Stigma, conscience, and science in psychiatry: past, present, and future.

Full Abstract

In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web of stigma in the future depends more on moral, educational, and political achievements than neuroscientific ones. Two, psychiatry's future depends upon the public trust, which has fluctuated over its history and into the present era, during which legacies of undue influence and failed regulation have damaged this trust. While explaining the mechanisms for mental disorders is crucial, the returns from these scientific investments are decades away, and failures of conscience today undermine the vital public trust and impede psychiatry's abilities to immediately address the plight of the mentally ill. Three, the researcher-entrepreneur in perennial search of funding has replaced the old model of the curious researcher-practitioner. This drive for funding promotes hubris and failures of conscience in psychiatric science. Moreover, the information explosion and superspecialization of contemporary academic medicine has led to an intellectual fragmentation analogous to the service fragmentation at the beginnings of psychiatry. Attention to integrative synthesis of research information, as well as conscientious moral reflection on scientific advances, will promote humility over hubris: enhancing the public trust, assuring public confidence in psychiatric science, and empowering patients.

Author information

Author/s: Sadler, John Z (JZ);

Affiliation: Department of Psychiatry and Clinical Sciences, Division of Ethics and Health Policy, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9070, USA. John.Sadler(-atsign-)UTSouthwestern.edu

Journal and publication information

Publication Type: Comment; Historical Article; Journal Article

Journal: Academic medicine : journal of the Association of American Medical Colleges (Acad Med), published in United States. (Language: eng)

Reference: 2009-Apr; vol 84 (issue 4) : pp 413-7

Dates: Created 2009/03/25; Completed 2009/04/23;

PMID: 19318767, status: MEDLINE (last retrieval date: 4/23/2009, IMS Date: 23 Apr 2009 00:00:00)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentOn: Acad Med. 2009 Apr;84(4):446-50. (PMID: 19318776)

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