Psychiatric Geneticists
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Psychiatry is the
medical specialty A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (pediatrics), cancer (oncology), ...
devoted to the
diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...
, treatment, and prevention of deleterious mental conditions. These include matters related to
cognition Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
,
perception Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. All perception involves signals that go through the nervous syste ...
s, mood,
emotion Emotions are physical and mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavior, behavioral responses, and a degree of pleasure or suffering, displeasure. There is ...
, and
behavior Behavior (American English) or behaviour (British English) is the range of actions of Individual, individuals, organisms, systems or Artificial intelligence, artificial entities in some environment. These systems can include other systems or or ...
. Initial psychiatric assessment of a person begins with creating a case history and conducting a
mental status examination The mental status examination (MSE) is an important part of the clinical Psychiatric assessment, assessment process in Neurology, neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological ...
. Laboratory tests, physical examinations, and
psychological test Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought t ...
s may be conducted. On occasion,
neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the neuroanatomy, structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive ...
or
neurophysiological Neurophysiology is a branch of physiology and neuroscience concerned with the functions of the nervous system and their mechanisms. The term ''neurophysiology'' originates from the Greek word ''νεῦρον'' ("nerve") and ''physiology'' (whic ...
studies are performed. Mental disorders are diagnosed in accordance with diagnostic manuals such as the ''
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
'' (ICD), edited by the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO), and the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
'' (DSM), published by the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
(APA). The fifth edition of the DSM (
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
) was published in May 2013. Treatment may include
psychotropic A psychoactive drug, psychopharmaceutical, mind-altering drug, consciousness-altering drug, psychoactive substance, or psychotropic substance is a chemical substance that alters psychological functioning by modulating central nervous system acti ...
s (psychiatric medicines),
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
, substance-abuse treatment, and other modalities such as interventional approaches,
assertive community treatment Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT teams serve individuals who have been diagnosed with serious and persistent forms of mental illness, predominantly ...
, community reinforcement, and
supported employment Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment. Supported ...
. Treatment may be delivered on an
inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...
or
outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other healt ...
basis, depending on the severity of functional impairment or risk to the individual or community. Research within psychiatry is conducted by
psychiatrist A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
s on an interdisciplinary basis with other professionals, including
clinical psychologists Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or Mental disorder, dysfunction and to promote ...
, epidemiologists,
nurses Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...
,
social workers Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
, and
occupational therapists Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abil ...
. Psychiatry has been controversial since its inception, facing criticism both internally and externally over its
medicalization Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...
of mental distress, reliance on
pharmaceuticals Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the ...
, use of
coercion Coercion involves compelling a party to act in an involuntary manner through the use of threats, including threats to use force against that party. It involves a set of forceful actions which violate the free will of an individual in order to i ...
, influence from the
pharmaceutical industry The pharmaceutical industry is a medical industry that discovers, develops, produces, and markets pharmaceutical goods such as medications and medical devices. Medications are then administered to (or self-administered by) patients for curing ...
, and its historical role in
social control Social control is the regulations, sanctions, mechanisms, and systems that restrict the behaviour of individuals in accordance with social norms and orders. Through both informal and formal means, individuals and groups exercise social con ...
and contentious treatments.


Etymology

The term ''psychiatry'' was first coined by the German
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
Johann Christian Reil in 1808 and literally means the 'medical treatment of the
soul The soul is the purported Mind–body dualism, immaterial aspect or essence of a Outline of life forms, living being. It is typically believed to be Immortality, immortal and to exist apart from the material world. The three main theories that ...
' ('' ψυχή psych-'' 'soul' from
Ancient Greek Ancient Greek (, ; ) includes the forms of the Greek language used in ancient Greece and the classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...
''psykhē'' 'soul'; '' -iatry'' 'medical treatment' from Gk. ιατρικός ''iātrikos'' 'medical' from ιάσθαι ''iāsthai'' 'to heal'). A medical doctor specializing in psychiatry is a
psychiatrist A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
(for a historical overview, see:
Timeline of psychiatry This is a timeline of the modern development of psychiatry. Related information can be found in the Timeline of psychology and Timeline of psychotherapy articles. Early history of psychiatry ;1550 BCE The Ebers papyrus, one of the most importan ...
).


Theory and focus

Psychiatry refers to a field of medicine focused specifically on the
mind The mind is that which thinks, feels, perceives, imagines, remembers, and wills. It covers the totality of mental phenomena, including both conscious processes, through which an individual is aware of external and internal circumstances ...
, aiming to
study Study or studies may refer to: General * Education **Higher education * Clinical trial * Experiment * Field of study * Observational study * Scientific study * Research * Study skills, abilities and approaches applied to learning Other * Study ...
, prevent, and treat
mental disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s in
human Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...
s.. It has been described as an intermediary between the world from a social context and the world from the perspective of those who are mentally ill. People who specialize in psychiatry often differ from most other
mental health professional A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a ...
s and
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
s in that they must be familiar with both the
social Social organisms, including human(s), live collectively in interacting populations. This interaction is considered social whether they are aware of it or not, and whether the exchange is voluntary or not. Etymology The word "social" derives fro ...
and
biological sciences Biology is the scientific study of life and living organisms. It is a broad natural science that encompasses a wide range of fields and unifying principles that explain the structure, function, growth, origin, evolution, and distribution of ...
. The discipline studies the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient. Psychiatry treats mental disorders, which are conventionally divided into three general categories:
mental illnesses A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
, severe learning disabilities, and
personality disorder Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture. ...
s. Although the focus of psychiatry has changed little over time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century, the field of psychiatry has continued to become more biological and less conceptually isolated from other medical fields.


Scope of practice

Though the medical specialty of psychiatry uses research in the field of
neuroscience Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions, and its disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, ...
,
psychology Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...
,
medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
,
biology Biology is the scientific study of life and living organisms. It is a broad natural science that encompasses a wide range of fields and unifying principles that explain the structure, function, growth, History of life, origin, evolution, and ...
,
biochemistry Biochemistry, or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided into three fields: structural biology, enzymology, a ...
, and
pharmacology Pharmacology is the science of drugs and medications, including a substance's origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology. More specifically, it is the study of the interactions that occur betwee ...
, it has generally been considered a middle ground between
neurology Neurology (from , "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine) , medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous syst ...
and psychology. Because psychiatry and neurology are deeply intertwined medical specialties, all certification for both specialties and for their subspecialties is offered by a single board, the American Board of Psychiatry and Neurology, one of the member boards of the American Board of Medical Specialties. Unlike other physicians and neurologists, psychiatrists specialize in the
doctor–patient relationship The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is bui ...
and are trained to varying extents in the use of psychotherapy and other therapeutic communication techniques. Psychiatrists also differ from psychologists in that they are physicians and have post-graduate training called residency (usually four to five years) in psychiatry; the quality and thoroughness of their graduate medical training is identical to that of all other physicians. Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order
neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the neuroanatomy, structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive ...
, and conduct
physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...
s. As well, some psychiatrists are trained in
interventional psychiatry Interventional Psychiatry is a subspecialty within the field of psychiatry, focusing on the use of procedural and device-based treatments to manage mental health disorders, particularly those resistant to conventional therapies such as pharmacothe ...
and can deliver interventional treatments such as
electroconvulsive therapy Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment that causes a generalized seizure by passing electrical current through the brain. ECT is often used as an intervention for mental disorders when other treatments are inadequ ...
,
transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a noninvasive neurostimulation technique in which a changing magnetic field is used to induce an electric current in a targeted area of the brain through electromagnetic induction. A device called a st ...
, vagus nerve stimulation and
ketamine Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) a ...
.


