Intended for healthcare professionals

Education And Debate

The limits of psychiatry

BMJ 2002; 324 doi: (Published 13 April 2002) Cite this as: BMJ 2002;324:900
  1. Duncan Double (, consultant psychiatrist
  1. Norfolk Mental Health Care NHS Trust, Carrobreck, Norwich NR6 5BE

    Much of the expansion of psychiatry in the past few decades has been based on a biomedical model that encourages drug treatment to be seen as a panacea for multiple problems. Psychiatrist Duncan Double is sceptical of this approach and suggests that psychiatry should temper and complement a biological view with psychological and social understanding, thus recognising the uncertainties of clinical practice

    The increasing accountability of doctors following the deaths of children in the Bristol Royal Infirmary's paediatric cardiac surgical unit has focused attention on the foundations of medical practice. Ian Kennedy, who chaired the Bristol inquiry,1 provides a direct link with earlier cultural critics of medicine—such as Ivan Illich—in his Reith lectures in 1980 about “unmasking” medicine.2

    Illich made specific comments about psychiatry in his critique of medicalisation and the limits to medicine.3 He attended the 1977 world federation for mental health conference in Vancouver, Canada, where he debated the issue of whether mental health professionals are necessary.4 He maintained that “do it yourself” care was preferable. The central concern of Illich's work was the legitimacy of professional power, whether in health systems or in other systems, such as education.

    There is no direct equivalent in general medicine of the “anti-psychiatry” movement, commonly seen as a passing phase in psychiatry and associated with the names of R D Laing and Thomas Szasz.5 Illich came from outside medicine, whereas the proponents of anti-psychiatry came from within psychiatry, even if their influence was subsequently marginalised by mainstream psychiatrists.

    The cultural role of psychiatry is more obviously open to criticism than is the case in the rest of medicine. This is because of its direct relation to social control through mental health legislation. Although diagnosis of mental illness should not be predicated on social conformity, in practice …

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