A Focus On: Psychiatry – Psychology, not Medicine?
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The newest edition (2013) of the American Psychiatric Association’s guide to classification and diagnosis, the DSM-51, highlights both the strengths and problems that modern classification systems raise for psychiatrists, other healthcare professionals, and users of psychiatric services. Many in the psychiatry field value these occasional revisions, which they see as taking steps closer to the perfect classification system. In contrast, other professional groups, including many in clinical psychology as well as a number of service users, view the classification systems with a degree of scepticism and dislike, as witnessed by the British Psychological Society’s criticisms of DSM-52.
The main stumbling block for modern psychiatric classification systems like the DSM is the manner in which they are produced. Large groups of experts confer and attempt to reach consensus, a process about which some of the leading participants have begun to come clean (and to write confessionals)3. Such processes can be vulnerable to a considerable amount of interference, power struggles, and personality conflicts that are in direct opposition to what should ideally be a scientific procedure, rather than a personal one.
An alternative approach to the atheoretical systems currently adopted in modern psychiatry (and to the alternative case formulation approach proposed by clinical psychology) is to identify a theoretical approach instead4. Enough is now known in psychology about emotion, drive, and cognition to sketch out what such a theoretical base might look like. However, a fundamental problem with this approach is that, because there are no identifiable biological signs for psychological disorders, psychology cannot be a branch of medicine5.
Currently, one difference between psychiatrists and psychologists is that, due to their medical training, psychiatrists can prescribe medication to their patients. However, there are now a number of states in the USA where even this difference no longer exists, because clinical psychologists are now allowed to prescribe medication. With this in mind, could psychiatry perhaps be better identified as a branch of psychology? Disorders are based on symptom self-reports made by individuals, the understanding of which must be based on psychological theories of emotion, cognition, and drive-related systems. Thus, the person who is experiencing a hallucination may or may not be experiencing a hallucinatory disorder that is currently labelled as ‘schizophrenia’. This label would be a result of patient/practitioner collaboration, and depend both on an individual’s own psychological construction of the experience and on the social construction by professional and other groups who are informed about that experience.
Mick Power is a clinical psychologist who works in the Rivers Centre for psychological trauma in the Royal Edinburgh Hospital.
1. 'DSM-5 Implementation and Support' American Psychiatric Association: DSM-5 Development, http://www.dsm5.org/Pages/Default.aspx. accessed 23 Jan. 2015
2. British Pyschological Society, British Psychological Society statement on the open letter to the DSM-5 Taskforce (Leicester, UK: British Psychological Society, 2011) http://www.bps.org.uk/sites/default/files/documents/pr1923_attachment_- _final_bps_statement_on_dsm-5_12-12-2011.pdf
3. Frances, A. 2013. Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York, USA: HarperCollins
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