Thursday, July 18, 2013

Psychiatry Has Nothing to Be Defensive About

APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. Please send your comments to

The integrity of our profession and the science of psychiatry are being questioned—again by articles in the media. Two recent missives, which I found particularly disturbing, are by the noted columnist David Brooks ("Heroes of Uncertainty," New York Times, May 28) who calls psychiatry a “semi-science,” and by Leonard Sax, a British psychologist (Wall Street Journal, June 26), who accused DSM-5 of having “broadened the definition of mental illness to absurdity.” Although the most recent media criticisms have been focused on the process and finished product of DSM-5, such invective is really nothing new. But it may be time to respond in a new way.

I recently wrote an article for the Scientific American blog that explores how stigma and antipsychiatry sentiments fuel prejudice against our field and our patients. But I think it’s also important to note how the unwillingness of the public and pundits to accept psychiatry as a scientific discipline and full-fledged medical specialty perpetuates the false dualism of the mind and the brain—attempting to transport psychiatry back to the Cartesian philosophy of the 17th century. It also undermines the progress that has been made to deconstruct the almost unfathomable complexity of the brain into its constituent neurobiological mechanisms that mediate emotion, perception, and cognition.

The intellectual thrust of psychiatry, throughout its entire history, has been to understand the maladies of the mind in terms of the brain. Prior to the 18th century, mental illness was considered a spiritual or moral affliction. When enlightenment thinking inspired the view of mental illnesses as medical conditions, psychiatrists proceeded to examine the brain but found no visible pathology. Even Freud, a neurologist, appreciated the need to invoke the brain to understand behavior and psychopathology. His “Project for a Scientific Psychology” anticipated a neurobiological explanation for mental processes and unconscious psychic phenomena.

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