Psychiatry in Crisis: Humanism vs. Scientific Progress

Mental HealthImmanuel Kant argued in the 18th century that “all the insane be turned over to the philosophers and that the medical men stop mixing into the business of the human mind.” Modern psychiatry, however, has increasingly aligned itself with physical medicine by emulating the precise and unbiased nature of medical science.  This is a problem that continues to plague the field.

Many of the concepts upon which psychiatry are based are intangible, philosophical constructs that are inherently subjective, value-laden, and difficult to define.  The transformation of the field away from its philosophical roots and toward the currently dominant medical paradigm has resulted in a humanistic crisis: the experience of the individual has become secondary to the importance of science.

The transformation of psychiatry to a medical science

Prior to the 1980s, psychiatry relied largely on a descriptive, dimensional system of diagnosis and classification. Psychiatry was understood as a deeply personal field inextricably linked to the thoughts, beliefs, emotions, and experiences of the individual. The third edition (1980) of the Diagnostic and Statistical Manual (known in psychiatric circles as the “bible” of diagnosis and treatment) shifted the emphasis from nuanced description to the identification of discrete biological diseases that could theoretically lead to disease-specific treatment.

This “disease model” of diagnosis and treatment lent itself naturally to the creation of psychopharmacology. Much like penicillin did within physical medicine, the development of biological methods to treat mental disorders revolutionized the practice of modern psychiatry. As it currently stands, the philosophical foundations at the core of the field have become almost unrecognizable beneath a sea of medical jargon and procedures that now dictate the practice of psychiatry.

Re-incorporating humanism into the practice of psychiatry would greatly benefit the field.  The ultimate goal of psychiatry is to help alleviate the pain and suffering associated with the experience of mental illness.  This cannot be done without an understanding of what mental suffering means to the individual, how it affects his or her life, how it contributes to his or her personal story, and what it would mean to liberate the patient from his or her mental suffering.

I envision three major benefits to adopting a more humanistic stance:

  1. Better adherence to treatment  — Exploring the patient narrative would provide a meaningful way for psychiatrists to conceptualize mental illness and improve their relationship with patients, thereby resulting in improved therapeutic compliance.
  2. Demystification of mental illness — Utilizing a less scientific, more philosophically based method for the creation, classification, and treatment of mental disorders would help both the patient and the general public demystify mental illness and also go a long way towards fighting the stigma associated with seeking treatment.
  3. Reclamation of the unique role of psychiatry — Adopting a more humanistic approach would allow modern psychiatry to accept its unique role as a bridge between the mind and the body, the mental and the physical, the philosophical and the scientific.

This is a call to action. What could you or other psychiatrists do, right now, to infuse more humanism into your work? What do you already do to keep the individual in mind?

Stacy Gallin

This post was written by Stacy Gallin, DMH. Her work in the Medical Humanities focuses on the philosophy of psychiatry, bioethics and the Holocaust, and various ways to remedy the healthcare system in America  You can find more of her work at IntellectualBabble, where she blogs about her journey to change the world (in between changing diapers).  

 

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