Saving psychiatry from itself: will young psychiatrists choose authoritarian power or authoritative respect?

This editorial comment from John Read appears in Acta Psychiatrica Scandinavica. It begins:

“In their important paper, ‘Images of psychiatry and psychiatrists’, Stuart et al. 1 document the negative beliefs about psychiatrists and psychiatric treatments held by other medical disciplines in 15 countries. How young psychiatrists react to such widespread criticism may be crucial to the future, perhaps even the survival, of their profession.

Psychiatry is facing a crisis of serious proportions. Less than 5% of UK medical students choose psychiatry, partly because of its poor scientific basis 2. The rejection of DSM-5, by senior psychiatrists 34, because of its woefully poor evidence-base and its pathologising of vast swathes of normal reactions to life events or ordinary human variations, is only part of the problem. Research over the last 10 years or so has revealed that the efficacy and safety of antidepressants 5 and antipsychotics 6, and the evidence for the bio-genetic theories 78 that are used to justify the ever increasing prescriptions of such drugs, have been wildly exaggerated.

There would seem to be two choices here, fraught with quite different risks for the profession. The options might be characterised as authoritarian and authoritative. Will psychiatrists dismiss all criticism as symptoms of ‘antipsychiatry disorder’? Or will they locate the problem where it is seen so clearly to be by people outside the profession (professional and client alike) – a rigid adherence to a narrow biogenetic ideology combined with arrogant dismissal of those with broader perspectives? Will they genuinely listen to the concerns of colleagues, service users, carers and medical students and seek to address those concerns in a professional, scientific, authoritative manner? …”

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