Biological Psychiatry, Psychodynamic Psychiatry, and a New Approach to Understanding Mental Illness

In Psychiatric Times, Dr. James Knoll IV writes in “The Humanities and Psychiatry: The Rebirth of Mind“:

What place do the humanities have in psychiatry? One might as well ask: What place does the mind have in the brain? What place does clinical experience have in medicine? What is the utility of the empty space within the vessel?…  In this article, I focus on the importance of the humanities to psychiatry, via the perennial conflict between biological psychiatry and psychodynamically oriented psychiatry. I hope to use a humanist approach to show that these “two cultures” depend on each other for balanced progress in the field…

Biological psychiatry has made truly impressive progress, yet it remains the case in 2013 that “biological psychiatrists do not hold the panacea for serious mental disorders,”particularly when standing on the lone pillar of science. The art of medicine remains a critical foundational structure in psychiatry, and both pillars are necessary for the stability of the field. One might say that the humanities and/or psychoanalytic thought helps provide science with the relevant questions on which to focus its “piecemeal work.”Put another way: the humanities provide the wonder, which science then illuminates.

It is sometimes the case that older theories are not proved false—rather, the very progress they contributed to now shows their limits.

In Mind, Modernity, Madness: The Impact of Culture on Human ExperienceLiah Greenfeld writes:

Today we know an awful lot about schizophrenia and manic-depressive illness. An enormous amount of information has been collected about the psychological and biological expressions of these diseases — about the personal experience and outward behaviors corresponding to them, the anatomical abnormalities which show themselves in certain groups of patients and neurochemical dynamics characteristic of others — about patterns of their transmission in families and certain genetic elements involved. But this information refuses to combine into a “case” — an explanatory argument based on the available evidence: there are gaping lacunae where pieces of the puzzle are supposed to dovetail; and none of the things we know can be said to constitute the smoking gun. We still do not know what causes these diseases and thus cannot either understand their nature or cure them. After two hundred years neither of the two approaches — the biological and the psychodynamic — in which psychiatry put its hopes brought these understanding and cure any closer. Therefore, I feel justified to offer a new – radically different — approach that has never been tried.

The historical recency, the timing of the spread in different societies, and the increase in the rates of mental disease of unknown etiology indicates that it cannot be understood in terms of any universal, biological or psychological, propensity of human nature, or explained by the characteristics of the individual human organism or personality as such. The observable trends (however incredible) pertain to and distinguish between specific societies and historical periods, and therefore must be accounted for historically. …

My intention is not to prove either the biological or the psychodynamic approach to mental disease wrong, but to complement them, adding to psychiatry a necessary element which has been heretofore missing. All the findings of the biological research, specifically, should be consistent with the approach I propose and, in cases they are not, the fault would lie with the approach rather than the findings. Culture, personality, and biology are different, but not mutually exclusive realities, and for this reason cultural, psychological, and biological arguments should not be mutually exclusive.

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