Psychiatry used to be a biopsychosocial profession that allowed time to get to know the person, not just treat the symptom. But drastic cuts in the funding of mental health services have dramatically reduced the quality of the service they can provide. Psychiatrists are now forced to follow very large panels of patients. Most of the limited time they are allowed with each is spent discussing symptoms, adjusting the meds, and determining side effects.
Little time is left to forge a healing relationship, provide support, and teach skills through psychotherapy. And patients usually get to a psychiatrist—if at all—as a last resort, only after other things have failed—and with the expectation by the patient and referral source that the main purpose of the visit is just to prescribe medication.
Psychiatrists didn't invent this system, but they have to live within it (except for those whose patients can pay out of pocket for much more personalized care). Most psychiatrists do a good job of diagnosis, prescribing meds, and providing support. Of course, some are incompetent—every profession has its great practitioners, its boobs, and the full spectrum in between.
Results overall for psychiatric treatment are good. The majority of patients improve at rates equal to, or above, those achieved by doctors treating medical illness. But, as in the rest of medicine, a significant minority of patients don't improve at all and a small minority get worse. Treatment failure may be due to the natural course of illness, difficult life circumstances, the patient's behavior, or the psychiatist's incompetence. Some psychiatrists are not good at diagnosis, use too much medication, and/or fail to establish a good relationship with the patient. And sometimes it may just be a bad match-up of doctor and patient—the nature of their relationship can strongly influence how well the patient does.
Another important factor in treatment failure is that most “psychiatry”' is not done by psychiatrists. Primary care doctors prescribe 90% of benzodiazepines; 80% of antidepressants; 60% of stimulants; and 50% of antipsychotics. Some are great at it, but most have too little time and too little training and are too subject to sales pitches from drug salesmen. Psychiatrists are clearly responsible for some of the harm done by excess medication, but the bigger problem by far is rushed primary care doctors, prescribing the wrong meds, to patients who often don't need them. Misleading drug company marketing increases inappropriate prescription by convincing both doctor and patient that there is a pill for every problem.
Psychiatry comes in for a lot of criticism: from within the profession; from other mental health professionals; and from dissatisfied patients. Some of the criticism is fair, some is overblown, and some is just plain wrong.
I, and others within the profession, have criticized psychiatry for its increasing bio-reductionism, decreased humanism, diagnostic exuberance, and excessive dependence on prescribing medication.
Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.
For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.
The most important and troubling attacks on psychiatry come from people who feel harmed by it. It has been surprising to me that my many forceful critiques of psychiatry have met so little criticism from psychiatrists, while my much less frequent and muted defenses of psychiatry have drawn such flak from dissatisfied patients. Whenever I twitter or blog anything suggesting that psychiatric treatment is valuable for some people but not others, I receive a flurry of angry responses declaring it is totally harmful for everyone.
Satisfied patients are a silent majority—people who have benefited from psychiatry generally have little motivation to go public with their gratitude. Dissatisfied patients want to be heard—to air their personal grievances and to protect others from what they see as a dangerous profession.