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?
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
2. Shapiro SJ. The “Hart-Dworkin” Debate: A Short Guide for the Perplexed. February 2, 2007. U of Michigan Public Law Working Paper No. 77. http://dx.doi.org/10.2139/ssrn.968657. Accessed January 24, 2013.
3. Annas G. Doctors, patients, and lawyers—two centuries of health law. N Engl J Med. 2012;367:445-450.
4. Stone AA. Law, science, and psychiatric malpractice: a response to Klerman’s indictment of psychoanalytic psychiatry. Am J Psychiatry. 1990;147:419-427.
5. Robertson M. Power and knowledge in psychiatry and the troubling case of Dr Osheroff. Australas Psychiatry. 2005;13:343-350.
6. Klerman GL. The psychiatric patient’s right to effective treatment: implications of Osheroff v Chestnut Lodge. Am J Psychiatry. 1990;147:409-418.
7. Malcolm JG. Treatment choices and informed consent in psychiatry: implications of the Osheroff case for the profession. J Psychiatry Law. 1986;14:9-106.
8. Snow CP. The Two Cultures: And a Second Look. New York: Cambridge University Press; 1963.
9. Furedi F, Kimball R, Tallis R, Whelan R. From Two Cultures to No Culture: CP Snow’s ‘Two Cultures’ Lecture Fifty Years On. London: Civitas; 2009.
10. Luhrmann TM. Of Two Minds: The Growing Disorder in American Psychiatry. New York: Alfred A. Knopf; 2000.
11. Klerman GL. The Osheroff debate: finale. Am J Psychiatry. 1991;148:387-390.
12. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2:576-582.
13. Freud S. The future chances of psychoanalytic therapy. Selected Papers on Hysteria and Other Psychoneuroses. http://www.bartleby.com/280. Accessed January 24, 2013.
14. Perry JC, Bond M. Change in defense mechanisms during long-term dynamic psychotherapy and five-year outcome. Am J Psychiatry. 2012;169:916-925.
15. Gerber AJ, Kocsis JH, Milrod BL, et al. A quality-based review of randomized controlled trials of psychodynamic psychotherapy. Am J Psychiatry. 2011;168:19-28.
16. Gabbard GO. Long-Term Psychodynamic Psychotherapy: A Basic Text. 2nd ed. Arlington, VA: American Psychiatric Publishing, Inc; 2010.
17. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65:98-109.
18. Douglas CJ. Studying the efficacy of psychodynamic psychotherapy. Am J Psychiatry. 2011;168:649-650.
19. Vaillant G. Lifting the field’s “repression” of defenses. Am J Psychiatry. 2012;169:885-887.
20. Dennett DC. Facing Backwards on the Problem of Consciousness. November 10, 1995. http://ase.tufts.edu/cogstud/papers/chalmers.htm. Accessed January 24, 2013.
References1. National Endowment for the Humanities. National Foundation on the Arts and the Humanities Act of 1965 (P.L. 89-209). http://www.neh.gov/about/history/national-foundation-arts-and-humanities-act-1965-pl-89-209. Accessed January 24, 2013.