Child and Adolescent Psychiatry - Criticisms

Criticisms

Critics of psychiatry often argue that psychiatric diagnosis lacks "objectivity", particularly when compared with diagnosis in other medical specialties. However, when one examines interrater reliability—an important component of objectivity—the agreement among psychiatrists for several major psychiatric disorders are generally on a par with those in other medical specialties. Nonetheless, in psychiatry as in all of general medicine, there is an irreducible element of the subjective. That is part of the "art" of medical and psychiatric practice (Pies 2007).

Traditional deficit and disease models of child psychiatry have been criticized as rooted in the medical model which conceptualizes adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterize problematic behavior as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behavior has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession (see references): it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behavior and symptoms, to promote a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behavior, to promote a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and to be based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability (Boorse, 1976; Jensen, 2003; Sadler et al. 1994; Timimi, 2006).