Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

Hermann Emminghaus--100 years of the psychopathology of childhood and adolescence

The centenary of Hermann Emminghaus's monograph "Die psychischen St?rungen des Kindesalters" ("The Psychic Disorders of Childhood") gives occasion to appreciate the life and work of the founder of modern children and youth psychiatry. Children and youth psychiatry, in the G.D.R., operates on the principle of sub-specialization out of its parent subjects. In this, Hermann Emminghaus's basic views, as expressed in his monograph of 1887, are confirmed.     

Ward assessment questionnaire--a further possibility for objectively evaluating therapeutically significant milieu conditions

Ways of evaluating the therapeutic environment in psychiatry and psychotherapy are discussed, and an account of work with Engels Ward Assessment Form is given.     

How new is the new philosophy of psychiatry?

In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a “new philosophy of psychiatry”. However, the optimism which the “new” philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton’s paper and the excellent series “International Perspectives in Philosophy and Psychiatry.” As Jaspers said “Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way”.     

A Model for the Role of Defined Spirituality in South African Specialist Psychiatric Practice and Training

The current bio-psycho-social approach in South African psychiatry refers to Engel’s extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.     

Perceptions of South Florida Hispanic and Anglo Catholics: From Whom Would They Seek Help?

Hispanic and Anglo Catholics in South Florida who attended Sunday services (N = 473) were surveyed to determine their help-seeking preferences for moral concerns, mental disorders, and practical life/family problems. Respondents were asked to indicate whether they would seek help from a priest; a priest with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); a layperson with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); or if they believed they could deal with the situation without external assistance. The findings suggest that Anglo Catholics prefer assistance from a person who was credentialed in one of the helping professions, whereas Hispanic Catholics would seek help from a priest with or without a background in the helping professions.     

Psychiatry,psychoanalysis and sociology in the work of H.S. Sullivan

Abstract

Conci, M. Psychiatry, Psychoanalysis and Sociology in the Work of H.S. Sullivan. Int Forum Psychoanal 1997;6: 127–135. Stockholm, ISSN 0803-706X.

The author tries to illuminate H.S. Sullivan's complex professional identity. With E. Fromm he shared a basic humanistic orientation, and also the project of creating an interdisciplinary new science of man. This is the perspective he inherited from W.A. White, who tried to make psychoanalysis a major ingredient of psychiatry and social science. Sullivan's pioneer work with schizophrenic patients changed the prognosis of these patients, represented the basis of his interpersonal theory of psychiatry and of his collaboration with Chicago social science. Not only is the epistemological sophistication of his definition of psychiatrywhich includes the biological, intra- psychic, cultural and social dimensions-very relevant today, but so is the work he conducted, through the Washington School of Psychiatry (1936) and the journal Psychiatry (1938), with the aim of creating what he called a “psychiatry of peoples”, leading to world peace and greater social justice. In his view, psychoanalysis was more than a profession: it was a fundamental instrument of personal, cultural and social change.     

Qualifizierung und Qualit?tskontrolle in der forensischen Psychiatrie

At the end of the last decade severely violent and sexual crimes by previously convicted persistent offenders initiated a discussion about the necessity of quality control in the forensic psychiatric practice in Switzerland. Subsequently, measures similar to those in Germany were adopted, e.g. the implementation of a specialisation in forensic psychiatry. In addition, they included the creation of commissions with the duty of evaluating the dangerousness of serious offenders, the implementation of a standardized and certificated postgraduate training in forensic psychiatry and guidelines for the qualification of forensic assessment experts and the quality of reports. The following article presents the implemented measures and discusses their possible consequences for the quality of forensic psychiatric work.     

Mental illness and the mind-brain problem: Delusion,belief and Searle's theory of intentionality

Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mental illness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mental illness from analyses of disease in terms of failure of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality.     

The computer psychiatrist: How far have we come? Where are we heading? How far dare we go?

The use of computers in psychiatry and psychology is reviewed. It is noted that computers are already being used successfully for consultation, interviewing, and continuing education. Issues related to the usage of computers in mental health are discussed. Guidelines for future work in the area are suggested.     

Problems in the Definition of 'Mental Disorder'

Current diagnostic manuals in psychiatry such as DSM and ICD offer definitions of mental disorder, though it is recognized that they are unsatisfactory. It is likely that philosophy can help in this problem of definition. I argue that philosophical theories of mind have always implied definitions of mental disorder. Contemporary theories of mind commonly take intentionality to be fundamental, and I consider to what extent mental disorder can be defined in terms of radical failures of intentionality. Dennett has suggested that breakdown of intentional systems is to be explained from the physical stance, but explanations of breakdown from the design stance and even from the intentional stance are possible. Evolutionary theory emphasizes the intentionality of mind and behaviour, and is increasingly applied in models of psychopathology. It is unlikely that these models support the concept of mental disorder at work in current psychiatry.     

