Problems with Modern Psychiatry

As seen here

Whenever the specific, biological basis of a formerly psychiatric disorder is fully understood, the disorder tends to leave the realm of psychiatry and become the province of neurologists, or possibly some other kind of doctor such as an infectious disease specialist. I mentioned recently that tertiary syphillis used to be conflated with schizophrenia. Now that we know it is an infectious disease, it is no longer considered a psychiatric disorder. Similarly, the dementias associated with aging used to be considered "insanity," but today people with Alzheimer's Disease and vascular dementia see neurologists, not psychiatrists. (The neurologists can't do anything for them either, but we still pay for visits.)

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Psychiatrists want to be credible within the medical profession. In the past, there was little or no demand that psychiatric treatments be proven efficacious by the methods used for medical treatments. For that matter, medical treatments didn't have to be shown to be effective either, but psychiatry came to the evidence-based game comparatively late.

The theories used by psychiatrists were firmly held and passionately defended, but they were largely speculative and often quite fungible and vague. Psychiatrists used to be convinced that schizophrenia was caused by suppressed conflicts and desires, and that autism was caused by emotionally distant mothers. Now they give drugs for schizophrenia and autism has been handed to the neurologists.

Oh yes, drugs. Although psychiatric disorders, almost by definition, are of unknown etiology, in order to be considered "scientific" psychiatry needs randomized controlled trials. It's a lot easier to do one for a drug than it is for talk therapy.

For one thing, drugs are perfectly standardized -- a specific dose of a specific chemical. Counseling is very difficult to package as a standard product in a standard dose.

For another, although psychiatrists nowadays like to talk about "rewiring neural circuits" by talking to people, they don't really have any way of proving that they have done so.

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So it seems that psychistrists are the folks who treat people when doctors do not know what the medical condition is that causes their 'condition'. Not very encouraging, is it?