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  • Dr Martin Whitely

Diagnosing Bad Psychiatry

Updated: Aug 25, 2019

Bad psychiatrists love lists and ticking boxes. During consultations, they ignore the individual in front of them, and look to tick enough boxes on a list of diagnostic criteria to justify a label. To help bad psychiatric practitioners diagnose their own incompetence, we have listed 30 symptoms below. On a more positive note, further below we have listed 20 characteristics of good psychiatry.

by Professor Jon Jureidini and Dr Martin Whitely

Bad Psychiatry:

  1. Is overconfident and arrogant - acting as if it knows much more than it actually does.

  2. Promotes unproven hypotheses as if they are indisputable facts

  3. Is quick to diagnose and prescribe.

  4. Assumes that human distress and dysfunction are caused by chemical imbalance despite the absence of any diagnostic brain scans, blood tests, genetic tests etc.

  5. Ignores the unique circumstances of the human being before them (their patients).

  6. Embraces arbitrary diagnostic labels like those defined in the DSM5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) as if they are clearly identifiable, discrete (although often co-morbid) diseases.

  7. Bullies patients into accepting diagnoses and treatments they don’t want or need, by threatening, (explicitly or by implication) to use the powers of mental health legislation to involuntarily detain and/or treat patients.

  8. Concentrates primarily on short-term symptom management, paying only lip service to, or completely ignoring, long-term outcomes. 

  9. Is overly pessimistic about the capacity of human beings with mental illness to recover.

  10. Ignores evidence that does not fit its views.

  11. Creates dependence by encouraging patients to ‘give up’. It does this by telling patients they are permanently disabled and unable to recover. 

  12. Inappropriately exempts patients (or, in the case of children, their parents) from responsibility for their own actions by attributing their behaviour to hypothesised permanent genetic and chemical defects.

  13. Specialises in treating a narrow range of (even a single) psychiatric disorders -'If all you have is a hammer, everything looks like a nail'.

  14. Is often practiced by non-psychiatrists, including some GPs (depression, anxiety) and paediatricians (ADHD), who frequently diagnose psychiatric disorders and prescribe psychotropic medications despite limited mental health and/or psycho-pharmacological training.

  15. Promotes a permanent disability model of mental illness which fosters dependence.

  16. Causes significant iatrogenic harm (harm from treatment) that often creates a lot of repeat business.

  17. Blames harms caused by treatment on the 'underlying mental illness', and sometimes uses this as a rationale for increasing doses or adding extra 'medications' that in turn create more problems.

  18. Exploits vulnerable patients and their families in crisis situations by unrealistically promising safe and effective quick fixes.

  19. Has close commercial ties to the pharmaceutical industry.

  20. Uses subjective, and methodologically dubious, estimates of ‘prevalence rates’ to claim that psychiatric disorders are massively under-diagnosed and under-treated.

  21. Expands the boundaries of mental illness and contracts the boundaries of normality.

  22. Is very good (quick) at getting people on psychiatric medications and very bad at helping patients get off them.

  23. Encourages off-label prescribing of psychotropic medications even when there is compelling evidence not to do so.

  24. Turns a blind eye to professional misconduct and incompetence.

  25. Exaggerates current understandings of the operations of the human brain, the most complex object in the known universe.

  26. Exaggerates current understandings of how mental health drugs affect the brain and body - particularly the developing brains and bodies of children.

  27. Reverses the onus of proof by assuming interventions are safe and effective and putting the obligation on critics to prove beyond doubt they are unsafe and ineffective.

  28. Over-promises and under-delivers.

  29. Is often very profitable.

  30. Conducts psychiatric consultations with a ‘tick box approach’, where the expert seeks evidence of sufficient diagnostic criteria to justify a diagnosis.

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In contrast, Good Psychiatry:

  1. Knows it limitations.

  2. Is comfortable with ambiguity, eccentricity and difference.

  3. Is not scared of admitting to patients that there is uncertainty over diagnoses and treatments and what is the best course of action.

  4. Is prepared to accept opposing evidence and change its position.

  5. Understands that ‘watchful waiting’ doesn’t mean doing nothing. It means working with patients to monitor their condition, responding appropriately to changes and identifying the best course of action.

  6. Partners with patients in decision-making that balances long-term outcomes and short-term symptom management.

  7. Helps patients to take appropriate responsibility for their own actions and recovery. Sometimes this may involve confronting (politely) patients (and, for children, their parents) who are seeking absolution for responsibility for their actions.

  8. Understands and accepts the obligation to respect patient autonomy.

  9. Understands the complexities of human behaviour and the significant limitations of current brain science.

  10. Knows, and shares with the patient, information about the appropriate uses, limitations and risks of psychiatric drugs, and other forms of treatment

  11. Sees the patient not the diagnosis.

  12. Is very cautious in applying psychiatric labels to patients and is prepared to change or remove their diagnoses.

  13. Acknowledges to patients that diagnostic labels are arbitrary, often change, and have limited predictive validity.

  14. Accepts a collective responsibility to ensure the promotion of ethical professional conduct, and will identify and call out bad psychiatric practice.

  15. Will use psychiatric medications in minimal therapeutic doses in line with robust independent evidence and adjust appropriately (admittedly it is often very difficult identifying what evidence is robust and independent).

  16. Will only use the coercive powers of mental health legislation to detain and/or treat patients in extreme circumstances, taking into account the harms inherent in involuntary treatment, and only for the minimum time necessary.

  17. Isn’t perfect and doesn’t pretend to be.

  18. Owns up and takes responsibility for its mistakes.

  19. Isn’t as profitable as it deserves to be.

  20. Helps more than it harms.

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