Bentall has already proposed a complaints-based system.

In his book Madness Explained he rips into the science of psychiatry, particulaly in schizophrenia, and alludes to its pseudoscienceness.

He saw a complaints based system as a way forward. At least that's what I was told. I got about halfway through the book.

What I reckon is this is pretty necessary.

Step 1 is understanding what patients want and expect. This is often least considered. It takes lobbying and campaigning. Listening is not a skill in psychiatry.

There isn't a definitive study of this as far as I am aware.

There is a small, scattered body of work though and this forms a starting point for progress.

Step 2 is making measures which are useful in practice and research.

The funky thing...and here's the really fucking funky thing is aligning this structure to successful treatment.

Let's take the assumption that many patients who accept treatment from psychiatrists have different ideas from theoretical psychiatry. For example their definition of psychopathology of schizophrenia is delusions and hallucinations. While psychiatrists may argue this is incorrect I am disinterested in their opinion.

I'm skipping the first step which is about truly understanding and delivering in what individual patients expect from treatment. It's to focus on the second bit. Getting the evidence to make clinical decisions based on this new system whereby the patient matters.

So the easy thing is a full systematic retrospective review of all modern trials of treatments for psychosis. I am sure clever people like dr Joanna Moncrieff or Prof Rich Bentall and their ilk could work out the details of a good paper. This is a relatively cheap research project I guess though there'll be a lot of contacting authors to get acess to all the original data.

The system creates a new diagnostic structure for the evidence. In fact it could be refined to delusions or hallucinations alone but differentiating between the two in clinical practice is probably beyond current medical expertise. Regardless, the patient request of "I want these delusions and hallucinations to cease" can allow a doctor to say "here is the best evidence based way to change that", thereby achieving what patients expect and creating an effective way to treat.

Of course this risks polypharmacy and all sorts of shit if it were a general system so I need to think more about this. Perhaps the best solution is..bugger...don't know the technical term...

Basically not all people will concurrently suffer all symptoms. There have also been other classification systems suggested for schizophrenia. Subtypings.

I have no idea if what I'm talking about is related to the dimensional model.

Basically in the large mass, often described as heterogeneous, of people with schizophrenia there may be subtypes which specifically relate to successful treatment which psychiatric science as yet doesn't see.

Let's take a basic measure like panss. What if a person score high on other measures than delusions and hallucinations. Someone must have already done this sort of pattern analysis. Its obvious. This is all about making types given a black box reverse engineering situation.

Statistically identifying types within the measured main category must already be the fundamental of psychiatric science. Assigning treatment basewd upon those mathemathically defined subtypes using practical clinical definitions. Well thatzls a good definition of psychiatry?

And so this little bit of research I'm talking about must already exist. Its obvious to do this small bit of research into what works based on patient and public expectation.

I mean...fuck...otherwise psychiatry would only be killing people with treatment to deal with their extenral behaviour and the effects of the cause. With antipsychotics I mean. If they're actually only major tranquilisers and that's the only efect psychiatry cares about..

Well...I think the entire profession should be struck off if that were true.