Psychiatry fail: What we know about the current state of psychiatry

I know what you are thinking. Here’s yet another article on the failings of modern psychiatry by either an anti-psychiatry contingent (such as the Church of Scientology) or a psychiatrist who is fed up and throws out the baby with the bathwater. I am neither…I happen to be a psychiatrist who sees the beneficial effects of psychiatry for those who suffer from mental illness. However, much needs to be improved in psychiatry.

Here is what we currently know about modern psychiatry:

• DSM-5 is an epic fail. It is not an improvement on the DSM-IV, as the diagnostic checklists that the DSM (Diagnostic and Statistical Manual of Mental Disorders) uses are fraught with diagnostic unreliability. In other words, diagnosis based on checklist and not objective tests are not going to be reliably diagnosed…in fact, there is greater risk of misdiagnosing people who are normal.
• Psychiatry is the only medical specialty which does not study and utilize its organ of interest for both diagnosis and treatment. Modern psychiatry is still “brainless.”
• The Decade of the Brain in the 1990’s was an epic fail. All of the research dollars that went into finding the cause of mental illness has come up short.
• Psychiatric diagnosis and treatment are heavily influenced by pharmaceutical companies. Pharmaceutical companies benefit from diagnostic inflation. Diagnostic inflation refers to overdiagnosing mental illness in people who don’t have mental illness.
• Only 12 psychiatric disorders have evidence from follow-up studies that they are real, valid illnesses. Much work needs to be done with the multitudes of other diagnoses listed in the DSM-5 to determine if they are valid. And if they are not valid, then they should be discarded.
• Insurance companies have required DSM diagnoses to reimburse for the assessment and treatment of mental illness, and this further leads to diagnostic inflation, where people are misdiagnosed as mentally ill.
• Psychiatry is subject to fads and psychiatrists’ pet projects. Recent fads in psychiatry have included overdiagnosis of pediatric bipolar disorder and overdiagnosis of autism. And psychiatrists may have their pet projects and interests, so if a psychiatrist is an expert at ADHD, they might see everything through an ADHD lens and overdiagnose that in the patients that they see.
• Split treatment has led to poor treatment for those with mental illness. Split treatment refers to the division of labor that occurs when a psychiatrist treats a patient with medication, and a separate therapist sees the same patient for psychotherapy. Split treatment leads to poor conceptualizations and formulations of the patient, and this leads to less than optimal treatment. Insurance company reimbursement is the culprit here, as psychiatrists are not reimbursed adequately for psychotherapy. So psychiatrists rely on the only thing that is reimbursable by the insurance companies…medication treatment. Hmmm…a psychiatrist that does not do counselling or psychotherapy is not practicing the type of psychiatry that helps patients.

Such is the current state of psychiatry. Without objective, biological markers to help psychiatrists diagnose mental illness, psychiatry will continue to be plagued by diagnostic inflation, fad diagnoses, and psychiatrists’ pet projects. In addition, psychiatry has failed to determine its own course, instead letting the pharmaceutical companies and the insurance companies dictate standards of care in psychiatry. Sadly, many psychiatrists refer to themselves as psychopharmacologists, and focus mainly on medication treatment, leading to split treatment. The common pathway for all these problems with a “brainless” psychiatry is that patients with mental illness do not get the optimal treatment they deserve.