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Psychiatry in the 21st century and its integrative role.

The identity of psychiatry and its role among the other medical specialties is a widely discussed topic lately, especially due to new technologies used in detecting brain activity, that become an integral part of the diagnosis, along with the therapeutic methods. Thus, in the 21st century, psychiatry finds itself continuously assessing its position, both as a result of the social aspects reflected in the life of the individual, but also due to its intrinsic changes.

Regarding the future of psychiatry, J. P. Dauwalder foresaw ever since 1996 the appearance of methodological challenges that eliminate the simple cause--effect relationships, nevertheless existing a causality that is interactive, circular, individual, and tied to the particular ecological context of each relationship (1). The arguments presented in studies on quality of life come to support his allegations, this being a subject that has become of great interest in recent years. This concept is otherwise widely used in most medical specialties.

New approaches in psychiatry put forefront the attitude towards the patient, the patient being approached through a sociorelational angle. Consequently, the study of the psychopathological phenomenon ceased to be a priority, being outweighed particularly by the patient's interactions with society, especially if we refer to the mental disorders with a chronic evolution. On the other hand, the financial aspect became an integral part of the economic policies of the health insurance system, and the concept of quality of life derives from a desire to set the human condition of every patient as the highest ranking priority. All these aspects apparently contributed to the usage, in daily practice and on an increasingly wider scale, of the term client, given the wish to assure the patient's satisfaction, but also concerning the financial aspects of the medical services. Therefore, the idea of subjective well-being will start being defined, taking into account satisfying human basic necessities to assuring the patient's state of happiness. In this context, the new perspectives of psychiatry focus on its social side, on the intense preoccupation for destigmatizing the patient and for a better understanding of mental disorders by the general public.

Nowadays, mental disorders are evaluated simultaneously in a complexity of ways that include elements of fundamental research, but also aspects of Freudian thinking and behavioural and cognitivist movements. Consequently, the bio-psycho-social model will be appreciated at its true value. The biopsycho-social three-dimensionality in psychiatry, presented ever since 1974 by Prof. Petre Branzei, was not just foreshadowing for the era, but also a precocious analysis of the different and intersecting methods of gaining knowledge in psychiatry. This way, the clinician will have access various possibilities, in several extents of approaching issues, through this unique model that integrates biological, psychological and social causes, and that will allow the implementation of a unique treatment plan that will be unitary, yet complex. With the help of this model, any person will be regarded as an entity involved in continuous change, requiring that, as S. Dilts suggested, the practitioner keep his critical sense and scientific spirit (2).

David Mechanic asserted that, in psychiatric practice today, we find a scientific part, an artistic part, and an ideological one. This fragmentation reflects precisely the uncertainty of knowledge, in which the psychiatrist is part of a large interdisciplinary network. But, in order to better define itself in the future, psychiatry does not necessarily require a revolution, but rather it must show free spirit that is not indebted to any theory, be it behavioural or social (3).

Psychiatry is an integral part of medicine; G. Gabbard declared since 1999 that it represents a unique niche among other medical specialties involving the biological and the psychosocial, both in the diagnostic process, as well as in the therapeutic one (4). This specialty always remains interesting, even attractive, through the mind--brain connection itself that apparently continues to be in the centre of its preoccupations. In this context, the discussions that were created around developing the two diagnostic textbooks, DSM (Diagnostic and Statistical Manual) and ICD (International Classification of Diseases) play an important role in what psychiatry represents among other medical specialties.

Research in psychiatry globalizes, the increase in the number of international clinical studies will also determine the better harmonisation, in the future, of the two classification systems. Beyond the operationalisation of the classification systems in psychiatry and the conceptualization of mental disorders, there still are subjects of great importance, such as psychopathology that will return in the spotlight. But apart from the new guidelines in neuroscience research, there is an acute necessity in terms of improving mental healthcare and foremost the realization of an integrative type of treatment. In this context, national and international psychiatry societies will play an important role, through creating a better connectivity between research and treating the body and the mind, which will represent the central element of this century's psychiatry (5).

Contemporary psychiatric assistance also implies human rights aspects, the use of alternative or complementary therapeutic methods, such as developing communitarian assistance or assuring specific legislation. Many of these issues are not found in other medical specialties, like the one regarding the protection of patients with mental disorders. Current psychiatric taxonomy also aims at a pragmatic approach, especially social level, but also economically, legally, and politically. The new taxonomy will meet both the demands of fundamental research and statistical study.

In conclusion, we find that psychiatry is currently on a new path, which aims towards integration into 21th century medicine.


(1.) Dauwalder, J. P., Systemes dynamiques complexes et avenir de la psychiatrie. Confrontations Psychiatriques, Epistemologie et Psychiatrie, 1996, 265-80

(2.) Dilts, S. L. Jr., Models of the Mind. A framework for biopsychosocial psychiatry, Brunner-Routledge, Philadelphia, 2001

(3.) Mechanic, D., Social science in relation to psychiatry, in The Scientific Foundation of Psychiatry, Cambridge University Press, Cambridge, 1985

(4.) Gabbard, G., The psychiatrist as psychotherapist, in: Weissman, S., Sabshin, M., Eist, H. (editors), Psychiatry in the new millennium, American Psychiatric Press, Washington, 1999, 163-17

(5.) Maj, M., The WPA Action Plan is in progress, World Psychiatry, 2009; 8:65-66

Alexandra BOLOS--M. D., Ph. D., Senior Psychiatrist, Lecturer, Department of Psychiatry, "Gr. T. Popa" University of Medicine and Pharmacy Iasi, Romania


Alexandra BOLOS

M. D., Ph. D., Senior Psychiatrist, Lecturer


No. 36 Sos. Bucium, zip code 700282, Iasi, Romania

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Author:Bolos, Alexandra
Publication:Bulletin of Integrative Psychiatry
Article Type:Editorial
Date:Mar 1, 2016
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