A critical appraisal of contemporary psychiatry

More and more is less and less the myth of massive psychiatric need

The idea of massive unmet need for mental health services is a myth, generated and perpetuated by processes within the system which provides psychiatric care and within society. Diffusion of the traditional boundaries of mental health care, lack of norms and standards, medicalisation and 'healthism', specialoid practice and patient selection, diversion of resources from the long-term mentally ill and their absorption by better-functioning patients, substitution and development of new mental health service providers, and changes in the threshold for help-seeking all affect our assumptions of need. Needs are less massive, if the boundaries of psychiatry are defined so as to include only those disorders which the profession is best able to treat.

A reappraisal of American psychiatry

Remarkable changes have taken place in American psychiatry over the past twenty years. The era of psychoanalytical supremacy has passed, and realism is replacing the exaggerated claims which were made of psychiatry's ability to produce personal, social, and even political change. The importance of phenomenology and accurate diagnosis is increasingly recognised, and American researchers have made many impressive contributions to psychiatric genetics and to psychopharmacology. Despite these advances, office practice generally continues to function on an outmoded model and psychiatric resources remain inequitably distributed.