Present at the Creation: The Clinical Pastoral Movement and the Origins of the Dialogue Between Religion and Psychiatry

The contemporary dialogue between religion and psychiatry has its roots in what is called the clinical pastoral movement. The early leaders of the clinical pastoral movement (Anton Boisen, Elwood Worcester, Helen Flanders Dunbar, and Richard Cabot) were individuals of talent, even genius, whose lives and work intersected one another in the early decades of the twentieth century. Their legacy endures in the persons they inspired and continue to inspire and in the professional organizations and academic programs that profit from their pioneering work. To understand them and the era of their greatest productivity is to understand some of what psychiatry and religion have to say to each other. Appreciating their legacy requires attention to the context of historical movements and forces current in America at the end of the nineteenth and the beginning of the twentieth century that shaped religious, psychiatric, and cultural discourse. This essay attempts to provide an introduction to this rich and fascinating material. This material was first presented as a Grand Rounds lecture at The New York Presbyterian Hospital, Payne Whitney Westchester in the Department of Psychiatry, Weill Cornell Medical College.     

Neurologist or psychiatrist? The public and private domains of Jean-Martin Charcot

The emergence of neurology as an autonomous, prestigious field in late-nineteenth-century Paris is well known. Less appreciated is the role that neurologists played vis-à-vis the cognate older field of psychiatry. Taking Jean-Martin Charcot, the most influential neurologist of his time, as a test case, this paper contrasts his attitudes and practice in the public setting of teaching and hospital work with his private practice. A staunch defender of a clear distinction between his field and psychiatry, Charcot's private practice displayed more flexibility. Treating hysteria and neurasthenia created a middle ground of nervous diseases for him to cultivate. Unpublished case histories and other materials, especially from the Charcot library, support the conception of neurologists as active agents in constituting a new psychological medicine.     

Chiarugi and Pinel considered: Soul's brain/person's mind

Pinel and Chiarugi enter the standard histories of psychiatry under the rubric of “psychiatric reformers.” True enough, but insufficient in terms of the complexity and breadth of their thought. Despite Pinel's fame for the “moral,” i.e. psychological treatment of the mentally ill, previous scholarship on Chiarugi and his work would lead one to expect a richer humanity and warmer personal investment in the vagaries of the mentally ill under Chiarugi's auspices. A careful study of Chiarugi's Della Pazzìa and Pinel's Traitésuggest a different portrait. Though conjoined in their humanitarian ideals, these foundational figures in modern psychiatry voiced disparate ideas on the nature, etiology, and treatment of mental disorders, Chiarugi in the context of a biologic or “organicist” theory, Pinel in a psychosocial framework. Their reasoning in support of their opposing perspectives about the centrality of “biologic vs. psychological” determinants and interventions in psychiatry is remarkably congruent with those expressed today. © 1997 John Wiley & Sons, Inc.     

On the legitimacy of psychiatric power

The author examines the existential, historical, and political roots of psychiatric power, locating them, respectively, in the universality of guilt feelings and the desire to escape them, in psychiatry (replacing religion) as an institution offering surcease from such (and similar disturbing) feelings, and in the alliance, in modern societies, between psychiatry and the state. Clinical psychiatry and psychoanalysis, each in its own distinctive way, have served to legitimize the uses of psychiatric power. Liberty from coercive psychiatry requires destroying the legitimacy, and hence power, of coercive psychiatric principles and practices.     

Emergency psychiatry and crisis intervention in a primary clinic

The terms Notfall and Krise, and the semantic problems arising, are elucidated; and an analysis of one years work in provision for emergency psychiatry and stress intervention is presented. Psychoreactive syndromes were found to be most common, followed in second place by psychotic conditions. In third place come disorders in connection with alcohol, which display a rising tendency. 40% of the clinic's beds are occupied by acute emergency cases, chiefly of short duration. Emergency provision is thus shown to be a major feature in the work of psychiatric clinics.     

A combined therapeutic approach in a family setting

Combined treatment approaches, co-therapy and family work are three concepts which are under much discussion in psychiatry. This paper describes the systematic use of an integrated treatment approach used by co-therapists working with families in which a child was the referred patient. The rationale behind this approach together with its advantages and disadvantages are discussed. The authors conclude that the approach is sufficiently promising to merit formal evaluation.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

Carl Westphal--a progressive university teacher of neurology and psychiatry in the 19th century

Carl Westphal (1833-1890) is described on the basis of his theoretical considerations concerning the teaching of psychiatry and neurology and his influence on the contents and organization of teaching in these fields at the then Charité as a university teacher with progressive pedagogic and didactic aims and methods. His other scientific work shows that C. Westphal was a worthy heir and like-minded successor to W. Griesinger (1817-1868).     

Practicing mind-body medicine before Freud: John G. Gehring,the “Wizard of the Androscoggin”

This article describes the psychotherapy practice of physician John G. Gehring and places it in historical context. Forgotten today, Gehring was a highly sought-after therapist from the 1890s to the 1920s by prominent figures in the arts, sciences, business, and law. He practiced a combination of work therapy, suggestion, and autosuggestion that has similarities to Cognitive Behavior Therapy and Behavioral Activation. Using biographies, memoirs, and archival records, the details of Gehring's work are reconstructed and the reasons for its success are analyzed. His invisibility in the history of psychiatry is attributed to the later dominance of Freudianism within the field.