Longtime critic of psychiatry Giovanni Fava comments, in what he refers to as “probably the most radical criticism of evidence-based medicine so far,” on the “increasing awareness of a crisis in psychiatric research and practice. Psychopathology and clinical judgment are often discarded as non-scientific and obsolete methods. Yet, in their everyday practice, psychiatrists use observation, description and classification, test explanatory hypotheses, and formulate clinical decisions.” In his review of the literature on clinical judgment, Fava finds that “evidence-based medicine does not appear to provide an adequate scientific background for challenges of clinical practice in psychiatry … A renewed interest in clinical judgment may yield substantial advances in clinical assessment and treatment.”
Fava, Giovanni; “Clinical judgment in psychiatry. Requiem or reveille?” Nordic Journal of Psychiatry, online July 23, 2012.
Papers by Dr. GA Fava, long-time critic of antidepressants (Surviving Antidepressants)
Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria (Mad in America)
The Problem of Drug-Induced Chronicity is Discussed (Mad in America)
From the study’s conclusion:
“Often, in their clinical practice, psychiatrists use sophisticated forms of clinical judgment that are suitable for clinical challenges, but are not addressed by current research strategies. A renewed interest in the process of clinical judgment (56) and in psychopathology as a science (8) may entail solution to the current impasse of psychiatric research and practice. The notion of psychiatric disease is not in line with the changed spectrum of health and the complex interplay of biological and psychosocial factors (56). Evidence-based medicine leads to undertreatment, overtreatment or mistreatment and is not geared to the complexity of clinical situations. Alternative models that articulate the clinical process may pave the way to a renewal of the appraisal of clinical judgment in psychiatry.”