A Path to the Future for Psychiatry

Abstract

This chapter offers suggestions for those psychiatrists who accept many of the critiques offered in this book yet continue to practice within the mainstream system of care. If critical psychiatrists practice in the public system, they can be agents of change. Many current ideas for reform focus on increasing access to psychiatry. The author posits that there is a distorted demand for psychiatric care that is based on an ever-expanding notion of what constitutes psychiatric disorder and compounded by an inaccurate gauge of the efficacy of psychiatric treatments, particularly pharmacological ones. While expertise in psychopharmacology needs to remain a core proficiency for psychiatrists, our suggestion is to contract the scope of psychiatric concern, use a drug-centered approach to psychopharmacotherapy, and, when psychiatrists do become involved, allow the time necessary to understand the people – including their social contexts – who seek their care. The framework of need-adapted treatment (NAT) is suggested as a model that can help critical psychiatrists incorporate these values into their practices. NAT offers a way in which the challenges and uncertainties of the field can be openly acknowledged, discussed, and integrated into care.