Psychiatry and Evidence-Based Psychiatry: A Distinction With a Difference

摘要

Evidence-based medicine (EBM) made its first appearance in the medical lexicon in 1990 and since then has enjoyed widespread support from within the medical profession, including among psychiatrists. Proponents of evidence-based psychiatry (EBP) point to its ability to demonstrate the efficacy of various psychiatric treatments, promising improved mental health outcomes and more efficient use of healthcare resources as a result. Policymakers and insurers have embraced EBP in hopes that these goals will be realized. However, the question of whether EBM is even applicable to psychiatry remains largely unaddressed, even though it is an urgent one, given the various corporate, professional, and governmental pressures to practice according to its principles. In their article, Thomas, Bracken, and Timimi (2012) address the fundamental question of whether there are features of psychiatric problems, or their treatment, that require the reconsideration of EBM's relevance to psychiatry (as distinguished from other medical specialties). Their paper begins by arguing that, because it is oriented toward picking out the effects of specific components of treatments, EBM's methods tend to neglect unspecified aspects, such as the placebo effect and the so-called nonspecific psychotherapeutic factors. The authors then consider EBP using the interpretive lens of Kuhn's concepts of normal science, paradigm, and anomalies.