Ethics

The
World Psychiatric Association The World Psychiatric Association (WPA) is an international Umbrella organization, umbrella organisation of psychiatric societies. Objectives and goals Originally created to produce world psychiatric congresses, it has evolved to hold regional ...
issues an
ethical code Ethical codes are adopted by organizations to assist members in understanding the difference between right and wrong and in applying that understanding to their decisions. An ethical code generally implies documents at three levels: codes of b ...
to govern the conduct of psychiatrists (like other purveyors of
professional ethics Professional ethics encompass the personal and corporate standards of behavior expected of professionals. The word professionalism originally applied to vows of a religious order. By no later than the year 1675, the term had seen secular appli ...
). The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977 has been expanded through a 1983 Vienna update and in the broader Madrid Declaration in 1996. The code was further revised during the organization's general assemblies in 1999, 2002, 2005, and 2011. The World Psychiatric Association code covers such matters as
confidentiality Confidentiality involves a set of rules or a promise sometimes executed through confidentiality agreements that limits the access to or places restrictions on the distribution of certain types of information. Legal confidentiality By law, la ...
, the
death penalty Capital punishment, also known as the death penalty and formerly called judicial homicide, is the state-sanctioned killing of a person as punishment for actual or supposed misconduct. The sentence ordering that an offender be punished in s ...
, ethnic or cultural discrimination,
euthanasia Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different Legality of euthanasia, euthanasia laws. The British House of Lords Select committee (United Kingdom), se ...
, genetics, the
human dignity Dignity is a human's contentment attained by satisfying physiological needs and a need in development. The content of contemporary dignity is derived in the new natural law theory as a distinct human good. As an extension of the Age of Enlighten ...
of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection,
coercion Coercion involves compelling a party to act in an involuntary manner through the use of threats, including threats to use force against that party. It involves a set of forceful actions which violate the free will of an individual in order to i ...
,
torture Torture is the deliberate infliction of severe pain or suffering on a person for reasons including corporal punishment, punishment, forced confession, extracting a confession, interrogational torture, interrogation for information, or intimid ...
, and up-to-date knowledge. In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of
lobotomy A lobotomy () or leucotomy is a discredited form of Neurosurgery, neurosurgical treatment for mental disorder, psychiatric disorder or neurological disorder (e.g. epilepsy, Depression in childhood and adolescence, depression) that involves sev ...
and
electroconvulsive therapy Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment that causes a generalized seizure by passing electrical current through the brain. ECT is often used as an intervention for mental disorders when other treatments are inadequ ...
. Discredited psychiatrists who operated outside the norms of
medical ethics Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. T ...
include Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky.


Approaches

Psychiatric illnesses can be conceptualised in a number of different ways. The
biomedical Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine)
approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. Both approaches are important in the field of psychiatry but have not sufficiently reconciled to settle
controversy Controversy (, ) is a state of prolonged public dispute or debate, usually concerning a matter of conflicting opinion or point of view. The word was coined from the Latin '' controversia'', as a composite of ''controversus'' – "turned in an op ...
over either the selection of a psychiatric
paradigm In science and philosophy, a paradigm ( ) is a distinct set of concepts or thought patterns, including theories, research methods, postulates, and standards for what constitute legitimate contributions to a field. The word ''paradigm'' is Ancient ...
or the specification of
psychopathology Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes Abnormal psychology, abnormal cognition, maladaptive behavior, and experiences which differ according to social norms ...
. The notion of a "
biopsychosocial model Biopsychosocial models (BPSM) are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio- environmental factors. These models specifically examine how these aspects play a role in a range o ...
" is often used to underline the multifactorial nature of clinical impairment. In this notion the word ''model'' is not used in a strictly scientific way though. Alternatively, Niall McLaren acknowledges the physiological basis for the mind's existence but identifies
cognition Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
as an irreducible and independent realm in which disorder may occur. The biocognitive approach includes a
mentalist Mentalism is a performing art in which its practitioners, known as mentalists, appear to demonstrate highly developed mental or intuitive abilities. Mentalists perform a theatrical act that includes special effects that may appear to employ ps ...
etiology Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origins ...
and provides a natural
dualist Dualism most commonly refers to: * Mind–body dualism, a philosophical view which holds that mental phenomena are, at least in certain respects, not physical phenomena, or that the mind and the body are distinct and separable from one another * P ...
(i.e., non-spiritual) revision of the biopsychosocial view, reflecting the efforts of
Australian Australian(s) may refer to: Australia * Australia, a country * Australians, citizens of the Commonwealth of Australia ** European Australians ** Anglo-Celtic Australians, Australians descended principally from British colonists ** Aboriginal Aus ...
psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of
philosopher Philosophy ('love of wisdom' in Ancient Greek) is a systematic study of general and fundamental questions concerning topics like existence, reason, knowledge, Value (ethics and social sciences), value, mind, and language. It is a rational an ...
Thomas Kuhn Thomas Samuel Kuhn (; July 18, 1922 – June 17, 1996) was an American History and philosophy of science, historian and philosopher of science whose 1962 book ''The Structure of Scientific Revolutions'' was influential in both academic and ...
. Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from.
Humanistic psychology Humanistic psychology is a psychological perspective that arose in the mid-20th century in answer to two theories: Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviorism. Thus, Abraham Maslow established the need for a "third force" ...
attempts to put the "whole" of the patient in perspective; it also focuses on self exploration.
Behaviorism Behaviorism is a systematic approach to understand the behavior of humans and other animals. It assumes that behavior is either a reflex elicited by the pairing of certain antecedent stimuli in the environment, or a consequence of that indivi ...
is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or ''subconscious''.
Psychoanalysis PsychoanalysisFrom Greek language, Greek: and is a set of theories and techniques of research to discover unconscious mind, unconscious processes and their influence on conscious mind, conscious thought, emotion and behaviour. Based on The Inte ...
, on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.


