The Lancet, Volume 379, Issue 9823, Page 1274, 7 April 2012
doi:10.1016/S0140-6736(12)60540-6
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Cite or Link Using DOIPsychiatry's identity crisis
Last week, the American Psychiatric Association issued a press release highlighting an ongoing decline in the recruitment of medical students into the specialty—at a time when the numbers of practising psychiatric professionals in the USA is falling. Various reasons are proposed, including the short-term nature of placements (usually just 4 weeks); the sheer breadth of an evolving specialty, which is drawing students towards newer areas such as clinical neuroscience; and concerns that psychiatry is not as lucrative as other specialties.
Tom Brown, Assistant Registrar of Recruitment at the Royal College of Psychiatrists (RCPsych), UK, views psychiatry's identity crisis as an international problem, and for profound reasons. He told The Lancet: “Common perceptions within the medical profession include the view that psychiatry is just not scientific enough, is too remote from the rest of medicine, is often viewed negatively by other medical professionals, and is a specialty too often characterised by difficult doctor—patient relationships and limited success rates of therapeutic interventions”.
So, what kind of therapy is psychiatry in need of? The RCPsych views the current problem crucial enough for a concerted campaign to promote the specialty, not just to medical students and doctors at foundation stage, but even to senior-school pupils studying psychology. While such initiatives may help raise the profile of psychiatry, perhaps there are more fundamental issues that need to change.
Psychiatrists, first and foremost, are clinicians. Evidence-based approaches should be at the core of the psychiatrist and non-clinical members of any mental health team. The evidence that psychiatric patients have poorer overall health than the general population should ensure that psychiatry is strongly connected to other medical specialties. But more fundamental still, it is time for the specialty to stop devaluing itself because of its chequered history of mental asylums and pseudo-science, and to realign itself as a key biomedical specialty at the heart of mental health.
