In the opening editorial of its bicentennial volume, the British Journal of Psychiatry plainly sighted the elephant in the room in terms that left no doubt it had always been there. In discussing psychiatry’s failings the author blamed the descriptive approach for diagnoses, “which almost certainly do not map simply onto underlying brain function and dysfunction” (read: do not indicate the cause of illness or even whether an illness exists at all). Descriptive diagnosis serves up “highly heterogenous patient populations” (read: a confused mix of alleged illnesses that do not have a consistent relationship with each other). “It set the stage for the far from praiseworthy marketing of certain drugs” (read: the unjustified preference by psychiatrists and their academic leaders for advertised pills that provide no added¬† benefit to patients at greatly increased cost for their communities).

The brief phrases delivered without the explanation, which I spell out in parenthesis, imply that the editor refers to widely recognised facts. Facts they are, but ignored by most. The real meanings lie disregarded even though they have the prominence of an elephant in the room. By concluding that the only reforms on the horizon promise “largely cosmetic” changes of “lists of descriptive clinical symptoms” the editor reveals a sad resignation. They have no hope that the profession will tackle the heart of the dilemma facing it or avoid the elephant that tramples it.