A proposed vision for psychiatry at the turn of the century

Psychiatric journals as the mirror of the dominant psychiatric model

Aims and method

Historical trends in the conceptual domains underlying articles published in psychiatric journals are indicators of major psychiatric concerns and practices. Articles inThe American Journal of PsychiatryandThe British Journal of Psychiatryduring the periods 1947–51, 1967–71 and 2002–6 were classified into either a biomedical, psychological or social conceptual domain to determine which domains, if any, were dominant.

Results

InThe American Journal of Psychiatryone or two domains were dominant for two of the three periods. No domain was dominant inThe British Journal of Psychiatry.

Clinical implications

Examined against various scientific and social developments, American psychiatry appears more responsive to current social, scientific and commercial trends and impulses than British psychiatry.

The clinical application of the biopsychosocial model in mental health: a research critique

Engel applied the term biopsychosocial to medicine to emphasize the need to take into account the psychologic and social aspects of medical practice. After an overview of the history of the biopsychosocial (BPS) model, we review criticisms of the model to reformulate its deficiencies and then analyze its application in mental health care. The objectives of this paper are 4-fold: (1) to examine the use of the BPS model since Engel's 1977 article to the present; (2) to examine the reasons for the popularity of the BPS model as well as the problems it faces when applied to mental health care; (3) to introduce two instruments, the International Classification of Functioning, Disability, and Health and the INTERMED, which implement the BPS model; and (4) to show why the BPS model is not yet a model of mental health practice. A total of 62 publications were retrieved and reviewed in the ScienceDirect, PubMed, and Scopus databases, and 32 of them were eventually included in this review. This is the first review of the studies published that applied the BPS model in mental health in the last 33 yrs. These criticisms are used to construct a more workable vision of the BPS model of clinical practice.

Psychiatry under pressure: reflections on psychiatry's drift towards a reductionist biomedical conception of mental illness

We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources--the plea for individual autonomy and the idea of Managed Care--and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mental illness. It ignores that the psychiatrist's profession is essentially characterized by fragility: fluctuating between scientific reduction and the irreducible complexity of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well.

Psychiatrists' views of managed care and the future of psychiatry

Managed care aims to insure the health of a population rather than that of an individual. This paper compiles opinions of psychiatrists and others on managed care and lists ways managed care potentially affects psychiatry. Managed care reverses the economic incentives indemnity insurance gave doctors to prolong treatment. It encourages psychiatrists to spend less time on empathic discussion and to use more standardized, less costly treatments. Many psychiatrists feel distressed about how managed care has changed their practices. Capitation care will change it further. Current trends suggest the U. S. will use and train fewer psychiatrists. Psychiatrists will spend less time with individual patients and more time planning and guiding the treatment of severely impaired patients. Many more psychiatrists will likely have unprecedented changes imposed on their careers.