I think that part of the trouble comes from the psychotic / neurotic distinction. I know that to even talk about 'psychotic' compared to 'neurotic' disorders isn't terribly politically correct these days but seems to me that there is a distinction to be had...

The distinction between the people who (prior to the development of medications) needed to be restrained by their families because they would run around naked or because they were a serious risk of hurting themselves and others. People who smeared their own %#@&#! all over their faces or people who gave away their inheritance in a fit of mania. Those people. The ones who are fairly uncontroversially regarded as having a biologically based mental illness. Compared with the middle class 'worried well' or those with significant 'problems in living' who came right with strategically applied magnets or prescriptions for spa visits or some care from a caring clinician or a prescription for prozac or xanax. Sure it is hard to draw the line... I'm not at all meaning to undermine the distress of the so called 'neurotics' (of which I am one). But there is a great deal of controversy over whether the latter people actually have a psychiatric illness at all. It all depends on how you delimit what psychiatry should be dealing with, you see.

The biologically inclined psychiatrists often feel that they should be dealing with the severe cases that are distinctly biological in origin. Schizophrenia, bi-polar and (before they gave this success away to general medicine) neuro syphilis.

The rest can be dealt with by the psychologists / social workers / councellors.

There was a time in the history of psychiatry where there was a lot of stigma around mental illness (of the psychotic and institutionalised variety). It was found that for several disorders (Huntingtons for example) there was a high degree of heritability and subsequent generations tended to have more severe forms of the disorder. People mistakenly came to believe that the mentally ill people were leading to the degeneration of the human race and eugenic policies were on the cards.

Given that situation many people kept the mentally ill at home (in confinement) rather than having them institutionalised. Nobody would marry the eligable daughters if elder son was known to me mentally ill because people would worry about the genetic worth of the whole family, you see.

Around that time neurologists came up with the notion of 'nerve disorders' (which of course don't really have anything to do with the nerves at all). One could take on the wealthy middle class people who reported subjective distress (but surely didn't need to be institutionalised) and treat them with little stigma. In fact it became fashionable to go to the nerve doctor (neurologist) and get a prescription for some time away in a spa or whatever. This was around the time that Freud (a neurologist) came up with his 'talking cure' (psychoanalysis) as well...

It never was suitable for the severely mentally ill (those with psychiatric conditions like schizophrenia and bi-polar and neuro syphilis). It was a way of making loads of money off wealthy individuals who reported subjective distress. Many biologically oriented psychiatrists would say that these people aren't mentally ill in the sense of having a psychiatric condition.

That is why people with personality disorders and psychosomatic symptoms and neurotic anxiety and depression and the like are often given a hard time by time pressured biologically inclined clinicians.

The DSM casts the net widely...

And the health insurance companies go with the DSM...

There are fairly convincing arguments that health insurance companies shouldn't reimburse for 'problems in living', however, as this isn't a medical problem. While people might be subjectively distressed (and that is a truely horrible thing) it doesn't constitute a biological mental disorder.

Psychoanalysis used to be tied to psychiatry. Psychiatrists were either alienists (that is the proper name for someone running a psychiatric institution) or they worked in private practice treating (mostly) wealthy neurotics. Psychoanalysis was useful for the neurotics, medication was useful for the psychotics. After some time... Especially after the development of new medications (the success of xanax and prozac) psychoanalysis started to be disowned by psychiatrists. Some psychologists sued psychoanalytic associations too because you used to have to be an MD before you could train as a psychoanalyst. The psychologists rightly pointed out that psychoanalysis has nothing to do with biological / medical psychiatry. Nowdays a number of people with backgrounds in education, councelling, nursing, psychology, english literature, philosophy etc train as analysts (though I think only people with prior clinical experience are allowed to practice).

Most of the biological psychiatrists are very keen to distance themselves from psychoanalysis which they see as part of the regrettable past of the profession. I really don't think that they will see adopting a manual with psychodynamic entities structures and processes (which have little scientific validity) to be a step forward. I'm fairly sure they will see it as a step backwards.

Moreover, the manual appears to be more interested in classifying neurotic rather than psychotic disorders and hence it would be of limited utility to the average biologically inclined psychiatrist at any rate.

Don't get me wrong I'm sure the neurotic patients will love it.

I'm just not sure that scientifically it is a step forward.

I suppose it has appeal to psychologists / psychoanalysts / social workers etc...

But I don't think it will influence biological psychiatry at all.

I think there would be more chance of integrating cognitive psychology with biological psychiatry than of integrating psychoanalysis with biological psychiatry. Basically... The problem is... That the psychoanalytic processes structures functions etc really don't seem to have a biological basis. The cognitive psychological structures functions and processes on the other hand... Have better prospects for being integrated into the other sciences.

That being said I'm shooting off at the mouth without having read it and I'll interloan it right now ;-)

Thanks very much for the link :-)