Practitioners

All
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry.
Psychiatrist A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
s are trained physicians who specialize in psychiatry and are certified to treat
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
. They may treat outpatients, inpatients, or both; they may practice as solo practitioners or as members of groups; they may be self-employed, be members of partnerships, or be employees of governmental, academic, nonprofit, or for-profit entities; employees of hospitals; they may treat military personnel as civilians or as members of the military; and in any of these settings they may function as clinicians, researchers, teachers, or some combination of these. Although psychiatrists may also go through significant training to conduct
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
,
psychoanalysis PsychoanalysisFrom Greek language, Greek: and is a set of theories and techniques of research to discover unconscious mind, unconscious processes and their influence on conscious mind, conscious thought, emotion and behaviour. Based on The Inte ...
or
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...
, it is their training as physicians that differentiates them from other
mental health professional A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a ...
s.


As a career choice in the US

Psychiatry was not a popular career choice among medical students, even though medical school placements are rated favorably. This has resulted in a significant shortage of psychiatrists in the United States and elsewhere. Strategies to address this shortfall have included the use of short 'taster' placements early in the medical school curriculum and attempts to extend psychiatry services further using telemedicine technologies and other methods. Recently, however, there has been an increase in the number of medical students entering into a psychiatry residency. There are several reasons for this surge, including the intriguing nature of the field, growing interest in genetic biomarkers involved in psychiatric diagnoses, and newer pharmaceuticals on the drug market to treat psychiatric illnesses.


Subspecialties

The field of psychiatry has many subspecialties that require additional training and certification by the
American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology, Inc. (ABPN) is a not-for-profit corporation founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and the t ...
(ABPN). Such subspecialties include: * Addiction psychiatry,
addiction medicine Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with addiction, of those with substance-related and addictive disorders, and of people who show unhealthy u ...
* Brain injury medicine *
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial fac ...
* Consultation-liaison psychiatry *
Forensic psychiatry Forensic psychiatry is a subspecialty of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatr ...
*
Geriatric psychiatry Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment ...
* Hospice and palliative medicine *
Sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions a ...
Additional psychiatry subspecialties, for which the ABPN does not provide formal certification, include: *
Biological psychiatry Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biology, biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as ...
* Community psychiatry *
Cross-cultural psychiatry Cross-cultural psychiatry (also known as ethnopsychiatry or transcultural psychiatry or cultural psychiatry) is a branch of psychiatry concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psy ...
* Emergency psychiatry *
Evolutionary psychiatry Evolutionary psychiatry, also known as Darwinian Psychiatry, is a theoretical approach to psychiatry that aims to explain psychiatric disorders in evolutionary terms. As a branch of the field of evolutionary medicine, it is distinct from the medic ...
*
Global mental health Global mental health is the international perspective on different aspects of mental health. It is 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worl ...
*
Learning disabilities Learning disability, learning disorder, or learning difficulty (British English) is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficulty ...
*
Military psychiatry Military psychiatry covers special aspects of psychiatry and mental disorders within the military context.Temple, M. & Greenberg, N. (2002)Military psychiatry. ''British Medical Journal Career Focus, 324'', S161a.Walter Reed Army Institute of Resear ...
*
Neurodevelopmental disorder Neurodevelopmental disorders are a group of mental conditions negatively affecting the development of the nervous system, which includes the brain and spinal cord. According to the American Psychiatric Association Diagnostic and Statistical Manu ...
s *
Neuropsychiatry Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind i ...
*
Interventional Psychiatry Interventional Psychiatry is a subspecialty within the field of psychiatry, focusing on the use of procedural and device-based treatments to manage mental health disorders, particularly those resistant to conventional therapies such as pharmacothe ...
*
Social psychiatry Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, m ...
Addiction psychiatry focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.
Biological psychiatry Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biology, biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as ...
is an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system.
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial fac ...
is the branch of psychiatry that specializes in work with children, teenagers, and their families. Community psychiatry is an approach that reflects an inclusive
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...
perspective and is practiced in
community mental health services Community mental health services (CMHS), also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of ...
.
Cross-cultural psychiatry Cross-cultural psychiatry (also known as ethnopsychiatry or transcultural psychiatry or cultural psychiatry) is a branch of psychiatry concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psy ...
is a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services. Emergency psychiatry is the clinical application of psychiatry in emergency settings.
Forensic psychiatry Forensic psychiatry is a subspecialty of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatr ...
utilizes medical science generally, and psychiatric knowledge and assessment methods in particular, to help answer legal questions.
Geriatric psychiatry Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment ...
is a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in the
elderly Old age is the range of ages for people nearing and surpassing life expectancy. People who are of old age are also referred to as: old people, elderly, elders, senior citizens, seniors or older adults. Old age is not a definite biological sta ...
.
Global mental health Global mental health is the international perspective on different aspects of mental health. It is 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worl ...
is an area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide, although some scholars consider it to be a neo-colonial, culturally insensitive project.
Liaison psychiatry Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry, is the branch of psychiatry that specialises in the interface between general medicine/pediatrics and psychiatry, usually taking place in a hospital or ...
is the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry.
Military psychiatry Military psychiatry covers special aspects of psychiatry and mental disorders within the military context.Temple, M. & Greenberg, N. (2002)Military psychiatry. ''British Medical Journal Career Focus, 324'', S161a.Walter Reed Army Institute of Resear ...
covers special aspects of psychiatry and mental disorders within the military context.
Neuropsychiatry Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychology factors. Within neuropsychiatry, the mind i ...
is a branch of medicine dealing with mental disorders attributable to diseases of the nervous system.
Social psychiatry Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, m ...
is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being. In larger healthcare organizations, psychiatrists often serve in senior management roles, where they are responsible for the efficient and effective delivery of mental health services for the organization's constituents. For example, the Chief of Mental Health Services at most VA medical centers is usually a psychiatrist, although psychologists occasionally are selected for the position as well. In the United States, psychiatry is one of the few specialties which qualify for further education and board-certification in
pain medicine Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...
, palliative medicine, and
sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions a ...
.


Research

Psychiatric research is, by its very nature, interdisciplinary; combining social, biological and psychological perspectives in attempt to understand the nature and treatment of mental disorders. Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals. Under the supervision of
institutional review board An institutional review board (IRB), also known as an independent ethics committee (IEC), ethical review board (ERB), or research ethics board (REB), is a committee at an institution that applies research ethics by reviewing the methods proposed ...
s, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology in order to enhance diagnostic validity and reliability, to discover new treatment methods, and to classify new mental disorders.


Clinical application


Diagnostic systems

Psychiatric diagnoses take place in a wide variety of settings and are performed by many different
health professionals A health professional, healthcare professional (HCP), or healthcare worker (sometimes abbreviated as HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physi ...
. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a
differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...
procedure where a
mental status examination The mental status examination (MSE) is an important part of the clinical Psychiatric assessment, assessment process in Neurology, neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological ...
and physical examination is conducted, with
pathological Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...
, psychopathological or
psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
histories obtained, and sometimes neuroimages or other
neurophysiological Neurophysiology is a branch of physiology and neuroscience concerned with the functions of the nervous system and their mechanisms. The term ''neurophysiology'' originates from the Greek word ''νεῦρον'' ("nerve") and ''physiology'' (whic ...
measurements are taken, or
personality test A personality test is a method of assessing human personality construct (psychology), constructs. Most personality assessment instruments (despite being loosely referred to as "personality tests") are in fact introspective (i.e., subjective) self ...
s or
cognitive test Cognitive tests are assessments of the cognitive capabilities of humans and other animals. Tests administered to humans include various forms of IQ tests; those administered to animals include the mirror test (a test of visual self-awareness) and ...
s administered. In some cases, a brain scan might be used to rule out other medical illnesses, but at this time relying on brain scans alone cannot accurately diagnose a mental illness or tell the risk of getting a mental illness in the future. Some clinicians are beginning to utilize
genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinians, Augustinian ...
and automated
speech Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, suc ...
assessment during the diagnostic process but on the whole these remain research topics.


