An extraordinary divide

These days I am a gardener.  Sometimes I am reminded of my previous occupation.  For 25 years I worked as an NHS psychiatrist. In my training I was taught how to divide the ‘subjective’ from the ‘objective’. This approach always bothered me.

In 2002 this paper was published in the Psychiatric Bulletin:

Psychiatry chose not to abandon this divide as a recent exchange on social media has demonstrated:

Comments were sought regarding a meta-analysis of a pharmacological intervention in psychiatry which was shown to be no better than placebo; however all treated groups showed some improvement. This common finding is why randomised-controlled trials are the ‘gold-standard’ for any proposed interventions.

One contributor, a senior and influential British psychiatrist, mentioned factors such as “clinician optimism [rather than nihilsm], the experience of being given treatment and other benefits that come with being held in a service including informal psychological therapy.” This contributor suggested that these subjective factors might justify the prescribing of the pharmacological intervention being considered. In consideration of the methodology used in this meta-analysis the same contributor stated that “we have to have some objective way to measure symptoms”.

It was clear from further contributions to this exchange that this appreciation of both what may be valued as ‘subjective’ or ‘objective’ was not due to confusion, or an acknowledgement of complexity, but carefully chosen to justify the contributor’s view point.