Why these 12 facts need to understood in larger context:
1. Ok, there are no objective tests. But what does that mean? For that u have to understand the numerous & complex pragmatic functions a diagnosis serves in medicine, many of which have nothing to do with objective tests. https://twitter.com/Mad_In_America/status/1266054179300270086

You only have to think what function do diagnoses like "migraine" & "low back pain" serve in medicine. Many diagnoses are simply ways of capturing presenting complaints of patients in ways that also reflect elements of assessment. Diagnoses are imperfect maps of terrain of sx

2. True, notion of "chemical imbalance" as a sole/predominant cause of mental disorders is incorrect, but what does this fact mean in terms of the multifactorial, complex etiology of mental disorders? It doesn't mean that biological factors aren't of explanatory relevance.

3. Aggregate genetics is different from specific genes. Absence of single genes of large effect doesn't mean absence of multiple genes of individual small effect but aggregate large effect. The contribution of genetic factors varies from disorder to disorder.

4. Antidepressants are not placebo. They are weakly effective on average but they are not placebos. They remain of therapeutic value, especially in severe depression.

5. "Prozac should never have been approved"... odd that this idiosyncratic opinion should constitute an "essential fact" about psychiatry.

6. Antidepressants are over-prescribed, especially in primary care settings. This constitutes as much a threat to the legitimacy of psychiatry as overprescription/overuse of PPIs does to the legitimacy of gastroenterology.

7. I (and most psychiatrists) support greater availability of psychotherapy services. Why don't we discuss the larger market and systemic forces which have made psychotherapy so hard to access?

8. It may be the case that most people will meet criteria for some mental disorder at some point in their lives (such research studies often have difficulty establishing "clinical significance" of symptoms), however, it is only alarming if we assume that distress/impairment...

... requiring clinical attention should necessarily be rare in the population. Such an assumption is conceptually problematic for many reasons, and this discussion is far more complex than is implied.

9. Stigma is complex, and etiological understanding plays a role but only to some degree. Think of stigma surrounding epilepsy or HIV. Also, psychiatric diagnosis does not equal "biogenetic explanations".

10. There are many different reasons for why that is the case. Complex discussion.

11. This is not completely true, at least in US. For instance, from 2015-2019 the number of psychiatry residency positions increased by 29% per NRMP.

12. The UN report is consistent with calls for biopsychosocial, pluralistic, and structurally-competent practice of psychiatry. I agree that reforms are needed. It doesn't mean that UN is calling to abolish psychiatric diagnoses and psychiatric interventions.

It is easy to criticize psychiatry but it is hard to criticize it in a manner that does justice to the conceptual, historical, scientific, and social realities of the profession. We should expect better from psychiatry but we should also expect better from its critics.