Potential use of MRI/fMRI in diagnosis

In 2018, the
American Psychological Association The American Psychological Association (APA) is the main professional organization of psychologists in the United States, and the largest psychological association in the world. It has over 170,000 members, including scientists, educators, clin ...
commissioned a review to reach a consensus on whether modern clinical
MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...
/
fMRI Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should: #"have a sensitivity of at least 80% for detecting a particular psychiatric disorder" #"should have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders" #"should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive" #"proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal" The review concluded that although
neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the neuroanatomy, structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive ...
diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.


Diagnostic manuals

Three main diagnostic manuals used to classify mental health conditions are in use today. The
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
is produced and published by the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
, includes a section on psychiatric conditions, and is used worldwide. The
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
, produced and published by the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
(APA), is primarily focused on mental health conditions and is the main classification tool in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
. It is currently in its fifth revised edition and is also used worldwide. The
Chinese Society of Psychiatry The Chinese Society of Psychiatry (CSP; ) is the largest organization for psychiatrists in China. It publishes the Chinese Classification of Mental Disorders ("CCMD"), first published in 1985. The CSP also publishes clinical practice guidelines; ...
has also produced a diagnostic manual, the
Chinese Classification of Mental Disorders The Chinese Classification of Mental Disorders (CCMD; ), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders. It is on its third version, the CCMD-3, written in Chinese an ...
. The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed upon standards, whilst being atheoretical as regards etiology. However, the categories are nevertheless based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur together. While originally intended only as a guide for experienced clinicians trained in its use, the nomenclature is now widely used by clinicians, administrators and insurance companies in many countries. The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and
reliability Reliability, reliable, or unreliable may refer to: Science, technology, and mathematics Computing * Data reliability (disambiguation), a property of some disk arrays in computer storage * Reliability (computer networking), a category used to des ...
of the diagnostic categories; the reliance on superficial
symptoms Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...
; the use of artificial dividing lines between categories and from ' normality'; possible
cultural Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...
bias;
medicalization Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...
of human distress and financial
conflicts of interest A conflict of interest (COI) is a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another. Typically, this relates to situations in whi ...
, including with the practice of psychiatrists and with the
pharmaceutical industry The pharmaceutical industry is a medical industry that discovers, develops, produces, and markets pharmaceutical goods such as medications and medical devices. Medications are then administered to (or self-administered by) patients for curing ...
; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement.


Treatment


General considerations

Individuals receiving psychiatric treatment are commonly referred to as ''
patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ...
s'' but may also be called ''
client Client(s) or The Client may refer to: * Client (business) * Client (computing), hardware or software that accesses a remote service on another computer * Customer or client, a recipient of goods or services in return for monetary or other valuable ...
s'', ''
consumer A consumer is a person or a group who intends to order, or use purchased goods, products, or services primarily for personal, social, family, household and similar needs, who is not directly related to entrepreneurial or business activities. ...
s'', or ''service recipients''. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self- referral or referral by a
primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...
. Alternatively, a person may be referred by hospital medical staff, by
court order A court order is an official proclamation by a judge (or panel of judges) that defines the legal relationships between the parties to a hearing, a trial, an appeal or other court proceedings. Such ruling requires or authorizes the carrying o ...
,
involuntary commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation, or informally in Britain sectioning, being sectioned, commitment, or being committed, is a legal process through which an individual who is deemed by a qual ...
, or, in countries such as the UK and Australia, by
sectioning Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation, or informally in Britain sectioning, being sectioned, commitment, or being committed, is a legal process through which an individual who is deemed by a qual ...
under a
mental health law Mental health law includes a wide variety of legal topics and pertain to people with a diagnosis or possible diagnosis of a mental health condition, and to those involved in managing or treating such people. Laws that relate to mental health incl ...
. A psychiatrist or medical provider evaluates people through a
psychiatric assessment A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but ...
for their mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement personnel, emergency medical personnel, and psychiatric rating scales. A
mental status examination The mental status examination (MSE) is an important part of the clinical Psychiatric assessment, assessment process in Neurology, neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological ...
is carried out, and a
physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...
is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems. A physical examination may also serve to identify any signs of
self-harm Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...
; this examination is often performed by someone other than the psychiatrist, especially if
blood test A blood test is a medical laboratory, laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose ...
s and
medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...
are performed. Like most medications, psychiatric medications can cause
adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complic ...
in patients, and some require ongoing therapeutic drug monitoring, for instance
full blood count A complete blood count (CBC), also known as a full blood count (FBC) or full haemogram (FHG), is a set of medical laboratory tests that provide cytometry, information about the cells in a person's blood. The CBC indicates the counts of white blo ...
s, serum drug levels, renal function, liver function or thyroid function.
Electroconvulsive therapy Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment that causes a generalized seizure by passing electrical current through the brain. ECT is often used as an intervention for mental disorders when other treatments are inadequ ...
(ECT) is sometimes administered for serious conditions, such as those unresponsive to medication. The efficacy and adverse effects of psychiatric drugs may vary from patient to patient.


Inpatient treatment

Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Average inpatient psychiatric treatment stay has decreased significantly since the 1960s, a trend known as
deinstitutionalization Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the 195 ...
. Today in most countries, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization. However, in Japan psychiatric hospitals continue to keep patients for long periods, sometimes even keeping them in physical restraints, strapped to their beds for periods of weeks or months. Psychiatric inpatients are people admitted to a hospital or clinic to receive psychiatric care. Some are admitted involuntarily, perhaps committed to a secure hospital, or in some jurisdictions to a facility within the prison system. In many countries including the United States and Canada, the criteria for involuntary admission vary with local jurisdiction. They may be as broad as having a mental health condition, or as narrow as being an immediate danger to themselves or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities. People may be admitted voluntarily if the treating doctor considers that safety is not compromised by this less restrictive option. For many years, controversy has surrounded the use of involuntary treatment and use of the term "lack of insight" in describing patients. Internationally, mental health laws vary significantly but in many cases, involuntary psychiatric treatment is permitted when there is deemed to be a significant risk to the patient or others due to the patient's illness. Involuntary treatment refers to treatment that occurs based on a treating physician's recommendations, without requiring consent from the patient. Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed, monitored, and often given medication and care from a multidisciplinary team, which may include physicians, pharmacists, psychiatric nurse practitioners, psychiatric nurses, clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision and may be put in physical restraints or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own. In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Italy has been a pioneer in psychiatric reform, particularly through the no-restraint initiative that began nearly fifty years ago. The Italian movement, heavily influenced by Franco Basaglia, emphasizes ethical treatment and the elimination of physical restraints in psychiatric care. A study examining the application of these principles in Italy found that 14 general hospital psychiatric units reported zero restraint incidents in 2022. Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed.


