East of England Postgraduate School of Psychiatry, UK.
Int J Soc Psychiatry. 2010 Nov;56(6):647-56. doi: 10.1177/0020764009106259. Epub 2009 Oct 12.
Psychiatry along with other medical disciplines has been under siege in the UK and the USA for a number of years and for a number of reasons. These have varied from various medical scandals and funding changes to political imperatives and public expectations. Changes in the knowledge base have added yet another dimension to this debate.
The subject is explored using historical figures and their writings and an overview of historic views on the psychiatry profession.
The demise of the psychiatrist as an expert and the profession of psychiatry as an expertise can be related to both real and perceived factors. Unlike, for instance, the language used by cardio-thoracic surgeons, the language used in and for professional communications in psychiatry has become very similar to that used in lay discourses on psychological and relationship matters in the general population--partly as a result of the Freudian project successfully insinuating itself into 'common knowledge' and partly as the influence of media grows across the globe. This language has been misappropriated by a wide variety of non-experts, who then speak and interpret it as if they are specialists and any challenge from professionals is seen as self-protection and heresy. As psychiatrists, we do not use technology in a persuasive way as other branches of medicine tend to and this takes away a powerful symbolic conveying 'expertise'. Increased consumerism adds yet another dimension to this discourse.
The patient is definitely the expert on how their illness affects their life, but it is the psychiatrist who is the expert on the illness rather than simply focusing on disease. It is time for the profession loudly to proclaim itself for what it is and what it can and cannot do.
精神医学与其他医学学科一样，多年来一直受到英国和美国的围攻，原因有很多。这些原因包括各种医疗丑闻和资金变化、政治需要和公众期望。知识基础的变化为这场辩论增添了另一个维度。
本文通过历史人物及其著作，以及对精神医学专业历史观点的概述，探讨了这一主题。
精神科医生作为专家的消亡和精神医学作为专业知识的消亡，可以与真实和感知的因素有关。与心胸外科医生使用的语言不同，精神医学中的专业交流语言已经变得非常类似于普通人群中关于心理和人际关系问题的日常话语中使用的语言——部分是由于弗洛伊德项目成功地将自己植入“常识”，部分是由于媒体在全球的影响力不断扩大。这种语言被各种各样的非专业人士不当使用，他们以专家的身份来解读和解释这些语言，而专业人士的任何质疑都被视为自我保护和异端邪说。作为精神科医生，我们不像其他医学分支那样以有说服力的方式使用技术，这就削弱了一种强大的象征性传达“专业知识”的方式。消费主义的增加为这一论述增添了另一个维度。
患者绝对是了解疾病如何影响其生活的专家，但精神科医生是疾病的专家，而不仅仅是关注疾病。现在是该专业大声宣称自己的身份、能力和局限性的时候了。
