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Home » Blogs » Couch in Crisis

Psychiatric Times. Vol. 30 No. 4
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HUMANITIES 

The Humanities and Psychiatry: The Rebirth of Mind

By James Knoll IV, MD | March 15, 2013
Acknowledgments—I am grateful to Alan Stone, MD, and Ron Pies, MD, for their thoughtful assistance, and to Philip J. Hirschkop, Esq, and Jonathan R. Mook, Esq, for their teaching and insights. Dr Knoll is Associate Professor of Psychiatry at the SUNY Upstate Medical Center in Syracuse, NY, where he is Director of Forensic Psychiatry, and Director of the Forensic Psychiatry Fellowship at Central New York Psychiatric Center. He is also the editor in chief of Psychiatric Times.

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? The term “humanities” is broad and includes “the study and interpretation of . . . language . . . literature; history; jurisprudence; philosophy . . . ethics . . . [and] aspects of social sciences. . . .”1

Is any of this relevant to everyday psychiatric practice?

(MORE: Religion, Spirituality, and Psychiatry)

The humanities are a variety of academic disciplines that focus on the human condition with analytic and sometimes speculative methods. This is in contrast to the empirical methods of the natural sciences. The humanities are required, primarily because science alone cannot answer the question of what it means to be human. In truth, neither can the humanities. Science and the humanities are like the yin and yang of our intellectual explorations into the human condition—one is necessary for (and contains) the other.

As a student of “psychiatry and the law” as well as of psychodynamic psychotherapy, the question of the relevance of the humanities to psychiatry has always seemed too obvious to me. Yet in this particular age, I realize I am obligated to back up my claim that we should focus on anything beyond the randomized controlled trial. Here I admit bias, because the study of law reveals a potent mix of social sciences and humanities, in so far as it focuses on the “relation between legality and morality.”2

Forensic psychiatry has occupied a distinctly hybridized place in the annals of medical jurisprudence for some 2 centuries. Students of both law and medicine are quickly led to the conclusion that both are “critical tools for improving health and well-being on a global level, and each profession is more effective when the two work together.”3 Thus, the value of mixing science with the humanities, at the proper time and place, seems evident, insightful, and farsighted.

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.

The battle for psychiatric knowledge

Had I not done a fellowship in forensic psychiatry, I would not likely have knowledge of what Alan Stone, MD, called “an important historical moment of transition in modern psychiatry.”4 Stone was referring to the case of Osheroff v Chestnut Lodge that settled out of court in the mid-1980s [for a pdf, please click here]. For a case that set no official legal precedent, it rocked the foundations of psychiatry: it was a “showdown between two forms of knowledge in psychiatry—evidence-based medicine and clinical experience.”5

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by William Houghton | April 19, 2013 1:42 PM EDT

The humanities express a more individual set of perceptions, primary process, a personal language, true of one person rather than a crowd of strangers who make a RCT---but if the psychiatrist wants to connect with one patient at a time, he or she better know the vocabulary of that one person, if he wants to respond in a way the patient understand. I hear many psyciatry patients complain that another psychiatrist did not understand them, spoke in purely diagnostic or chemical terms, so they didn't follow through. I wonder if with the Oscheroff case there was a mismatch of vocabularies, or the patient had difficulty expressing opposition or frustration in other ways, or the rescuing by his family was a curative factor---? I'd love to see the records, but I'm sure no one will release them now. Both the scientific method and the law have little tolerance for individuals and one-of-a-kind situations
Bill Houghton

Also in this Special Report

Introduction: Why Does Psychiatry Need the Humanities?

Shakespeare and Psychiatry: A Personal Meditation

Psychiatry and Art

The Humanities and Psychiatry: The Rebirth of Mind

Religion, Spirituality, and Psychiatry






 
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