Rethinking and reclaiming psychiatry
Year: 2025
Type: article
Abstract: The term psychiatry was coined by German physician Johann Christian Reil in 1808, derived from the ancient Greek words ’psyche’ (mind or soul) and ‘iatreia’ (healing). The word psychiatry literally means ‘medical treatment of the soul’. Prior to the 17th century, there was no concept of diseased mind. Mental illness was in the realm of supernatural afflictions, animalism, and religion. In the 17–18th century, the brain was thought to be the seat of mind. That is how psychiatry came in the fold of medicine. But descriptions of the mental phenomenon and psychopathology were derived from concepts of philosophy. Philosophy provided the vocabulary to psychopathology and psychiatry remained at crossroads between medicine and philosophy. During most of the 19–20th century, there have been parallel developments in brain-based sciences like genetics or neurobiological theories and mind-based theories like psychoanalytic theory, learning theories, or psychosocial theories of mental illness. Methods of treatments based on brain-based theories and mind-based theories have been developed in parallel. Despite some tensions and schism, these two parallel streams have flourished separately and continue to remain complimentary to one another till date. In the 21st century, with advancements in psychoneuroimmunology and cellular and molecular biology, psychiatry has moved much closer to somatic medicine. Mental health and mental disorders generally have been poorly understood and often mishandled in society. There is lack of clarity on the boundary between mental illness and mental health, who can treat mental illness, what treatment methods are required, and for how long. A large variety of professionals such as psychologists, counselors, social workers, life coaches, skills trainers, even religious leaders, and physicians are delving into management of “mental health” and/or “mental disorders”, without knowing the distinction between them or the limits of their expertise. The problem is further compounded by the use of overlapping or similar sounding terms like mental (ill) health, mental illness, or mental wellness. It is important to understand what is mental wellness, where wellness ends and illness begins, and what is meant by mental health or ill health. MENTAL ILLNESS VERSUS MENTAL HEALTH? Although no definition of mental disorders can do full justice to the entire spectrum of conditions covered under the rubric of mental disorders, the following definition is officially approved by the international community and is used in clinical practice and research worldwide. A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable and culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above” (DSM5,[1] ICD 11[2]). Mental illness as described above is ubiquitous and universal and occurs across all ages, genders, geographical locations, social classes, and religions in the world. According to WHO (2019), one in eight persons in the world suffers from mental illness at a given time. So, with 8 billion population of the world, there are 1 billion persons with mental illness. In India, 10.6% of the population has mental illness requiring treatment immediately and about 13.7% will need it in life time (National Mental Health Survey 2015–16).[3] Mental disorders arise from dysfunctions of the brain caused by complex interaction of a multitude of factors. Mental health, on the other hand, reflects our emotional, psychological, and social wellbeing; how we think, feel, and act; and the way we interact with others, handle problems, and make decisions. There are no known limits to mental health, and it is a highly subjective state. Moreover, mental health is unique to each individual. What looks like good mental health for one person will not be the same for someone else. For example, parameters for good mental health will differ for a farmer from those for a teacher or a house wife or a top ranking business executive or a scientist. Although mental health and mental illness are two different constructs, like physical health and physical illness, these are not mutually exclusive [Figure 1]. Individuals diagnosed with mental illness can have periods or elements of physical, mental, and social wellbeing and vice-versa.Figure 1: Spectrum of Mental Wellness and IllnessOne can have good mental health while living with a mental disorder, and many people live well with mental illnesses that are in remission or stabilized with medication, therapy, and so on or may harbor elements of minor aberration or deviance. It is important to realize that mental illness does not always lead to poor mental health and that poor mental health is not always due to mental illness. Blurring of boundaries between health and disease can cause people to misjudge, dismiss, or misperceive the condition. On the other hand, mental illnesses are medical disorders, arising out of genetic, biological, physical, and psychosocial factors, and are treatable. Psychiatry does not focus on the science of wellness. Promotion of mental health/wellness is a big business industry these days. There are several professionals or even quasiprofessionals involved in managing mental health, so much so that the public is often at loss or confused as to whom to approach and what to choose from. Mental wellness taps into life style, spirituality, exercise, meditation, yoga, diet, and so on. All these are important for preventive as well as supportive interventions for mental disorders. However, none of these will treat mental disorder per se. There is urgent need to shed light on this confusion so that the public can make informed decisions and approach the right professional for the right purpose in the right time. MENTAL HEALTH CARE WORKFORCE Psychiatrists are primarily medical doctors with expertise in the field of psychiatry, which is a branch of medicine focused on diagnosis, treatment, and prevention of mental disorders. Their expertise lies in understanding the complex interplay between biological, psychological, and social factors that contribute to mental illness. Psychiatrists can assess and treat accordingly both the physical and psychological aspects of mental ill health that often coexist and influence one another reciprocally. However, ‘psychologists’ are arts graduates with master’s degree in psychology. 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It can be and with the health in the and The has the to make mental health to most even in the of In a psychiatry this will the to of for living at a and to make use of time. is the such and the in the world that to the practice of clinical psychiatry for in the or of both and such as psychologists, social workers, or to and mental health at their with or of use of the has the of and of the and skills of the them time. The is and and the and is and with of on in time of this at the can the problem of mental health in one A has been in in for the of in a that both the right of to their and the need to such for and for or further make the use of and of with of and as well as is in a advanced of to many other of the world. can be a in a and for mental health to the and the world. In from it is that we and in mental health the of psychiatry in mental health for in of to mental health, and of for treatment of for of mental health with health clarity and in the and of practice of different mental health and professionals and physician a treatment of disorders. Psychiatrists in the and not or to the of as in the where the clinical is by psychologists, social workers, and and clinical is to and In the practice of community psychiatry, and have been into the social field and and are to of psychiatry are the that are where are the Psychiatry is important to be to of and There is need to treatment of mental illnesses that are or to or society or or disability Psychiatrists are at of from their medical and into for of which will make them as poorly social Psychiatry be by 21st science and not by and and of There are no conflicts of
Source: Indian Journal of Psychiatry
Author: Savita Malhotra
Language: English
Topic: Mental Health and Psychiatry
Subfield: Philosophy
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4407719361