Outpatient treatment

Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. During initial appointments, a psychiatrist generally conducts a psychiatric assessment or evaluation of the patient. Follow-up appointments then focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient's mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms. The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best. Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications), as opposed to previous practice in which a psychiatrist would provide traditional 50-minute psychotherapy sessions, of which psychopharmacology would be a part, but most of the consultation sessions consisted of "talk therapy". This shift began in the early 1980s and accelerated in the 1990s and 2000s. A major reason for this change was the advent of managed care insurance plans, which began to limit reimbursement for psychotherapy sessions provided by psychiatrists. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy, and it could be delivered more efficiently because less time is required for the appointment. Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e.g., clinical social workers and psychologists.


Telepsychiatry


History


Earliest knowledge

The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text,
Charaka Samhita The ''Charaka Samhita'' () is a Sanskrit text on Ayurveda (Indian traditional medicine). Along with the '' Sushruta Samhita'', it is one of the two foundational texts of this field that have survived from ancient India. It is one of the three w ...
. The first hospitals for curing mental illness were established in India during the 3rd century BCE. Greek philosophers, including
Thales Thales of Miletus ( ; ; ) was an Ancient Greek philosophy, Ancient Greek Pre-Socratic philosophy, pre-Socratic Philosophy, philosopher from Miletus in Ionia, Asia Minor. Thales was one of the Seven Sages of Greece, Seven Sages, founding figure ...
,
Plato Plato ( ; Greek language, Greek: , ; born  BC, died 348/347 BC) was an ancient Greek philosopher of the Classical Greece, Classical period who is considered a foundational thinker in Western philosophy and an innovator of the writte ...
, and
Aristotle Aristotle (; 384–322 BC) was an Ancient Greek philosophy, Ancient Greek philosopher and polymath. His writings cover a broad range of subjects spanning the natural sciences, philosophy, linguistics, economics, politics, psychology, a ...
(especially in his treatise), also addressed the workings of the mind. As early as the 4th century BC, the Greek physician
Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...
theorized that
mental disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s had physical rather than supernatural causes. In 387 BCE, Plato suggested that the brain is where mental processes take place. In 4th to 5th century B.C. Greece, Hippocrates wrote that he visited
Democritus Democritus (, ; , ''Dēmókritos'', meaning "chosen of the people"; – ) was an Ancient Greece, Ancient Greek Pre-Socratic philosophy, pre-Socratic philosopher from Abdera, Thrace, Abdera, primarily remembered today for his formulation of an ...
and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democritus had with him a book on madness and melancholy. During the 5th century BCE, mental disorders, especially those with
psychotic In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...
traits, were considered
supernatural Supernatural phenomena or entities are those beyond the Scientific law, laws of nature. The term is derived from Medieval Latin , from Latin 'above, beyond, outside of' + 'nature'. Although the corollary term "nature" has had multiple meanin ...
in origin, a view which existed throughout
ancient Greece Ancient Greece () was a northeastern Mediterranean civilization, existing from the Greek Dark Ages of the 12th–9th centuries BC to the end of classical antiquity (), that comprised a loose collection of culturally and linguistically r ...
and
Rome Rome (Italian language, Italian and , ) is the capital city and most populated (municipality) of Italy. It is also the administrative centre of the Lazio Regions of Italy, region and of the Metropolitan City of Rome. A special named with 2, ...
, as well as Egyptian regions. Alcmaeon, believed the
brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
, not the
heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...
, was the "organ of thought". He tracked the ascending sensory nerves from the body to the brain, theorizing that mental activity originated in the CNS and that the cause of
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
resided within the brain. He applied this understanding to classify mental diseases and treatments. Religious leaders often turned to versions of
exorcism Exorcism () is the religious or spiritual practice of evicting demons, jinns, or other malevolent spiritual entities from a person, or an area, that is believed to be possessed. Depending on the spiritual beliefs of the exorcist, this may be do ...
to treat mental disorders often utilizing methods that many consider to be cruel or barbaric methods. Trepanning was one of these methods used throughout history. In the 6th century AD, Lin Xie carried out an early psychological experiment, in which he asked people to draw a square with one hand and at the same time draw a circle with the other (ostensibly to test people's vulnerability to distraction). It has been cited that this was an early psychiatric experiment. The
Islamic Golden Age The Islamic Golden Age was a period of scientific, economic, and cultural flourishing in the history of Islam, traditionally dated from the 8th century to the 13th century. This period is traditionally understood to have begun during the reign o ...
fostered early studies in Islamic psychology and psychiatry, with many scholars writing about mental disorders. The Persian physician
Muhammad ibn Zakariya al-Razi Abū Bakr al-Rāzī, also known as Rhazes (full name: ), , was a Persian physician, philosopher and alchemist who lived during the Islamic Golden Age. He is widely regarded as one of the most important figures in the history of medicine, and a ...
, also known as "Rhazes", wrote texts about psychiatric conditions in the 9th century. As chief physician of a hospital in Baghdad, he was also the director of one of the first
bimaristan A bimaristan (; ), or simply maristan, known in Arabic also as ("house of healing"; in Turkish), is a hospital in the historic Islamic world. Its origins can be traced back to Sassanian Empire prior to the Muslim conquest of Persia. The word ...
s in the world. The first
bimaristan A bimaristan (; ), or simply maristan, known in Arabic also as ("house of healing"; in Turkish), is a hospital in the historic Islamic world. Its origins can be traced back to Sassanian Empire prior to the Muslim conquest of Persia. The word ...
was founded in
Baghdad Baghdad ( or ; , ) is the capital and List of largest cities of Iraq, largest city of Iraq, located along the Tigris in the central part of the country. With a population exceeding 7 million, it ranks among the List of largest cities in the A ...
in the 9th century, and several others of increasing complexity were created throughout the
Arab world The Arab world ( '), formally the Arab homeland ( '), also known as the Arab nation ( '), the Arabsphere, or the Arab states, comprises a large group of countries, mainly located in West Asia and North Africa. While the majority of people in ...
in the following centuries. Some of the bimaristans contained wards dedicated to the care of mentally ill patients. During the
Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of global history. It began with the fall of the Western Roman Empire and ...
,
Psychiatric hospital A psychiatric hospital, also known as a mental health hospital, a behavioral health hospital, or an asylum is a specialized medical facility that focuses on the treatment of severe Mental disorder, mental disorders. These institutions cater t ...
s and lunatic asylums were built and expanded throughout
Europe Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west, the Mediterranean Sea to the south, and Asia to the east ...
. Specialist hospitals such as
Bethlem Royal Hospital Bethlem Royal Hospital, also known as St Mary Bethlehem, Bethlehem Hospital and Bedlam, is a psychiatric hospital in Bromley, London. Its famous history has inspired several horror books, films, and television series, most notably ''Bedlam (194 ...
in
London London is the Capital city, capital and List of urban areas in the United Kingdom, largest city of both England and the United Kingdom, with a population of in . London metropolitan area, Its wider metropolitan area is the largest in Wester ...
were built in
medieval Europe In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of World history (field), global history. It began with the fall of the West ...
from the 13th century to treat mental disorders, but were used only as custodial institutions and did not provide any type of treatment. It is the oldest extant psychiatric hospital in the world.. An ancient text known as '' The Yellow Emperor's Classic of Internal Medicine'' identifies the brain as the nexus of wisdom and sensation, includes theories of personality based on yin–yang balance, and analyzes mental disorder in terms of physiological and social disequilibria. Chinese scholarship that focused on the brain advanced during the
Qing Dynasty The Qing dynasty ( ), officially the Great Qing, was a Manchu-led Dynasties of China, imperial dynasty of China and an early modern empire in East Asia. The last imperial dynasty in Chinese history, the Qing dynasty was preceded by the ...
with the work of Western-educated Fang Yizhi (1611–1671), Liu Zhi (1660–1730), and Wang Qingren (1768–1831). Wang Qingren emphasized the importance of the brain as the center of the nervous system, linked mental disorder with brain diseases, investigated the causes of dreams,
insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...
,
psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...
, depression and
epilepsy Epilepsy is a group of Non-communicable disease, non-communicable Neurological disorder, neurological disorders characterized by a tendency for recurrent, unprovoked Seizure, seizures. A seizure is a sudden burst of abnormal electrical activit ...
.


