Hey. I enjoyed your post :-)

>... schizophrenia is seen as a 'genetic disorder' with heritability rates of around 40-50%

Paul Griffiths (who works in science communications) has a lot to say about these kinds of statistics. In particular, there are three different working concepts of the gene that different scientists work with. The above kinds of statistic comes from conflating all of those different notions - lumping them all together into something called the 'gene' that seems to have (in virtue of the lumping) this amazing heritability factor. One could do a similar thing by lumping together all kinds of environment factors (if one doesn't get adequate nutrition then genes can't express - it is as simple as that).

Acquiring a natural language (the language your caregivers speak) has a heritability rate up in the 90's, I'd imagine. I don't think anybody considers speaking a natural language to be genetically heritable, however. And yet... Why not? Our success in finding the genetic basis for language is comperable to our success in finding the genetic basis for schizophrenia.

I think the main (practical rather than justificatory) reason for the axis 1 and axis 2 distinction comes down to the (practical rather than justified) difference between psychiatry (as a field) and clinical psychology (as a field). What justifies psychiatry being a branch of medicine? The practice of prescribing medication. What makes clinical psychology distinct from psychiatry? Psychometrics and therapy (especially cognitive behavior therapy and modifications of that).

Borderline personality used to be a name given to people who were treatment resistent from the perspective of psychiatry. The medication might help with symptoms a little... But it doesn't help as much as it seems to for other more paradigmatic psychiatric disturbance such as psychosis and extreme mania and extreme depression (though this is controversial it is standardly accepted in psychiatry).

There is a little more to the axis 1 / axis 2 distinction. Mental retardation is an axis 2 disorder - remember, but there are many genetic reasons for mental retardation (downs syndrome and the like). The genetic basis for some forms of mental retardation is far better understood than the genetic basis for paradigmatic axis 1 conditions.

> A lot of the 'Is it genetic or not?'/axis 1 or 2' seem also to be tied in with whether meds work or not.

> Several studies have come out saying that the atypicals aren't really any more effective for sz than the first generation antipsychotics .

They were never thought to be more effective. They were marketed as a breakthrough for the simple reason that the side-effects were thought to be less severe. The breakthrough is that (since we haven't had time to see the long term side effects) the development of tardive dyskinesia (parkinsonian like movement disorder) and tardive dementia (kind of early onset dementia) seems to be lower. Similarly for anti-depressants. They aren't thought to be more effective than MAOI's - but they aren't potentially lethal if one doesn't stick to a restrictive diet. Psychiatric medications simply haven't become more effective - old medications are replaced by newer medications simply in virtue of the side effects being considered preferable.

> "Officially recognized in 1980 by the psychiatric community, borderline personality disorder is at least two decades behind in research, treatment options and education compared to other serious mental illnesses.

Though the term was around well before that. Has origins in both medical psychiatry and traditional psychoanalysis. The DSM III had many many many more disorders than the previous manual (the majority of mental disorders weren't in the DSM II) and the DSM was the first attempt at an a-theoretic description of symptom clusters.

> As it is as an intelligent person with a mental illness i get increasingly pissed off with the bull %#@&#! that stems from those opposed to psychiatry ie the anti psychiatry mob

Forget about Tom Cruise. He is an actor and not an authority on either psychiatry or anti-psychiatry. Forget about the scientologists. They believe that UFO's gave us disorders (though not mental disorder apparently). They are not an authority on either psychiatry or anti-psychiatry. Forget about psychiatrists characterizations of the anti-psychiatry movement. They (almost willfully) mischaracterize their views. Try reading Szasz or Laing to come to grips with the issues that they have with psychiatry. They have many terrific points to make - points that psychiatry needs to take on board. For example... The role of social factors in the production and maintenence of mental disorder.

> Psychiatry over here is increasingly being hijacked as a vehicle for pushing government social policy rather than meeting the varying individual needs of the mentally ill.

Yep. It has been that for a long time. Did you know that homosexuality was taken out of the DSM in response to LOBBY GROUP pressure? PTSD was included as a result of LOBBY GROUP pressure? Addiction will similarly be either included or not included as a result of LOBBY GROUP pressure. They ad hoc pick the science that seems to justify their view. But that is the only sense in which they 'defer' to science (which is to say that the APA is driven more by political considerations than scientific considerations). It has always been that way and it probably always will be.

So... Don't underestimate how much the APA and psychiatry thinks they need the pharmaceutical industry to justify their place within the medical sciences. And given that is the case don't underestimate how much the development of medications that seem effective is a significant driving force in what mental disorders are considered the legitimate subject matter of psychiatry.

Clinical psychologists have much more invested in personality disorders as they have much more invested in personality (social psychology) and psychometrics for assessing personalitly. They don't prescribe, however, so we can expect treatments to consist in therapy.

> Also i'm browned off with the long running turf war between psychiatrists and psychologists who seem to be content to see who can intellectually outdo one another at the expense of the clients they are supposed to be helping.

No %#@&#!. Much as people go on about the bio-psycho-social model there is no theoretically sophisticated account of how these factors are supposed to interrelate with none being fundamental. Since there isn't a good account there is the suspicion (all round) that genetics/neurology really is fundamental and that sciences that focus on those factors are somehow 'better' and that there is where the significant advances are supposed to come from.

There is a lot of professional jealousy from psychologists because the psychiatric association gets to make the authorative diagnostics manual for mental disorder. There is a lot of professional jealousy from psychologists who think that genetics / neurology is where it is at after all - so they want to prescribe meds too.