genetic etiologies. Psychiatry views itself as a branch of medicine, and consequently ascribes to the modernist impulses of reductionism and essentialism that characterize much of medical science. Psychiatry also aspires to transition from its current symptom-complex based diagnostic system to pathoetiology-driven diagnostic taxonomy. This move would signify a shift from a nominalist understanding of disease towards an essentialist one, which would put it on par with the rest of the medical profession. At the moment it is generally acknowledged that the current classification system is imprecise and has significant overlap between diagnostic categories. A lack of precision in the diagnostic classifications remains problematic, and impedes progress in both psychiatric research and treatment.
The foundation of biological security, however, is far from secure. It is a paradigm that is plagued by vexing discrepancies in its body of evidence. For example, recent studies have called into question the true effectiveness of anti-depressant medication. These studies indicate that most psychopharmacueticals work on less than 50% of the intended patient group. The inconsistent effectiveness of psychopharmacological agents belies a lack of knowledge of the disease process behind most psychiatric illnesses. Further, while it has been rigorously proven that most mental illnesses have important hereditary elements, the search for specific genetic causes has largely proven fruitless. While innumerable genes have been linked to incidence of psychiatric illness, no gene or combination of genes have yet proven to be a controlling factor in any of the major psychiatric illnesses. In fact, only 3 chromosomes do not contain genes that have been linked to schizophrenia. It appears that search for specific genetic causes for mental illnesses are complicated by diagnostic overlap, assortive mating and the polygenic nature of most mental illness. Nevertheless, contemporary psychiatry remains confident in and allegiant to molecular biology.

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