Is Psychiatry Stuck in the Past?

Ever since psychiatry emerged as an independent field of medicine, it has stood in the shadows of other specialties, never progressing scientifically as fast as neurology, oncology, or cardiology. In many developed countries, the decline of mental hospitals has brought psychiatric services into closer professional contact than ever with these and other medical domains. Yet psychiatry continues to inhabit medicine's netherworld - within the mainstream clinically, outside it scientifically.

Psychiatry is separated from other medical specialties by its lack of an objective basis for diagnosis. Other medical fields have refined the diagnostic process to the point where computerized laboratory tests have virtually replaced clinical examination of patients. Psychiatry remains dependent on interpretation of detailed case histories. These can be obtained only through careful examination and direct questioning of patients. No universal diagnostic tests exist for the most frequent mental disorders, such as depression, anxiety, and schizophrenia.

Of course, computer programs can now process data derived from patients' symptoms and generate psychiatric diagnoses. But these apply rules that only replicate the way one or more psychiatrists interpret a patient's symptoms. There is nothing absolute about the program's output, although it does at least do the same thing every time, which cannot be said for psychiatrists. After all, interpretations of a case may differ, and the outcome cannot be resolved other than by an appeal to authority - "I am more senior and experienced than you, so my diagnosis takes precedence."

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