As a psychiatrist do you see yourself as anything more than an especially astute "diagnoser"? Let me explain, for as it turns out I want to be something like a psychiatrist myself oneday, or so I believe.
What I am saying is that psychiatry, perhaps like most other specialties of medicine is really good at diagnosing things, but once they've done that, there is only a game of trial and error to follow, wherein this drug or combination of drugs or that drug or that combination of drugs is used to alleviate the symptoms of the disease diagnosed. But unlike most other specialties of medicine, psychiatry is, at least at this point, treating the symptoms qua disease, whereas the symptoms of physical diseases are reduced or eliminated when the underlying pathophysiology is resolved; that is, the underlying pathophysiology in these latter cases is not usually what you physicians call the 'symptoms' of a disease. Do you see the point I am making; why is this distinction lost on psychiatry?
By collecting in the DSM-IV all of the behavioral manifestations of so-called diseases (some of which no doubt have established physiological bases), and then making a diagnosis based on these purely behavioral and subjectively interpretted 'traits' or 'signs' of a disease, while having no real idea of its etiology, how do you psychiatrists (and how will I) present yourselves to patients as healers. It doesn't seem like anything but regulated drug-dealing; I'm sure you've had a few patients "addicted" to your input.
The motivation for my question really comes from the apparent malfiesant (tell me if I spelled that wrong, I know you will) or at least ethically suspect fiduciary relationship to which psychiatrists (must?) subject their patients, when they all know how little research there is supporting the use of this drug or that drug for this disorder or that disorder--the research is usually to the effect that drug X reduces symptoms A,B,C of disease Q. At last I see the responsibility of a psychiatrist to use drug X for disease Q to ameliorate suffering, regardless of whether the connection between the pharmocological action of that drug and the etiology of the disease has been made. However, I see also as a responsibility of a psychiatrist to be skeptical that such research makes the accurate identity statement "symptoms A,B,C = disease Q".
In my opinion, psychiatrists should also be skeptical in allowing the inference (made readily, and indeed supporting the continued use of psychoactive pharmaceuticals to treat mental disease) that such research strongly implicates the neurotransmitter system(s) upon which drug X is pharmacologically active to be central to the etiology of disease Q, to go through. Each and every advertisement one sees these days for psychopharmaceuticals-- Paxil, Zoloft, Prozac, Zyprexa, Abilfly, etc.(I'm sure you know the rest of the list)--all say that the disorder for which the particular drug is intended "may be due to a chemical imbalance". Why only "may be"? How do you act like you know when you really don't? And why do you let those people who seek help from you and trust you, just go on thinking that like any other disease they may have, the doctor has the answer?
To keep all of this in line with the Topic Abstract, it seems best to me that only mental "problems" that can be linked to an actual brain bases, namely the severe mental illnesses, distinct enough to be able to perform differential diagnosis of the sort neurologists do to find a lesion site, for example(that are later confirmed by PET, fMRI, etc.), or that can be tested for using some more objective measure should be treated by physicians. Let everything else be dealt with by psychologists and social workers, who don't have as much professionalism to wield, or the social station with as much to lose in terms of its reputation. Even if at first blush such a situation would seem to increase the number of people suffering from things like clinical depression (however briefly), it would over the longer term probably reduce the dissent of both psychiatric patients who are often erroneously convinced that they have a disease, and doctors like yourself, who are hopefully doing what you do with an expectation of being able to cure the diseases you diagnose, and not simply diagnose them.
This will require neuroscience to understand the ethological significance of the abhorrent behaviors manifested in patients with bipolar disorder and schizophrenia and other severe mental illnesses, and then understand how the brain achieves those behaviors "normally". There is no way that any single neurotransmitter's level in the body can be seen as the CAUSE of bipolar disorder, though the case for 5HT and clinical depression seems pretty good (still an oversimplification), when the very behaviors that are disturbed rely on what must be pretty complex, multi-transmitter neural activity.
Perhaps psychiatry is locked in place because it wants or expects these simple neurotransmitter models of mental diseases. Sorry, nature is a bit more interesting than that. I don't know what to do in the mean time, but understanding the neurobiology of emotion in general and goal-directed behavior in particular seem two good places to start. Then "normal" would mean more than "socially accepted" or any similar subjective construction. Then mental illnesses could be diagnosed with less subjectivity, and thus greater accuracy, and above all less ethically suspect fiduciary relationships could be formed between psychiatrists (if they would still be called that) and their patients.
We as a society need to cut out the bullshit.