Editor word: Issue 2 2025
- Hans-Peter Mofors
- 24 hours ago
- 3 min read
Change is the only truly constant thing; everything is in continuous motion. There is no doubt that this also applies to psychiatry. As a physician, one does not have to work long to experience how the pendulum swings back and forth. During my years as a psychiatrist, I have also observed how society’s attitudes toward and expectations of psychiatry have changed radically. A few decades ago, diagnoses - and not least medical treatment - were questioned. Today, the situation is different: psychiatric diagnoses are no longer stigmatized (at least not all of them), and expectations regarding pharmacological treatment are often extensive. Physicians who previously argued in favor of pharmacological symptom relief are now not infrequently the very ones trying to limit it.
A clear trend seems to be that patients desire medications that increase levels of dopamine and GABA in the brain - substances that can also lead to dependence and be used recreationally. Representatives of academia are likewise seeking evidence for the use of such substances in the treatment of various conditions. There is an ongoing de-stigmatization of controlled substances, and demand for them continues to rise steadily. Interestingly, non-addictive medications, for example for sleep disturbances, receive far less attention.
The boundary between suffering that falls within the scope of mental illness and the suffering that is an expected part of life itself is no longer self-evident. Increasingly, more and more aspects of life appear to fall under the domain of psychiatry. Which symptoms should be treated medically, and who is actually responsible for determining treatment? Patients in psychiatric care - now often referred to as users or clients - frequently present with a clear request early in the course, both regarding diagnosis and treatment. The principle of prescribing what is most beneficial, rather than simply fulfilling wishes, is becoming increasingly difficult to uphold in everyday clinical practice.
The media often states that mental ill health is constantly increasing - a claim that may seem self-evident in a society where more than ten percent of young people are treated with amphetamine derivatives, and an equal proportion use antidepressants and sleeping medications. Many patients take multiple medications simultaneously.
How did we end up here? How, over just a few decades, did we move from a contextual understanding of psychological suffering to a manualized system of care with ever-increasing demands for pharmacological treatment to manage everyday life? What is the state of the scientific evidence supporting all this treatment, which is often more performance-enhancing in nature? An increasing number of psychiatrists express frustration in their work, as the very meaning of psychiatry seems to be increasingly devalued. Are we approaching a tipping point where psychiatric diagnoses become the new definition of normal health?
Attitudes toward pharmacological treatment vary across the Nordic countries. Antipsychotic treatment is largely uncontroversial in many places, yet in Norway there has for many years been a debate about whether antipsychotic medications are appropriate in the treatment of schizophrenia and other psychotic disorders. Treatment units for psychosis without medication have even been established. How can such differences exist among countries that otherwise share similar values? I believe it has to do with who has managed to drive a wedge into the debate and gain ownership of the narrative in public discourse.
One thing is certain - much has happened in psychiatry over recent decades. As physicians, we like to believe that we treat according to the prevailing evidence, but the fact remains that there is a significant gap between medication prescribing in controlled studies and what happens in the real world. What we do today will undoubtedly be questioned by future generations. The question is: what do we do about it?
In this issue of The Nordic Psychiatrist, we explore different perspectives on the pharmacological treatment of psychiatric conditions. We aim to highlight a variety of viewpoints and hope this will spark your interest.
As always, you can read a summary of the contents of our scientific journal, Nordic Journal of Psychiatry, as well as a column about a week in psychiatry. I wish you an engaging and thought-provoking read. â–¡
Hans Peter Mofors
Editor-in-Chief