Skip to main content

Is psychiatry dying? Crisis and critique in contemporary psychiatry

Abstract

In the wake of the publication of DSM-5, the debate around the validity, usefulness and meaning of psychiatric categories has revived to an extent that is reminiscent of the battles over psychiatry’s legitimacy waged in the 1960s and 1970s. However, what is distinctive about the current crisis of legitimacy are the multiple and varied critical positions that are deployed against a psychiatry that is uncertain about its own central paradigm. In this article, I outline five critical positions that respond to the contemporary crisis in psychiatry and that point towards different directions for the future of psychiatry. Finally, I draw some conclusions about the possibilities of a paradigm shift within psychiatry and the prospects for the survival of a different discipline in the twenty-first century.

This is a preview of subscription content, access via your institution.

References

  1. Andreasen, N. (2007) DSM and the death of phenomenology in America: An example of unintended consequences. Schizophrenia Bulletin 33 (1): 108–112.

    Article  Google Scholar 

  2. Bentall, R. (2004) Madness Explained: Psychosis and Human Nature. London: Penguin.

    Google Scholar 

  3. Bentall, R.P. (2006) Madness explained: Why we must reject the Kraepelinian paradigm and replace it with a ‘complaint-oriented’ approach to understanding mental illness. Medical Hypotheses 66 (2): 220–233.

    Article  Google Scholar 

  4. Bentall, R.P. (2009) Doctoring the Mind. Is Our Current Treatment of Mental Illness Really any Good? New York: New York University Press.

    Book  Google Scholar 

  5. Bracken, P. and Thomas, P. (2005) Postpsychiatry – Mental Health in a Postmodern World. Oxford: Oxford University Press.

    Book  Google Scholar 

  6. Bracken, P. and Thomas, P. (2010) From Szasz to Foucault: on the role of critical psychiatry. Philosophy, Psychiatry,Psychology 17 (3): 219–228.

    Google Scholar 

  7. Braver, L. (2007) A Thing of This World. A History of Continental Anti-Realism. Evanston, IL: Northwestern University Press.

    Google Scholar 

  8. Broome, M., Harland, R., Owen, G. and Stringaris, R. (eds.) (2013) The Maudsley Reader in Phenomenological Psychiatry. Cambridge, UK: Cambridge University Press.

    Google Scholar 

  9. Bullmore, E., Fletcher, P. and Jones, P. (2009) Why psychiatry can’t afford to be neurophobic? British Journal of Psychiatry 194: 293–295.

    Article  Google Scholar 

  10. Burns, T. (2013) Our Necessary Shadow. The Nature and Meaning of Psychiatry. London: Penguin.

    Google Scholar 

  11. Callard, F. (2014) Psychiatric diagnosis: The indispensability of ambivalence. Journal of Medical Ethics 40 (8): 526–530.

    Article  Google Scholar 

  12. Choudhury, S. and Slaby, J. (eds.) (2012) Critical Neuroscience. A Handbook of the Social and Cultural Contexts of Neuroscience. Chichester and Malden: Wiley- Blackwell.

    Google Scholar 

  13. Conrad, P. (2007) The Medicalisation of Society. On the Transformation of Human Conditions into Treatable Disorders. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  14. Cuthbert, B. and Insel, T. (2010) Toward new approaches to psychotic disorders: The NIMH research domain criteria project. Schizophrenia Bulletin 36 (6): 1061–1062.

    Article  Google Scholar 

  15. Davidson, L. (2005) Recovery, self-management and the expert patient-changing the culture of mental health from a UK perspective. Journal of Mental Health 14 (1): 25–35.

    Article  Google Scholar 

  16. Deegan, P. (2001) Recovery as a self-directed process of healing and transformation. Occupational Therapy in Mental Health 17 (3/4): 5–21.

    Google Scholar 

  17. Elliott, C. (2003) Better than Well: American Medicine Meets the American Dream. London and New York: W.W. Norton and co.

    Google Scholar 

  18. Frances, A. (2013) Saving Normal. New York: William Morrow.

    Google Scholar 

  19. Frith, C. (1992) The Cognitive Neuropsychology of Schizophrenia. East Sussex, UK: Lawrence Erlbaum.

    Google Scholar 

  20. Gallagher, S. and Zahavi, D. (2008) The Phenomenological Mind. An Introduction to the Philosophy of Mind and Cognitive Science. London and New York: Routledge.

