2 Is Psychiatry Ethical? Finian Fallon The author considers the practice of psychiatry in Ireland in the context of mental health distress. He looks at some historic controversies related to lobotomy and in Ireland the use of electroconvulsive therapy (ECT) which is still practiced in Ireland. He also looks at the contemporary context in the Irish mental health services. He offers a critique of psychiatry believing it to be in the service of a scientific status quo and its own power base rather than applying up to date science in the primary interest of the client. He outlines criticisms of the DSM 5 including those from the field of psychology. He also discusses the impact of medication for restraint and control which he claims is also responsible for shortening the lives of patients. Then he discusses the move in research focus to the Research Domain Criteria of the US National Institute of Mental Health and considers what this might mean for psychiatry. He explores the recent refusal of the Irish government to formalise in law the participation of families in the care those in psychiatric care. He concludes by asking if psychiatry is ethical. Key Words: PSYCHIATRY ETHICS MENTAL ILLNESS ELECTROCONVULSIVE THERAPY (ECT) LOBOTOMY In this article I will refer to content of a recent radio documentary broadcast in Ireland. I will use this to consider some historical and contemporary controversies associated with psychiatry. In discussing psychiatry I will outline the example of Freeman who developed the lobotomy and, related to this, the contemporary use of Electroconvulsive Therapy (ECT) in Ireland. Some of the literature related to ECT efficacy will be discussed. I will then discuss my experience of psychiatry as a psychotherapist and the rigidities that seem to me apparent in the reactions to challenges raised when discussing client presentations. In discussing the power of psychiatry I will explore the position of psychiatry vis a vis the state and the critique of psychiatry as complying with cultural and political demands. Connected to this reference will be made to the high level of institutional incarceration in Ireland during the 1950s ostensibly for mental illness, a rate of imprisonment which at one time was the highest per capita in the world. I will discuss what I perceive as the death of the DSM and the growing criticisms of DSM including from psychology. I will explore the refocussing of mental health research by the National Institute of Mental Health to its Research Domain Criteria, which is an attempt to restart mental illness research from first principals while incorporating a more continuum-based approach to human mental distress. I will briefly discuss the emerging research which exposes the adverse effect of psychotropic medication on the life expectancy of those with mental distress. I will then discuss some controversial diagnoses included in historical and contemporary versions of the DSM. I will review a recent refusal of the Irish government to facilitate more family involvement in psychiatric care. Finally I will ask whether, given the expediency, controversies and issues that allow us to critique psychiatry, if the practice of psychiatry is ethical.