François Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis.

Barry Blackwell’s comments on Edward Shorter’s comments on Luc Ciompi’s comments


       While I agree with Ned Shorter’s characterization assigning specific biological, psychological or social approaches precedence in the treatment of particular disorders I suggest a more parsimonious approach is to apply a biopsychosocial model to all mental disorders.

         For example, while schizophrenia indubitably has an organic etiology drugs that effectively stifle its positive symptoms often fail to alleviate negative symptoms that impede integration into the community where social and psychological techniques are helpful.

       Likewise, melancholia, often considered “endogenous,” frequently seems to lack obvious psychosocial precipitants that may reveal themselves over time with scrupulous enquiry, hidden behind shame, fear or alexithymia.

        Similarly, mania usually yields to carefully titrated lithium but relapses are common, ushered in by the many causes of poor compliance which respond to a therapeutic alliance that offers comprehensive strategies.

       As Ned mentions stress related disorders usually yield to psychological or social interventions directed towards its precipitants but drugs  provide equanimity and a respite quelling anxious or somatic symptoms, thus facilitating benefits therapy bestows while stifling triggers for relapse and recurrence.

       As noted in a recent posting the contemporary “medicalization” of psychiatry and severance of therapy from drug treatment, creating the preponderance of “med-checks,” is contributing to drug dependence, failure to wean; perhaps even to therapeutic despair and suicidal tendencies (Blackwell 2019).


Blackwell B. Reply to Edward Shorter’s comment on Sir Aubrey Lewis and Psychopharmacology (Barry Blackwell and David P. Goldberg: Sir Aubrey Lewis and psychopharmacology. October 24, 2019.


November 7, 2019