Our forum last week on the assumptions behind evidencing our work couldn’t have been more timely. Psychiatry and one of its main diagnostic manuals the DSM (as opposed to the ICD-10) is in turmoil. This article “Why Psychiatry’s Seismic Shift Will Happen Slowly” in Forbes is a really useful update on the situation. From a research perspective re-focusing on endophenotypes and broader phenotypes will be crucial in understanding co-morbidity and all the overlap across “diagnoses” we see in clinical practice.
But, and this is a big but, a focus on physiology alone (as per the Forbes article) is not enough of a paradigm shift. We know genes and environment interact both ways. We know that trauma and life events can collide with pre-existing vulnerabilities or resilience to produce coping of some kind, whether that be socially deemed adaptive or maladaptive. We also know that attachment and upbringing, economic and social factors all contribute to an individual’s (proximal and distal) resilience and vulnerabilities. So why does psychiatry insist on pursuing a purely medical model of explanation and intervention?