Although a bit slow to produce, psychodynamic psychiatry did listen to Klerman because it has attempted, to the best of its ability, to subject its approach to the scientific method.14-16 In applying scientific methods to psychodynamic psychiatry, more important lessons have been learned. For example, nonpsychodynamic therapies may be effective, in part because more skilled practitioners use techniques that have long been central to psychodynamic theory and practice.17 Real-world clinical practice is often very different from the conditions of most RCTs (eg, patients commonly bring more than one illness to therapy), and psychiatrists find themselves employing a mix of evidence-based treatments with other empirically supported approaches and a good measure of creativity.18,19
Should providence be with psychiatry, the next swing of the pendulum will not be so wild as to threaten to suppress an entire form of knowledge. Yet, this may be too much to ask, since progress often requires the most frustrating and convulsive upheavals. It does seem encouraging for psychiatry that over 2 decades since Klerman proclaimed psychoanalysis a disappointment, we find both it and its progeny alive and well.
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,”7 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.”20 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. This incremental progress is a “gradual accumulation of truth; or truth is approached by successive approxi-mations.”9 Pure science, in isolation, cannot tell us why we should undertake a certain act, such as attempting to relieve human suffering. It can only yield for us the most logical method of accomplishing, for good or ill, “what we have already decided to do.”9 In 2009, Chestnut Lodge was to be renovated when, sadly, it burned to the ground. One hopes that from the ashes of this symbolic edifice, arises a rebirth of a balanced, progressive psychiatry that fights for the benefit of its patients.
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.