Psychiatry in 21^st century: The long and hard road ahead

I read with a great interest this important (may be a little bit too optimistic) overview concerning the challenge and future of psychiatry.[1] The author summarized not only the present problems (the place of psychiatry in medicine, the conceptualization of mental disorders, the problems of gradual and postgradual education, etc.), but some promising fields of psychiatry (e.g. community psychiatry), possible ways of future developments (finding “hard” scientific evidences, integration of scientific knowledge in the everyday practice, etc.) and most important challenges (stigma reduction, developing drugs better suited to the patients biological and psychosocial features etc.).

In spite of the optimistic view of the author psychiatry faced some other serious problems. In the past decades some disadvantageous changes have been occurred in almost each field of medicine, especially neurology and psychiatry. Medical students and young doctors are less and less able to utilize their knowledge in the everyday clinical practice and the number of doctors specialized in neurosciences is decreasing. I think that recent problems of psychiatry originate from special development, controversial process of detachment, particular societal and cultural roots, differences from medical model, and problems of identity, self-determination and competence, which may cause many difficulties. Academic and clinical psychiatry has to faced several problems,[2] for example, difficulties of diagnosing and classification of mental disorders (in spite of the growing efforts to develop new classification systems, such as DSM 5),[3] the diagnostic and treating problems being in the background of psychopathological symptoms, etc., The present situation results in several difficulties for the psychiatrists like emotional overburden, somatic and mental disorders and burnout;[4] moreover, psychiatry became one of the least popular medical professions,[5] which causes huge difficulties in the aftergrowth.[6]

The author pointed out that “the future may see the dawn of democratic ‘participatory medicine”. He emphasized that it has special importance to find the relevant issues and aims of mental health development in accordance with the rapid socio-politico-cultural, economical and scientific changes. In order to find feasible solutions for the most important problems of psychiatry, we have to actualize the humanistic view in clinical practice[3] based on the holistic bio-psycho-socio-spiritual approach.[2] The (neuro) scientific and consultative psychiatric viewpoints, the constructive intra- and interdisciplinary communication, the more effective value-based advocacy and the modern, evidence-based, interactive and personal education together have a key role in the solution of the above-mentioned problems.[6]