In June 2005, a movie star sat on a sofa and told the world that my profession was a “pseudoscience”. He called the anchor of the Today Show “glib” for defending the chemical imbalance theory. At the time, as a consultant forensic psychiatrist with the weight of the Royal College and the GMC behind me, I found it offensive. We had the manuals. We had the science. We had the authority. But that was twenty years ago. Today, looking across ...
What This Article Is Actually About Prof Keith Rix, a forensic psychiatrist with fifty years’ experience, has collected the court judgments where these failures were exposed. His 2025 paper in BJPsych Advances shows what happens when diagnostic habits formed in clinics meet the scrutiny of a courtroom. The results are disturbing. And they affect everyone who has ever received a psychiatric diagnosis, instructed an expert, or sat on a tribunal. Consider the following: A man loses his compensation claim because an occupational ...
In the world of physical medicine, there is a concept known as “ground truth.” If a patient presents with chronic abdominal pain, a surgeon does not simply “divine” the presence of appendicitis based on the patient’s personality or the “vibe” of the consultation. There is a verifiable chain of evidence based on physical examination, blood markers, and imaging. If a surgeon operates on a healthy appendix because they “felt” it was diseased without proper diagnostics, they’re courting a malpractice claim. ...
The mental state examination sits at the heart of psychiatric practice. It is both a clinical skill and a professional responsibility. Yet it remains one of the most poorly executed aspects of psychiatric assessment across all levels of experience. Persons in higher management would do well to study this article, to better understand the time involved in both carrying out a proper MSE and in proper documentation of it. In January 2012, I touched on Mental State Examination (MSE) rather ...
The motor system is profoundly affected in schizophrenia, with a significant body of evidence confirming the presence of robust, observable movement disorders that are independent of antipsychotic medication or substance use. These abnormalities are not merely secondary features but represent core components of the illness, impacting various domains including posture, gait, balance, and fine motor control. Prevalence and Clinical Manifestations of Intrinsic Motor Abnormalities The clinical manifestations range from subtle deficits to overt syndromes like catatonia, and their prevalence varies ...
A crucial issue in psychiatry and criminology is how to correctly diagnose personality disorders in people who have committed crimes. It’s not as simple as saying that a criminal record automatically equals a diagnosis of Antisocial Personality Disorder (ASPD). This is far more than an academic debate; it has serious real-world consequences. A person’s diagnosis can affect their legal position, their access to psychological services, and even how the public views them. The two main diagnostic manuals, the World Health ...
In an era of TED Talks and trauma-informed evangelism, the public understanding of complex clinical phenomena is increasingly shaped by by emotionally compelling narratives instead of peer-reviewed evidence. Figures like Johann Hari and Gabor Maté have become cultural touchstones—revered not for their methodological rigour, but for their ability to reframe suffering in ways that feel intuitively true. The result is a widespread phenomenon we might call epistemic oversimplification, amplified by narrative seduction. The author and this site now coins the ...
The bedrock of modern medicine rests upon the firm principles of evidence-based practice and scientific rigour. Yet, across the global healthcare landscape, unsettling developments frequently expose the considerable vulnerability of these foundations to external pressures. Recent policy decisions in India, particularly concerning the integration of allopathic medicine with homeopathy, serve as a stark and disquieting case study. These compel a critical examination of how socio-political forces can decisively outweigh scientific consensus. This intricate interplay carries substantial implications especially for psychiatry; ...
When engaging with health professionals, it is common to encounter clinical terms used to describe presented experiences. These terms are valuable for accurate communication amongst clinicians and for documenting a presentation. However, it is important to recognise that a clinical description of a symptom or sign, whilst precise, does not inherently provide a full explanation of why that experience is occurring, nor does it equate to a definitive diagnosis of a condition. Some patients leave consultations none the wiser about ...
The claim that psychiatric diagnosis is “an art, not a science” is a dangerous myth, often perpetuated to the detriment of those struggling with mental illness. This misconception implies a reliance on subjective guesswork rather than the rigorous application of scientific principles that underpin other medical fields. While psychiatric diagnosis certainly presents unique complexities, it is undeniably grounded in scientific methodology. The idea of “art vs. science” in psychiatric diagnosis is squarely challenged. This exploration covers the science behind diagnosis, ...
