This blog follows the history of psychiatry

The latest issue of History of Psychology is online and contains at least five articles that may interest the readers of h-madness.

“Individual perception and cultural development: Foucault’s 1954 approach to mental illness and its history,” by Line Joranger.

In his 1954 book Mental Illness and Personality Foucault combines the subjective experience of the mentally ill person with a sociocultural historical approach to mental illness and suggests that there exists a reciprocal connection between individual perception and sociocultural development. This article examines the ramifications of these connections in Foucault’s 1954 works and the connection with his later historical works. The article also examines the similarities between Foucault’s 1954 thoughts and contemporary intellectual thought, such as those outlined in Maurice Merleau-Ponty’s existential phenomenology and in Gaston Bachelard and Georges Canguilhem’s historical epistemology. In sum, my study shows that Foucault’s historical analysis began long before his 1961 dissertation History of Madness. It also shows that, more than announcing the “death” of the subject, Foucault’s historical analysis may have contributed to saving it.

“Cyclical swings: The bête noire of psychiatry,” by Hannah S. Decker.

Progress in psychiatry in the West has been retarded by the proclivity of the discipline to swing violently between 2 approaches to viewing mental illness; that is, emphasizing—to the exclusion of the other—the material–somatic vs the psychical–experiential avenues to knowledge. Each time a shift occurs, the leaders of the new dominant approach emotionally denounce the principles and ideas that came before. We can examine this phenomenon historically by looking at Romantic psychiatry, mid-/late-19th century empirical psychiatry, psychoanalysis, and modern biological psychiatry. Looking at the 2 approaches in treatment today, the gold standard of patient care involves combining empirical/psychological care in 1 person (the psychiatrist) or shared between 2 clinicians working intimately with each other (psychiatrist with psychologist or social worker.) Yet as regards psychiatrists, they are discouraged from paying full attention to the psychological side by the way managed care and third-party payment have combined to remunerate them. Finally, how do we account for the intense swings and denunciations in psychiatry? The author speculates on possible explanations but leaves the question open for her readers.

“Entrenched reductionisms: The bête noire of psychiatry,” by Allen Frances.

Like Hannah Decker, I too deplore the destructive battle of psychosocial and biological reductionisms that has bedeviled psychiatry. When I started my psychiatric training almost 50 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel and Freud, brought to and adapted in America by Adolph Meyer. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature. Unfortunately, the mental health field has since degenerated into a civil war between the biomedical and psychosocial models with little room for compromise or finding middle ground. The inflexible biological reductionists assume that genes are destiny and that there is a pill for every problem: they take a “mindless” position. The inflexible psychosocial reductionists assume that mental health problems all arise from unpleasant experience: They take a “brainless” position. I have spent a good deal of frustrating time trying to open the minds of extremists at both ends, though rarely making much headway. In my view, however, and where I differ from Decker, the reductionisms do not sort so neatly into alternating historical periods.

“Comments on “cyclical swings” by Professor Hannah Decker: The underappreciated “solid center” of psychiatry,” by Ronald W. Pies.

The history of psychiatry is characterized by some deep ideological and conceptual divisions, as adumbrated in Professor Hannah Decker’s essay. However, the schism between “biological” and “psychosocial” models of mental illness and its treatment represents extreme positions among some psychiatrists—not the model propounded by academic psychiatry or its affiliated professional organizations. Indeed, the “biopsycho-social model” (BPSM) developed by Dr. George L. Engel has been, and remains, the foundational model for academic psychiatry, notwithstanding malign market forces that have undermined the BPSM’s use in clinical practice. The BPSM is integrally related to “centralizing” and integrative trends in American psychiatry that may be traced to Franz Alexander, Karl Jaspers, and Engel himself, among others. This “Alexandrian-Jaspersian-Engelian” tradition is explored in relation to Professor Decker’s “cyclical swing” model of psychiatry’s history.

“Professor Decker replies,” by Hannah S. Decker.

Replies to comments by Allen Frances (see record 2016-05673-005) and Ronald W. Pies (see record 2016-05673-006) on the article by Hannah Decker (see record 2016-05673-004). Frances’ sophisticated fine-tuning of Decker’s dichotomies is most welcome. Nevertheless, the impact of reductionism on an era does persist. As for Pies, Decker wishes she could share Pies’ hopes for the future of an integrated psychiatry, but we are in a biological period that shows little evidence of becoming inclusive of the psychological and the social.