THE EPISTEMOLOGICAL BASIS OF PSYCHIATRIC CONTROVERSIES

D. Kecmanovic recently published a paper on the reasons of the endless psychiatric controversies. A debate followed. Among the others, M. Aragona focused on the epistemology of psychiatry. He reminds that “taken as a whole the disciplines concerned with the mind and with mental pathologies do not constitute a mature science. While the various branches of medicine are all subtended by a common basic science grounded on a unique and shared view of the human body functioning, the various disciplines studying the mental phenomena are based on different theoretical principles, see their field of study from different viewpoints, use different techniques of inquiry and presuppose interpretations and solutions which are widely heterogeneous” (Aragona M. Aspettando la rivoluzione. Editori Riuniti, Roma, 2006, p.34). However, the author notes that to define psychiatry as a pre-paradigmatic scientific activity risks to pass unnoticed a fundamental assumption. In fact, the implicit idea is that psychiatry should conform to this model and that its current position is that of an immature science that in the future will be based on a unique scientific paradigm. This process will let all the other perspectives on the matter to progressively disappear from the scientific debate, being reconceptualized as non-scientific or proto-scientific cultural forms. This is the faith accompanying from its beginning any somatological theory about mental illness but the risk is to covertly introduce here a reductionist assumption: there are many perspectives and many models only because psychiatry is not scientific yet. Is it a correct picture of psychiatry, or at the opposite the peculiar object of study of our discipline (the mental suffering of the human being) cannot in principle be fully reduced to the materialistic study of his brain? The plurality of models is a transient phenomenon, or the multi-perspectivist approach is intrinsic to psychiatry and thus unavoidable? The methodological pluralism of Karl Jaspers is used here to support a multiperspectivist stance. In conclusion, psychological perspectivism and pragmatism (intended as choosing this or that model depending on the relevance of specific scientific/clinical questions and on the most appropriate model to answer) are proposed. It is suggested that the basic epistemological tension underlying psychiatric controversuies is that between a realist model (that sounds scientific but is historically untenable) and a constructivist model which is better corroborated by the historical inquiry but that by acknowledging the unavoidable role of hermeneutics risks to be perceived as anti-scientific and radically relativistic.
The link to read this article and the entire debate is: http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol23_no3/dnb_vol23_no3_02.pdf