    Google Scholar 

  21. Greenberg, G. (2013) The Book of Woe. The DSM and the Unmaking of Psychiatry. London and Melbourne: Scribe Press.

    Google Scholar 

  22. Heidegger, M. (2002) The Essence of Truth. London and New York: Continuum.

    Google Scholar 

  23. Hyman, S. (2003) Diagnosing disorders. Scientific American 289 (3): 96–103.

    Article  Google Scholar 

  24. Hyman, S. (2010) The diagnosis of mental disorders: The problem of reification. Annual Review of Clinical Psychology 6: 155–179.

    Article  Google Scholar 

  25. Insel, T. (2013) Transforming diagnosis, http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml, accessed 14 April 2014.

  26. Insel, T. and Quirion, R. (2005) Psychiatry as a clinical neuroscience discipline. Journal of the American Medical Association 294 (17): 2221–2224.

    Article  Google Scholar 

  27. Kandel, E. (1998) A new intellectual framework for psychiatry. American Journal of Psychiatry 155 (4): 457–469.

    Article  Google Scholar 

  28. Katschnig, H. (2010) Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry 9 (1): 21–28.

    Article  Google Scholar 

  29. Kays, J., Hurley, R. and Taber, K. (2012) The dynamic brain: neuroplasticity and mental health. Journal of Neuropsychiatry and Clinical Neurosciences 24 (2): 118–124.

    Article  Google Scholar 

  30. Kinderman, P. (2014) A Prescription for Psychiatry. Why We Need a Whole New Approach to Mental Health and Wellbeing. Basingstoke, UK: Palgrave MacMillan.

    Google Scholar 

  31. Kirmayer, L. and Crafa, D. (2014) What kind of science for psychiatry? Frontiers in Human Neuroscience 8 (Article 435): 1–12.

    Google Scholar 

  32. Klerman, G.L. (1978) The evolution of a scientific nosology. In: J.C. Shershow (ed.) Schizophrenia, Science and Practice. Cambridge, MA: Harvard University Press.

    Google Scholar 

  33. Kuhn, S. (2012) The Structure of Scientific Revolutions, with an introductory essay by Ian Hacking Chicago; London: University of Chicago Press.

    Book  Google Scholar 

  34. Kupfer, D., First, M. and Regier, D. (eds.) (2002) A Research Agenda for DSM-V. Washington DC: American Psychiatric Association.

    Google Scholar 

  35. Kupfer, D. and Regier, D. (2011) Neuroscience, clinical evidence and the future of psychiatric classification in DSM-5. American Journal of Psychiatry 168 (7): 672–674.

    Article  Google Scholar 

  36. Leader, D. (2011) What is Madness? London: Penguin.

    Google Scholar 

  37. Leader, D. (2013) Strictly Bipolar. London: Penguin.

    Google Scholar 

  38. Leff, J. (2010) The historical development of social psychiatry. In: C. Morgan and D. Bhugra (eds.) Principles of Social Psychiatry. Oxford: Wiley Blackwell.

    Google Scholar 

  39. Lewis, B. (2000) Psychiatry and postmodern theory. Journal of Medical Humanities 21 (2): 71–84.

    Article  Google Scholar 

  40. Mathalon, D. and Ford, J. (2012) Neurobiology of schizophrenia: Search for the elusive correlation with symptoms. Frontiers of Human Neuroscience 6: 20–25.

    Article  Google Scholar 

  41. Middleton, H. (2007) Critical psychiatry. Mental Health Review Journal 12 (2): 40–44.

    Article  Google Scholar 

  42. Moncrieff, J. (2010) Psychiatric diagnosis as a political device. Social Theory and Health 8 (4): 370–382.

    Article  Google Scholar 

  43. National Institute of Mental Health. (2011) NIMH research domain criteria (RDoC), http://www.nimh.nih.gov/research-priorities/rdoc/nimh-research-domain-criteria-rdoc.shtml, accessed 14 April 2014.

  44. Parnas, J., Sass, L. and Zahavi, D. (2013) Rediscovering psychopathology: The epistemology and phenomenology of the psychiatric object. Schizophrenia Bulletin 39 (2): 270–277.

