The Multiple Dimensions of the Identity Crisis in Psychiatry
There is a consensus that the field of psychiatry is facing a multidimensional crisis. The crisis has an epistemological dimension: there is widespread doubt concerning the validity of symptoms and disorders used to diagnose patients. Though its categories are grounded in objective epidemiological data, they also depend on social concepts of normality that change over time and culture. Since our societies are complex, volatile, uncertain and ambiguous, our concept of normality is undefined.
There is a socio-economic crisis: mental disorders have an unprecedented high level of prevalence globally. Despite record levels of funding, there remains substantial unmet need for psychiatric care, especially among children and adolescents.
There is an institutional crisis: the desperate response of governments to the mental health crisis has led to excessive control and distrust in mental health services. Clinicians have less and less time to work with patients to develop a robust therapeutic relationship. Administration and management has taken over sophisticated patient care.
There is a treatment crisis: the psychopharmacology and psychotherapy professionals currently rely on are limited in their efficacy, and new discoveries in genetics and clinical neuroscience have so far failed to translate into new treatment options for improving the lives of patients.
There is a metaphysical crisis: the categories used to diagnose disorders fail to pick out “real” disorders and their causes as opposed to artificial clusters of symptoms. Mental disorders, unlike the diseases treated by other medical disciplines, are essentially subjective depending on the lived experience of suffering, and the uniqueness to each patient of their symptoms.
Finally, there is the identity crisis itself, expressing the impotence and helplessness of the professional himself looking for a foothold in the field of medicine.
The aim of this project will be to analyse each of these dimensions and to identify a way forward out of each of these crises for a psychiatry of the future.
Publications
Book: D. Denys 2020 Het Tekort van Het Teveel: De Paradox van de Mentale Zorg. Nijgh & Van Ditmar Uitgeverij
https://www.singeluitgeverijen.nl/nijgh-van-ditmar/boek/het-tekort-van-het-teveel/
Essays:
- Denys 2024. Professionals in psychiatry need reflective competence. World Psychiatry Commentary, https://doi.org/10.1002/wps.21196
Video recording:
Psychiatrie: lapmiddel van de neoliberale samenleving. De Balie met Esther van Fenema, Damiaan Denys and Jim van Os.