Clinical Judgment, Evidence-Based Medicine, and Psychiatry

Kermit Cole
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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.”

Abstract → 

Fava, Giovanni; “Clinical judgment in psychiatry. Requiem or reveille?” Nordic Journal of Psychiatry, online July 23, 2012.

Related Items:
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.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

1 COMMENT

  1. “Clinical Judgment”

    The primary function in psychiatry is to find something that is “wrong”. It looks for a flaw, error or mistake. When it finds something, that is nearly the same thing as issuing a criminal conviction – and that effectively condemns a person (social death). There is no question as to why there is such heavy stigma for “mental illness”.

    Where on earth is the ultimate salvation?

    Psychiatry cannot and will not ever produce salvation or health or soul rescue or spirit liberation or mental wealth or emotional intelligence.

    Psychiatry condemns the soul, denies the spirit, programs the mind under the guise of educating, and destroys the very heart of a person.

    Psychiatry is weaponry. It is a branch of military government – NOT medicine.

    Psychiatry is ignorant. It calls symptoms and signs “disease” or “disorder” – instead of looking at what’s CAUSING those things.

    Humanity does not provide for or cultivate any sort of EASE in this world. Instead, incredible un-ease (difficulty) is cultivated.

    Why do you not provide or cultivate EASE? What is so difficult about that? Not enough money in it? Exactly.

    666. Sickness Sells. There’s a reason to keep sickness going, forever and ever more: because it’s so BANKABLE.

    Psychiatry is that “anti-christ” – denying people the ultimate salvation, denying SPIRIT – with your mock “bible”, that half-brained, no-heart DSM.

    Psychiatry deserves World Judgment, and the people deserve Clinical Salvation.