Medical specialty

The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century, although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. In 1713, the Bethel Hospital Norwich was opened, the first purpose-built asylum in England. In 1656,
Louis XIV of France LouisXIV (Louis-Dieudonné; 5 September 16381 September 1715), also known as Louis the Great () or the Sun King (), was King of France from 1643 until his death in 1715. His verified reign of 72 years and 110 days is the List of longest-reign ...
created a public system of hospitals for those with mental disorders, but as in England, no real treatment was applied. During the
Enlightenment Enlightenment or enlighten may refer to: Age of Enlightenment * Age of Enlightenment, period in Western intellectual history from the late 17th to late 18th century, centered in France but also encompassing (alphabetically by country or culture): ...
, attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. In 1758, English physician
William Battie William Battie (sometimes spelt Batty;) 1 September 1704 – 13 June 1776) was an English physician who published, in 1758, ''A Treatise on Madness'', a highly influential book on the use of institutionalisation and shock therapy as methods of ...
wrote his ''Treatise on Madness'' on the management of
mental disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
. It was a critique aimed particularly at the Bethlem Royal Hospital, where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family. He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind. The introduction of moral treatment was initiated independently by the French doctor
Philippe Pinel Philippe Pinel (; 20 April 1745 – 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist. He was instrumental in the development of a more humane psychological approach to the custody and care of ps ...
and the English
Quaker Quakers are people who belong to the Religious Society of Friends, a historically Protestant Christian set of denominations. Members refer to each other as Friends after in the Bible, and originally, others referred to them as Quakers ...
William Tuke William Tuke (24 March 1732 – 6 December 1822), an English tradesman, philanthropist and Quakers, Quaker, earned fame for promoting more humane custody and care for people with mental disorders, using what he called gentler methods that cam ...
. In 1792, Pinel became the chief physician at the Bicêtre Hospital. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel's student and successor,
Jean Esquirol Jean may refer to: People * Jean (female given name) * Jean (male given name) * Jean (surname) Fictional characters * Jean Grey, a Marvel Comics character * Jean Valjean, fictional character in novel ''Les Misérables'' and its adaptations * Jea ...
(1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles. Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the
Lincoln Asylum The Lawn is an early nineteenth century Greek revival building on Union Road, in Lincoln, Lincolnshire, England, to the west of Lincoln Cathedral. The complex features a walled garden and children's play area. The building housed The Lawn Hos ...
in England,
Robert Gardiner Hill Robert Gardiner Hill MD (26 February 1811 – 30 May 1878) was a British surgeon specialising in the treatment of lunatic, lunacy. He is normally credited with being the first superintendent of a small Insane asylum, asylum (approximately 100 p ...
, with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with—a situation he finally achieved in 1838. In 1839, Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum, by then the largest in the country. The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. In England, the Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of
mentally ill A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
people to
patients A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other healt ...
who required treatment. All asylums were required to have written regulations and to have a resident qualified
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
.Wright, David: "Mental Health Timeline", 1999 In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The
Utica State Hospital The Utica Psychiatric Center, also known as Utica State Hospital, opened in Utica, New York, Utica on January 16, 1843. It was New York (state), New York's first state-run facility designed to care for the mentally ill, and one of the ...
was opened around 1850. Many state hospitals in the United States were built in the 1850s and 1860s on the
Kirkbride Plan The Kirkbride Plan was a system of mental asylum design advocated by American psychiatrist Thomas Story Kirkbride (1809–1883) in the mid-19th century. The asylums built in the Kirkbride design, often referred to as Kirkbride Buildings (or simp ...
, an architectural style meant to have curative effect. At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization ran into difficulties.. Psychiatrists were pressured by an ever-increasing patient population, and asylums again became almost indistinguishable from custodial institutions. In the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include
mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the ''Diagnostic ...
s, in addition to disease level
delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...
or irrationality. The 20th century introduced a new psychiatry into the world, with different perspectives of looking at mental disorders. For
Emil Kraepelin Emil Wilhelm Georg Magnus Kraepelin (; ; 15 February 1856 – 7 October 1926) was a German psychiatrist. H. J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric ...
, the initial ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature, evolved into a new concept of "nerves", and psychiatry became a rough approximation of neurology and neuropsychiatry. Following
Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies seen as originating fro ...
's pioneering work, ideas stemming from
psychoanalytic theory Psychoanalytic theory is the theory of the innate structure of the human soul and the dynamics of personality development relating to the practice of psychoanalysis, a method of research and for treating of Mental disorder, mental disorders (psych ...
also began to take root in psychiatry.. The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums. By the 1970s, however, the psychoanalytic school of thought became marginalized within the field. Biological psychiatry reemerged during this time.
Psychopharmacology Psychopharmacology (from Greek ; ; and ) is the scientific study of the effects drugs have on mood, sensation, thinking, behavior, judgment and evaluation, and memory. It is distinguished from neuropsychopharmacology, which emphasizes ...
and
neurochemistry Neurochemistry is the study of chemicals, including neurotransmitters and other molecules such as psychopharmaceuticals and neuropeptides, that control and influence the physiology of the nervous system. This particular field within neuroscience e ...
became the integral parts of psychiatry starting with
Otto Loewi Otto Loewi (; 3 June 1873 – 25 December 1961) was a Germany, German-born pharmacology, pharmacologist and psychobiologist who discovered the role of acetylcholine as an endogenous neurotransmitter. For this discovery, he was awarded the Nobel ...
's discovery of the neuromodulatory properties of
acetylcholine Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...
; thus identifying it as the first-known neurotransmitter. Subsequently, it has been shown that different neurotransmitters have different and multiple functions in regulation of behaviour. In a wide range of studies in neurochemistry using human and animal samples, individual differences in neurotransmitters' production, reuptake, receptors' density and locations were linked to differences in dispositions for specific psychiatric disorders. For example, the discovery of
chlorpromazine Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar d ...
's effectiveness in treating
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
in 1952 revolutionized treatment of the disorder, as did
lithium carbonate Lithium carbonate is an inorganic compound, the lithium salt of carbonic acid with the chemical formula, formula . This white Salt (chemistry), salt is widely used in processing metal oxides. It is on the WHO Model List of Essential Medicines, Wor ...
's ability to stabilize mood highs and lows in
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
in 1948. Psychotherapy was still utilized, but as a treatment for psychosocial issues. This proved the idea of neurochemical nature of many psychiatric disorders. Another approach to look for biomarkers of psychiatric disorders is
neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the neuroanatomy, structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive ...
that was first utilized as a tool for psychiatry in the 1980s. In 1963,
US president The president of the United States (POTUS) is the head of state and head of government of the United States. The president directs the executive branch of the federal government and is the commander-in-chief of the United States Armed For ...
John F. Kennedy John Fitzgerald Kennedy (May 29, 1917 – November 22, 1963), also known as JFK, was the 35th president of the United States, serving from 1961 until his assassination in 1963. He was the first Roman Catholic and youngest person elected p ...
introduced legislation delegating the
National Institute of Mental Health The National Institute of Mental Health (NIMH) is one of 27 institutes and centers that make up the National Institutes of Health (NIH). The NIH, in turn, is an agency of the United States Department of Health and Human Services and is the primar ...
to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals.. Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those with acute but less serious mental disorders. Ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals, resulting in a large population of chronically homeless people with mental illness.


