Psychiatry and Society

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Abstract
The very legitimacy of psychiatry as a medical specialty has been challenged by social-labeling theory: the hypothesis that psychiatric disorders are artifacts that result from assigning diagnostic labels to minor deviations in behavior and thus generating expectations that condemn the person to a career of patienthood. Close examination of the evidence demonstrates that, though improper care can retard recovery, psychiatric illness exists before the name assigned to it and independently of theories about its genesis. In this respect, psychiatric illness does not differ from other medical problems. All human diseases reflect the outcome of an interaction between biology and social organization, with culture in a mediating role. Whatever the proximate cause of disease — viral, genetic, metabolic or neoplastic — the way in which society is organized affects prevalence, cause and outcome. The physician's task is to intervene to minimize distress and preserve adaptive capacity, when cure is not possible. (N Engl J Med 296:903–910, 1977)

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