In 1980, the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980). This departed radically from its two previous editions (DSM-I, 1952 & DSM-II, 1968). It proved an unexpected best seller, which might have raised an eyebrow or two. This paper compares the two standard medical texts, the ICD-10 and DSM-IV (1994) to illustrate quite how extensive these changes were, and to demonstrate how far they deviate from ordinary medical practice, which, for the purposes of clarification is here boiled down to five basic tasks. Having applied these five to abdominal pains, verbatim extracts from the two texts cited, are compared to see how each fares against the other. Further implications for psychiatric practice in general are discussed in the light of the wider “philosophical” differences revealed. Is medical practice even possible, without taking aetiology, reaction and Patient Agency into full and open consideration? Consciousness is the pinnacle of our biosphere—as a recent paper emphasised—time it received the awe it is due.

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Alcuni recenti editoriali del British Journal of Psychiatry hanno argomentato che la psichiatria sta attraversando una crisi, e che tra le soluzioni vi sarebbe un rafforzamento della sua identita come essenzialmente neuroscienza applicata. Senza sminuire l’importanza delle neuroscienze e della psicofarmacologia, gli Autori sostengono che la psichiatria deve superare l’attuale paradigma tecnologico dominante. Questo rifletterebbe maggiormente le evidenze empiriche e servirebbe anche a rafforzare una collaborazione piu significativa col movimento degli utenti dei servizi psichiatrici. Vengono presi in rassegna vari studi controllati randomizzati (RCT) che mostrano l’efficacia degli interventi non specifici e non tecnologici.

Access the most recent version at DOI: 2012, 201:430-434. BJP Derek Summerfield, Jeremy Wallace and David Yeomans Smyth, Moldavsky, Joanna Moncrieff, Simon Mullins, Julia Nelki, Matteo Pizzo, James Rodger, Marcellino Garland, William Hopkins, Rhodri Huws, Bob Johnson, Brian Martindale, Hugh Middleton, Daniel Browne, Navjyoat Chhina, Duncan Double, Simon Downer, Chris Evans, Suman Fernando, Malcolm R. Pat Bracken, Philip Thomas, Sami Timimi, Eia Asen, Graham Behr, Carl Beuster, Seth Bhunnoo, Ivor Psychiatry beyond the current paradigm

Summary A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.