ABSTRACT
The psychiatrist and neuroscientist Nancy Andreasen has pointed out that a crucial characteristic of psychiatry as a research-led clinical discipline is the unique way in which it combines some of the most challenging scientific questions with equally challenging conceptual problems. Andreasen argues that the conceptual difficulties that we face have been driven increasingly to the top of psychiatry’s practical agenda by the recent rapid pace of advances in the neurosciences.1 These conceptual and empirical difficulties are evident in a wide range of contexts; examples include (i) disputes around the current revision processes for both the International Classification of Diseases (ICD) and the American Psychiatric Association’s Diagnostic and Statistical Manual;2 (ii) the contested shift in the UK and in many other countries in service delivery from psychiatry to a more multidisciplinary approach;3 and (iii) growing pressure for a move away from professional-led mental health and social care services to a more equal partnership between professionals and service users and carers.4
