Power and knowledge in psychiatry and the troubling case of Dr Osheroff

Australas Psychiatry. 2005 Dec;13(4):343-50. doi: 10.1080/j.1440-1665.2005.02212.x.


Objective: To consider the state of knowledge in psychiatry with reference to the 'Osheroff debate' about the treatment of depression.

Method: A review of the key philosophical issues regarding the nature of knowledge applied to the Osheroff case.

Results: There is an apparent dichotomy between knowledge derived from a reductionist scientific method, as manifest in evidence-based medicine, and that of a narrative form of knowledge derived from clinical experience. The Focauldian notion of knowledge/power and knowledge as discourse suggests that scientific knowledge dominates over narrative knowledge in psychiatry. The implication of this applied to the Osheroff case is the potential annihilation of all forms of knowledge other than science.

Conclusions: Knowledge in psychiatry is a pluralist, rather than singularly scientific enterprise. In the Osheroff case, the potential for scientific knowledge to abolish other forms of knowledge posed a serious threat of weakening the profession. In the light of the current debate about best practice, there is a need for reconsideration of the implications of Osheroff.

Publication types

  • Biography
  • Case Reports
  • Historical Article
  • Legal Case

MeSH terms

  • Antidepressive Agents, Tricyclic / therapeutic use*
  • Anxiety / complications*
  • Anxiety / drug therapy*
  • Anxiety / therapy
  • Attitude
  • Combined Modality Therapy
  • Countertransference
  • Depressive Disorder, Major / complications*
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / therapy
  • Evidence-Based Medicine / methods*
  • Health Knowledge, Attitudes, Practice*
  • History, 19th Century
  • History, 20th Century
  • Humans
  • Interpersonal Relations
  • Knowledge*
  • Marriage / psychology
  • Narcissism
  • Patient Compliance
  • Patient Rights / legislation & jurisprudence
  • Philosophy
  • Power, Psychological*
  • Psychiatry / history*
  • Psychoanalytic Therapy / methods
  • Psychomotor Agitation / complications
  • Psychomotor Agitation / therapy
  • Psychotherapy / methods*
  • United States


  • Antidepressive Agents, Tricyclic

Personal name as subject

  • Raphael Osheroff