Paradigms lost and gained: has psychiatry in Australasia lost its voice?

Objective: The evolution of views about causes and management models in psychiatry is of keen interest to those who respect the field's history. The objective of this study was to identify international paradigm shifts since 1950 in psychiatric theorising and management models. Method: Multiple methods were used, including citation analysis, qualitative judgments by highly cited researchers and obtaining the views of historians of psychiatry. Results: The quantitative citation analysis was of low yield, seemingly reflecting limitations intrinsic to such an approach, but it did identify some 'signals' to broader domain shifts, such as the progressive loss of salience of psychoanalysis and a contrasting emphasis on a science-weighted model. Also, the highly cited researchers tend to nominate narrow exemplars. Nominations by the historians were more panoramic and, while capturing the domains identified by the two other strategies, went further in proposing a wide set of additional candidates for consideration. Conclusion: Of the three strategies employed, the qualitative approach (canvassing the views of historians and of highly cited authors) captured the paradigm changes, or at least theoretical or research trends, more accurately than the quantitative citation analysis. Changes in Australasian psychiatry would appear to generally mirror such international changes, rather than evidence a distinctive voice.