    Article  Google Scholar 

  45. Phillips, A. (2012) Missing out. In praise of the unlived life. London: Hamish Hamilton.

    Google Scholar 

  46. Pilgrim, D. and Rogers, A. (2009) Survival and its discontents: The case of British psychiatry. Sociology of Health and Illness 31 (7): 947–961.

    Article  Google Scholar 

  47. Repper, J. and Perkins, R. (2009) Recovery and social inclusion: Changing the mental health agenda. In: C. Brooker and J. Repper (eds.) Mental Health From Policy to Practice. Edinburgh, UK: Churchill Livingstone.

    Google Scholar 

  48. Rose, N. (2003) Neurochemical Selves. Society 41 (1): 46–59.

    Article  Google Scholar 

  49. Rose, N. (2006) The Politics of Life Itself: Biomedicine, Power and Subjectivity in the 21st Century. Princeton, NJ: Princeton University Press.

    Google Scholar 

  50. Rose, N. (2007) Beyond medicalisation. Lancet 369 (9562): 700–701.

    Article  Google Scholar 

  51. Rose, N. (2010) Screen and intervene; Governing risky brains. History of the Human Sciences 23 (1): 79–105.

    Article  Google Scholar 

  52. Rose, N. and Abi-Rached, J. (2013) Neuro. The New Brain Sciences and the Management of the Mind. Princeton and Oxford: Princeton University Press.

    Google Scholar 

  53. Rose, N. and Novas, C. (2004) Biological citizenship. In: A. Ong and S. Collier (eds.) Global Assemblages: Technology, Politics and Ethics as Anthropological Problems. Oxford: Blackwell, pp. 439–463.

    Google Scholar 

  54. Rose, S. (2012) The need for a critical neuroscience. From neuroideology to neurotechnology. In: J. Slaby and S. Choudhury (eds.) Critical Neuroscience. A Handbook of the Social and Cultural Contexts of Neuroscience. Chichester, UK: Wiley- Blackwell.

    Google Scholar 

  55. Rowlands, M. (2010) The New Science of the Mind. From Extended Mind to Embodied Phenomenology. Cambridge, MA: MIT Press.

    Book  Google Scholar 

  56. Sass, L. (2014) Self-disturbance and schizophrenia: Structure, specificity, pathogenesis (current issues, new directions). Schizophrenia Research 152 (1): 5–11.

    Article  Google Scholar 

  57. Sass, L. and Parnas, J. (2003) Schizophrenia, consciousness and the self. Schizophrenia Bulletin 29 (3): 427–444.

    Article  Google Scholar 

  58. Spitzer, R. (2009) APA and DSM-V: Empty promises, Psychiatric Times 2 July, http://www.psychiatrictimes.com/articles/apa-and-dsm-v-empty-promises, accessed 23 April 2014.

  59. Stanghellini, G. (2013) The ethics of incomprehensibility. In: G. Stanghellini and T. Fuchs (2013) One Century of Karl Jaspers’ General Psychopathology. Oxford: Oxford University Press.

    Google Scholar 

  60. Timimi, S. (2013) No more psychiatric labels: Campaign to abolish psychiatric diagnostic systems such as ICD and DSM ( CAPSID). Self and Society 40 (4): 6–14.

    Google Scholar 

  61. Vidal, F. (2009) Brainhood, anthropological figure of modernity. History of the Human Sciences 22 (1): 5–36.

    Article  Google Scholar 

  62. Wallcraft, J. and Michaelson, J. (2001) Developing a survivor discourse to replace the psychopathology of breakdown and crisis. Journal of Critical Psychology, Counselling and Psychotherapy 1 (4): 254–277.

    Google Scholar 

  63. Whitaker, R. (2010) Anatomy of an Epidemic – Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. New York: Broadway paperbacks.

    Google Scholar 

  64. Woods, A. (2013) Rethinking ‘patient testimony’ in the medical humanities: the case of Schizophrenia Bulletin’s first person accounts. Journal of Literature and Science 6 (1): 38–54.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Morgan, A. Is psychiatry dying? Crisis and critique in contemporary psychiatry. Soc Theory Health 13, 141–161 (2015). https://doi.org/10.1057/sth.2015.5

Download citation

Keywords

  • psychiatry
  • critique
  • DSM-5
  • neuroscience
  • crisis
  • mental illness