Ep. 71 Psychiatry: Past, Present, and Future

Paul McHugh, MD

Despite its many scientific and therapeutic advances, the field of psychiatry remains lacking in coherence or cohesiveness as compared to other areas of medicine.  Part of the issue undoubtedly has to do with the intractable mind-body problem, but part of it may also be due to the effort of standardization of diagnosis set in motion by the Diagnostic and Statistical Manual.  Is there a way to move forward?

Our guest is optimistic.  Paul McHugh, MD, is one of the most important figures in academic psychiatry of the last 30 years.  He is University Distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine where he was department chairman from 1975 until 2001.  He is the author or co-author of several academic books and texts of psychiatry.


Paul McHugh, MD. Professional web page


Paul R. McHugh and Philip R. Slavney, D. Mental Illness: Comprehensive Evaluation or Checklist? (New Engl J Med, 2012)

Paul McHugh and Philip Slavney.  The Perspectives of Psychiatry (Wolters Kluwer, 2nd ed. 1998)


  1. Greg Huff on 03/26/2019 at 2:28 PM

    This was very enlightening, as usual. Any chance of an episode on Thomas Szasz some day?

    • Michel Accad on 03/26/2019 at 11:17 PM

      Thank you, Greg. I thought about bringing up Szasz but I decided against it. Deserves an episode of its own/. Any thought on someone who could speak about him and the anti-psychiatry movement? Michel

      • Jean Franklin, RN, BSN on 04/04/2019 at 4:23 AM

        How about Peter Breggin, MD? He was trained in psychiatry just as the use of psychiatric medications began taking off. He can address the consequences of reliance on medications as opposed to other therapeutic interventions. He is a practicing psychiatrist as well as an outspoken critic of psychiatry.

      • David C. Norris, MD on 04/26/2019 at 1:49 AM

        Episodes like this are why the world needs the A&K Report. Where else could a modern thinker’s convergence with Aristotelian thinking come to light, in the same 40 minutes where the hazards of Medicaid psychiatry get exposed?

        As for anti-psychiatry, perhaps you’d like to try @BigPhilHickey? Here’s a recent post of his on the topic: http://behaviorismandmentalhealth.com/2019/04/25/in-defense-of-anti-psychiatry/.

        • Michel Accad on 04/26/2019 at 5:27 PM

          Thank you, David. We’ll look into your recommendation.

        • Marc Fouradoulas on 04/27/2019 at 6:16 AM

          It‘s not about anti- or pro-psychiatry. Shrinks know their pitfalls too and there certainly is some value to psychiatry. Its all about anti-monopoly and pro-market.

  2. Marc Fouradoulas, MD on 03/29/2019 at 7:42 AM

    Great interview! Still I dont get it. The DSM “field guide” was an attempt standardize diagnosis for the sake of research and cooperation. But wasn’t it an attempt to artificially unify the totally heterogenous field of psychiatry for the sake of monopoly? Leaving out the DSM, there is no such thing as a field of psychiatry but just different schools of studying the mind. But in real life, what is more scary than a medical-guild monopoly over the psyche? (I worked in psychiatry as a resident..)

    • Michel Accad on 03/29/2019 at 5:01 PM

      Excellent point, Marc!

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