Is psychiatry such a fragile house of cards?

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House of cards

On October 9, 2021 an opinion piece was published in the Globe and Mail entitled ‘Woke’ psychiatrists have lost sight of the biological causes of mental illness. The author, Thomas Ungar, is an associate professor of psychiatry at the University of Toronto and a research consultant with the Mental Health Commission of Canada. Ungar’s article can also be found here. He opens with,

“It’s not uncommon in medicine for different approaches to fall in and out of favour. These days in psychiatry, the pendulum toward viewing mental illness as a disease resulting from social determinants has swung too far.”

Going by the title and opening paragraph, I anticipated that Ungar’s piece would be a reaction to the growing body of critical literature about the dominant biomedical paradigm in the ‘mental health’ industry.  For example, I thought he might comment on the recent (June 10, 2021) publication of the World Health Organization’s Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches which recommended a shift away from “…an entrenched overreliance on the biomedical model in which the predominant focus of care is on diagnosis, medication and symptom reduction” (p. XVII) and urged countries to “…widen their focus beyond the biomedical model in order to change and broaden mindsets, address stigmatizing attitudes and eliminate coercive practices” (p. 200).  Contrary to Ungar’s claim, this does not sound like the pendulum has swung very far at all, yet.

Rather than call our attention to this, Ungar seems to mock newly-recruited psychiatrists who are inclined toward social justice:

“In my efforts to recruit and hire psychiatrists over the years, I’ve been impressed by the kindness, compassion and strong sense of social responsibility demonstrated by doctors singularly focused on the social determinants of health.
But the irony of their inclination to run around the streets doing the jobs of social and community workers and saving the world in trendy Chelsea boots is not lost on me.”

Trying to paint any potential shift away from the biomedical model as a silly, youthful, misguided fad seems desperate and indicative of a growing existential anxiety in psychiatry (see “Psychiatry Concerned it Will be ‘Marginalized’ in Push for Rights-Based Mental Health“).

Ungar writes that such a paradigm shift will suppress “a bitter truth” that ‘mental illness’ is biologically caused.  What truth is this?  More psychiatrists are finally admitting publicly that “…there is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.” This quote, from psychiatrists Gardner and Kleinman in the New England Journal of Medicine and later cited in the Harvard Review of Psychiatry and Mad in America, is not new information.  Many other prominent psychiatrists, critical scholars and activists have been saying this for decades.

Are Ungar’s comments a sign that the guild of psychiatry is trembling like a fragile house of cards?