Controversy and criticism

The institution of psychiatry has attracted controversy since its inception. Scholars including those from
social psychiatry Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, m ...
,
psychoanalysis PsychoanalysisFrom Greek language, Greek: and is a set of theories and techniques of research to discover unconscious mind, unconscious processes and their influence on conscious mind, conscious thought, emotion and behaviour. Based on The Inte ...
,
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
, and critical psychiatry have produced critiques. It has been argued that psychiatry confuses disorders of the mind with disorders of the brain that can be treated with drugs; that its use of drugs is in part due to lobbying by drug companies resulting in distortion of research; and that the concept of "mental illness" is often used to label and control those with beliefs and behaviours that the majority of people disagree with; and that it is too influenced by ideas from medicine causing it to misunderstand the nature of mental distress. Critique of psychiatry from within the field comes from the critical psychiatry group in the UK. Double argues that most critical psychiatry is anti-reductionist. Rashed argues new mental health science has moved beyond this reductionist critique by seeking integrative and
biopsychosocial Biopsychosocial models (BPSM) are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio- environmental factors. These models specifically examine how these aspects play a role in a range o ...
models for conditions and that much of critical psychiatry now exists with orthodox psychiatry but notes that many critiques remain unaddressed. The term ''
anti-psychiatry Anti-psychiatry, sometimes spelled antipsychiatry, is a movement based on the view that psychiatric treatment can often be more damaging than helpful to patients. The term anti-psychiatry was coined in 1912, and the movement emerged in the 1960s, ...
'' was coined by psychiatrist David Cooper in 1967 and was later made popular by
Thomas Szasz Thomas Stephen Szasz ( ; ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate Medical University. A dis ...
. The word ''Antipsychiatrie'' was already used in Germany in 1904.Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, , page 87 The basic premise of the anti-psychiatry movement is that psychiatrists attempt to classify "normal" people as "deviant"; psychiatric treatments are ultimately more damaging than helpful to patients; and psychiatry's history involves (what may now be seen as) dangerous treatments, such as
psychosurgery Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorders. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under ...
an example of this being the frontal lobectomy (commonly called a
lobotomy A lobotomy () or leucotomy is a discredited form of Neurosurgery, neurosurgical treatment for mental disorder, psychiatric disorder or neurological disorder (e.g. epilepsy, Depression in childhood and adolescence, depression) that involves sev ...
). The use of lobotomies largely disappeared by the late 1970s.


See also

*
Glossary of psychiatry This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry ...
*
Medical psychology Medical psychology or Medicopsychology is the application of psychological principles to the practice of medicine, sometimes using drugs for both physical and mental disorders. A medical psychologist must obtain specific qualification in psych ...
*
Biopsychiatry controversy The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include dis ...
*
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial fac ...
* Telepsychiatry * Psychiatry Innovation Lab *
Anti-psychiatry Anti-psychiatry, sometimes spelled antipsychiatry, is a movement based on the view that psychiatric treatment can often be more damaging than helpful to patients. The term anti-psychiatry was coined in 1912, and the movement emerged in the 1960s, ...
*
Controversies about psychiatry Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the ...


