Fads and Fallacies in Psychiatry

Book excerpt: Relative to some other medical specialties, psychiatry is a new and still scientifically underdeveloped field - as a result practitioners can be influenced by attractive but unproven ideas. Since mental illness is still a mystery and answers to the most important questions about mental illness will require another century of research, it is important to criticise contemporary practice - especially as fads in psychiatry have occurred not only on the fringe, but in the very mainstream of theory and practice. Some of the trendiest theoretical paradigms may turn out to be unsupported by data. In diagnosis, the many faddish approaches to classification are unlikely to last. In treatment, both psychopharmacology and psychotherapy sometimes embrace interventions with a weak base in evidence that run the risk of doing harm to patients. This book examines the fads and fallacies that have and continue to plague psychiatry, in both diagnosis and in treatment. These include over-diagnosis (especially of depression, bipolar disorder, ADHD, PTSD and autism), over- treatment with pharmaceuticals and the assumption that neuroscience has all the answers for psychiatry. The reasons why psychotherapy has long been prone to faddishness are explored; as are the reasons for more recent faddishness in psychopharmacology, which can lead to irrational methods of over-treatment, and a failure to consider alternatives. There is discussion of the problematic areas of diagnostic systems (ICD and DSM) and an over-reliance on drugs. Many examples from the author's own personal clinical experience are included. The author's strong opinions and critical tone may seem to conflict with the dispassionate approach of evidence-based medicine, however, the book presents balanced arguments and includes positive suggestions and recommendations for change. Until we really understand the nature of serious mental illness, psychiatrists need to resist fads in diagnosis and treat