I read with interest Laugharne's article about postmodern psychiatry (Psychiatric Bulletin, September 2004, 28, 317-318). Whilst there may indeed be a paradigm shift underway in a ‘postmodern’ direction, running counter to this is just as potent a trend, which has a distinctly ‘modernist’ flavour. If modernism is a paradigm encouraging empirical measurement, reductionist classification, technicism, etc., then one need not look beyond one's everyday practice to see that ‘ modernist’ values dominate and are likely to do so in the near future. Many of us express reservations about an emerging psychiatric culture permeating all areas of training and practice, which places disproportionate emphasis on that which can be measured, compared and tabulated. CPD points, star ratings, crude performance indicators such as ‘bed occupancy days’, requirements for judgements about risk to be denoted in discrete categories such as H M or L are but a few examples of the ‘ symbols’ of this culture.

Secondly, some branches of psychiatry will be resistant to accommodating the postmodern model, which holds knowledge to be tentative and partial, and replaces absolute truth claims with ‘relative’ or ‘ pluralistic’ truth. The challenge for psychiatry to tolerate ambiguity is more likely to be met at the non-coercive end of the spectrum than at the criminal justice interface. The criminal justice system relies much more on absolute or dogmatic assertions and encourages suppression of ambiguity in psychiatric judgements around risk, dangerousness and diagnoses. Whilst this is perhaps understandable given that such judgements lead to very unambiguous disposals, the notion of a truly postmodern psychiatry remains illusory.