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The Humanities and Psychiatry: The Rebirth of Mind: Page 4 of 5

The Humanities and Psychiatry: The Rebirth of Mind: Page 4 of 5

But the clash was not fully over. In a rebuttal letter to the editor, Klerman asked: “Why doesn’t psychodynamic psychiatry attempt to be scientific?” He concluded that “psychoanalysis is now on the defensive intellectually and scientifically. . . . My dominant feelings about psychoanalysis are frustration and disappointment.”11

Beyond dichotomy: rising to the challenge

And so what can be said, 2 decades later, about the outcome of this “important historical moment of transition in modern psychiatry”? Did Klerman’s proposals, in fact, have “serious consequences for the innovation, diversity, and independent thought essential to scientific progress in psychiatry”? After Osheroff, and particularly during the “decade of the brain,” the schism widened between “a reductionist scientific method, as manifest in evidence-based medicine, and that of a narrative form of knowledge derived from clinical experience.”5 The dualism was outlined rather comprehensively by anthropologist T. M. Luhrmann10 in her book Of Two Minds: The Growing Disorder in American Psychiatry. Luhrmann concluded that neither the biomedical nor psychodynamic approach “mirrors” the reality, but each provides a different and valuable way of approaching mental illness.

It can be argued that the greedy reductionism of scientific psychiatry inexorably wrapped itself around the brainstem of psychiatry, threatening to squeeze the life out of the art of psychiatry. Despite the best intentions of the biopsychosocial model, it can be argued that the practice of psychiatry, particularly from Osheroff forward, deteriorated into a de facto biological reductionism (R. Pies, personal communication, October 15, 2012). Should psychiatry be faulted for taking this path? While opinions may be divided on this issue, it should be noted that psychiatry was merely following the lead of medicine generally.

Although the biopsychosocial model has been heavily critiqued in recent decades, many would argue that it was never meant to “discover” neuropsychiatric pathology. Rather, it is a philosophy of clinical care and a practical clinical guide for the application of psychiatric knowledge to needs of individuals.12 As for the way in which biological psychiatry allowed its knowledge to become subservient to the pharmaceutical industry, one is left to wonder if this was not part of the serious consequences dreaded by Stone.

Despite Klerman’s indictment, psychodynamic psychiatry has managed to survive as a viable model for clinical practice. And why might this be? The humanities search for truths about the human condition, just as science searches for truths about physical matter. Truths do not dissolve so easily. Freud13 noted: “In the end the most cutting truths are heard and recognized especially after the injured interests and affects aroused by them have exhausted themselves.” In fact, Freud anticipated the perennial fate of psychoanalytic thought. Who among us wants to be told that we are each the author of our own story, be it comedy, tragedy, or other? This is a painfully bright sun to stare directly into, and Freud13 was fully aware of this: “I must put a damper on your expectations. Society will not hasten to furnish us authority. Society must remain in a state of resistance towards us because we assume a critical attitude towards her. We inform her that she herself plays a great part in the causation of the neuroses.”

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