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What is the heartland of psychiatry?

University Department of Psychiatry, Warneford Hospital, Oxford, UK

Correspondence: Dr Guy M. Goodwin, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. Email: guy.goodwin{at}psych.ox.ac.uk

Declaration of interest Both authors have received financial support from pharmaceutical companies. G.M.G. is a non-executive director of the Oxfordshire and Buckinghamshire NHS Mental Health Partnership Trust.

Psychiatry has long identified schizophrenia as its defining disorder, its heartland as it has been called. In the past 20 years, this has had a number of negative consequences for psychiatry as a medical specialty, which result from the uncertainty of diagnosis and an increasing emphasis on demedicalising services in an attempt to provide social care outside hospital. These changes have probably increased the stigma attached to psychiatric practice and threaten to deskill doctors. They have also meant that services for other disorders do not meet the needs of patients. To continue to allow schizophrenia to be the paradigm condition is against the interests of psychiatrists and their patients.

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