A “Crisis in Psychiatric Research and Practice”


The full text of “Clinical Judgment in Psychiatry: Requiem or Reveille?” has been made available for free by the Nordic Journal of Psychiatry. The article, which author Giovanni Fava calls “probably the most radical criticism of evidence-based medicine so far,” examines the role “of clinical phenomena that do not find room in customary taxonomy” in the context of a field which increasingly regards clinical judgment as “non-scientific and obsolete.”

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Note from Kermit Cole, “In the News” editor:
Thanks to Giovanni Fava, who had previously regretted not being able to make this article available for free to our readers, for helping this to happen.

Related Blog:
Psychiatry as a Mixed Blessing
Anosognosia: how conjecture becomes medical “fact”

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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. This paper is a very ‘left-brained’ approach to a problem which I feel calls for *much* more ‘right-brained’ thinking – as it’s my view, that, generally speaking, when men and women of science have something truly important to say, they should be able to say it without resort to an excess, of scientific jargon; there should be some clearly heartfelt appeal to the senses. Personalization is *key* to offering a message that will be memorable.

    But, meanwhile, in the interest of forwarding *genuine* reason (as opposed to the, all too typically, *faulty* logic of most psychiatric literature), I will acknowledge the positive value in this paper and will state, that:

    Dr. Fava makes some great points! I recommend this paper to anyone who appreciates ‘scientific writing’; it is *good* reading for those who care to take a more genuinely scientific/science-minded approach to ‘mental health’ issues; and, in my view, the world would surely become a better place – by degrees – if only earnest researchers (i.e., those who genuinely care for the truth) could *carefully* study what he’s pointing out, in terms of how various erroneous conclusions derive from an over-reliance, upon meta-analyses of much ‘scientific’ raw data, in ‘mental health’ research studies. So-called “evidence based” data does *not* at all necessarily point to truth, especially in the ‘mental health’ field. This paper is making that clear.

    At the same time, I emphasize: This paper does not necessarily make *entirely* clear the degree to which each and every person represents an utterly unique life – and is thus someone deserving to be known, as utterly beyond labels.

    Yes, psych-labeling creates a *focus* which may, at first, provide some little good – in some instances; but, most often, it becomes a ‘sore spot’ – worse than the original set of issues, which was *supposedly* being defined by it. Psych-labels generalize (thus, suggesting the supposedly ‘afflicted’ person suffers any number of ‘symptoms’ which s/he does *not* actually ‘have’ or exhibit), and they ‘metastasize’ (or, concretize) what are, otherwise, typically, *transient* sufferings. Psych-labels drag the labeled person down, in the end – very, very often. Psych-labels tend to blind us to this fact; for, dire endings are often predicted by some number, of various so-called “prognoses,” associated with the labels themselves.

    Simply put: In becoming ‘attached’ to the psychiatric label, that set of problems which it *supposedly* defines becomes an albatross, that the “patient” carries around his/her neck…

    In my view, it would be, by far, best… were Dr. Fava to more fully recognize all this and point it out – by the end of his paper. He should emphasize: in fact, one can only begin to imagine the immense harm, which is done by much, most or all standard psychiatric labeling (but, in particular, that which suggests supposed, “serious mental illness”).

    But, in Dr. Fava’s (most probably) never having, himself, borne any such label, I guess he can’t quite understand? he does not realize? that any label, which is widely thought to be pointing to a “major mental illness” (and, thus, which is associated with this concept, of “serious mental illness”), becomes, to some extent, a self-fulfilling prophecy.

    Labels like “bipolar” and “schizophrenia” (or, “schizophrenic”) tend to destroy the lives of those who accept them, as part and parcel of their own identity; for, psychiatry would have us believe, that these supposed “disorders” cannot be overcome; society buys into this; and, therefore, the labeled person finds little or no refuge from the limited expectations, of the society in which s/he lives.

    As I believe Dr Fava’s paper may well move some readers at least a step or two in the direction, of understanding all this, I do quite sincerely recommend reading it; but, really, I feel it could have much been better, had the author deliberately led us to consider the potential boon to be had, in altogether *rejecting* psychiatry’s (‘pathologizing’) labels.

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