Notes


References


Citations


Cited texts

* * * *


Further reading

* * * * * Francis, Gavin, "Changing Psychiatry's Mind" (review of Anne Harrington, ''Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness'', Norton, 366 pp.; and Nathan Filer, ''This Book Will Change Your Mind about Mental Health: A Journey into the Heartland of Psychiatry'', London, Faber and Faber, 248 pp.), ''
The New York Review of Books ''The New York Review of Books'' (or ''NYREV'' or ''NYRB'') is a semi-monthly magazine with articles on literature, culture, economics, science and current affairs. Published in New York City, it is inspired by the idea that the discussion of ...
'', vol. LXVIII, no. 1 (14 January 2021), pp. 26–29. " ntal disorders are different rom illnesses addressed by other medical specialties... treat them as purely physical is to misunderstand their nature." " re eeds to bebased on distress and ognitive, emotional, and physicalneed rather than n psychiatricdiagnos s, which is often uncertain, erratic, and unreplicable. (p. 29.) * Halpern, Sue, "The Bull's-Eye on Your Thoughts" (review of Nita A. Farahany, ''The Battle for Your Brain: Defending the Right to Think Freely in the Age of Neurotechnology'', St. Martin's, 2023, 277 pp.; and Daniel Barron, ''Reading Our Minds: The Rise of Big Data Psychiatry'', Columbia Global Reports, 2023, 150 pp.), ''
The New York Review of Books ''The New York Review of Books'' (or ''NYREV'' or ''NYRB'') is a semi-monthly magazine with articles on literature, culture, economics, science and current affairs. Published in New York City, it is inspired by the idea that the discussion of ...
'', vol. LXX, no. 17 (2 November 2023), pp. 60–62. Psychiatrist Daniel Barron deplores psychiatry's reliance largely on subjective impressions of a patient's condition – on behavioral-pattern recognition – whereas other medical specialties dispose of a more substantial armamentarium of objective diagnostic
technologies Technology is the application of Conceptual model, conceptual knowledge to achieve practical goals, especially in a reproducible way. The word ''technology'' can also mean the products resulting from such efforts, including both tangible too ...
. A psychiatric patient's diagnoses are arguably more in the eye of the physician: "An
anti-psychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizoph ...
'works' if a sychiatricpatient ''looks and feels'' less
psychotic In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...
." Barron also posits that talking – an important aspect of psychiatric
diagnostics Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". ...
and treatment – involves vague, subjective
language Language is a structured system of communication that consists of grammar and vocabulary. It is the primary means by which humans convey meaning, both in spoken and signed language, signed forms, and may also be conveyed through writing syste ...
and therefore cannot reveal the
brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
's objective workings. He trusts, though, that
Big Data Big data primarily refers to data sets that are too large or complex to be dealt with by traditional data processing, data-processing application software, software. Data with many entries (rows) offer greater statistical power, while data with ...
technologies will make psychiatric
signs and symptoms Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...
more quantifiably objective. Sue Halpern cautions, however, that "When numbers have no agreed-upon, scientifically-derived, extrinsic meaning, quantification is unavailing." (p. 62.) * * * * * * Singh, Manvir, "Read the Label: How psychiatric diagnoses create identities", ''
The New Yorker ''The New Yorker'' is an American magazine featuring journalism, commentary, criticism, essays, fiction, satire, cartoons, and poetry. It was founded on February 21, 1925, by Harold Ross and his wife Jane Grant, a reporter for ''The New York T ...
'', 13 May 2024, pp. 20-24. " e ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
'', or ''DSM'' ..guides how Americans .. understand and deal with
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
. ..The ''DSM'' as we know it appeared in 1980, with the publication of the ''DSM-III''
hich Ij () is a village in Golabar Rural District of the Central District in Ijrud County, Zanjan province, Iran Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq ...
favored more precise diagnostic criteria and a more scientific approach han the first two ''DSM'' editions wever, the emerging picture is of overlapping conditions, of categories that blur rather than stand apart. No disorder has been tied to a specific
gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleotides in DNA that is transcribed to produce a functional RNA. There are two types of molecular genes: protei ...
or set of genes. Nearly . 20all genetic vulnerabilities implicated in mental illness have been associated with many conditions. ..As the philosopher
Ian Hacking Ian MacDougall Hacking (February 18, 1936 – May 10, 2023) was a Canadian philosopher specializing in the philosophy of science. Throughout his career, he won numerous awards, such as the Killam Prize for the Humanities and the Balzan Prize, ...
observed, labelling people is very different from labelling
quark A quark () is a type of elementary particle and a fundamental constituent of matter. Quarks combine to form composite particles called hadrons, the most stable of which are protons and neutrons, the components of atomic nucleus, atomic nuclei ...
s or
microbe A microorganism, or microbe, is an organism of microscopic size, which may exist in its single-celled form or as a colony of cells. The possible existence of unseen microbial life was suspected from antiquity, with an early attestation in ...
s. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how 'individuals experience themselves – and may even lead people to evolve their feelings and behavior in part because they are so classified.' Hacking's best-known example is multiple personality disorder ow called dissociative identity disorder">dissociative_identity_disorder.html" ;"title="ow called dissociative identity disorder">ow called dissociative identity disorder Between 1972 and 1986, the number of cases of patients with multiple personalities exploded from the double digits to an estimated six thousand. ..[I]n 1955 [n]o such diagnosis [had] existed. [Similarly, o]ver the past twenty years, the prevalence of autism in the United States has quadrupled [...]. A major driver of this surge has been a broadening of the definition and a lowering of the diagnostic threshold. Among people diagnosed with autism ..evidence of the
psychological Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...
and
neurological Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...
traits associated with the condition declined by up to eighty per cent between 2000 and 2015.
Temple Grandin Mary Temple Grandin (born August 29, 1947) is an American academic, inventor, and ethologist. She is a prominent proponent of the humane treatment of livestock for slaughter and the author of more than 60 scientific papers on animal behavior. ...
as commented that . 21'The spectrum is so broad it doesn't make much sense.' onfusion has also surrounded the term "sociopathy", which">sociopathy.html" ;"title="onfusion has also surrounded the term "sociopathy">onfusion has also surrounded the term "sociopathy", whichwas dropped from the ''DSM-II'' with the arrival of 'antisocial personality disorder' [...]. Some scholars associated sociopathy with remorseless and impulsive behavior caused by a brain injury. Other people associated it with an antisocial personality. e psychologist Martha Stout used it to mean a lack of
conscience A conscience is a Cognition, cognitive process that elicits emotion and rational associations based on an individual's ethics, moral philosophy or value system. Conscience is not an elicited emotion or thought produced by associations based on i ...
." (p. 22.) Yet another confusing
nosological Nosology () is the branch of medical science that deals with the Medical classification, classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the ...
entity is
borderline personality disorder Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, an acute fear of Abandonment (emotional), abandonment, and intense emotiona ...
, "defined by sudden swings in mood,
self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that ...
, and perceptions of others. ..The concept is generally attributed to the psychoanalyst Adolph Stern, who used it in 1937 to describe patients who were neither neurotic nor
psychotic In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...
and thus
ere Ere or ERE may refer to: * ''Environmental and Resource Economics'', a peer-reviewed academic journal * ERE Informatique, one of the first French video game companies * Ere language, an Austronesian language * Ebi Ere (born 1981), American-Nigeria ...
'borderline.' t has been noted thatkey symptoms such as identity disturbance, outbursts of
anger Anger, also known as wrath ( ; ) or rage (emotion), rage, is an intense emotional state involving a strong, uncomfortable and non-cooperative response to a perceived provocation, hurt, or threat. A person experiencing anger will often experie ...
, and unstable interpersonal relations also feature in narcissistic personality disorder, narcissistic and histrionic personality disorders. [Medical sociologist] Allan Horwitz ..asks why the ''DSM'' still treats B.P.D. as a personality disorder, disorder of personality rather than mood disorder, of mood. [p. 23.] e process of labelling Reification (fallacy), reifies categories [that is, endows them with a deceptive quality of "Wiktionary:thingness, thingness"], especially in the age of the Internet. ..[P]eople everywhere encounter models of illness that they unconsciously embody. ..In 2006, a [Mexican] student ..developed devastating leg pain and had trouble walking; soon hundreds of classmates were afflicted." (p. 24.) * * * * {{Authority control Psychiatry, Academic disciplines Behavioural sciences