PubMed · 15765365
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Susan L Jones. 2005. Patient education about basic brain functions.. https://doi.org/10.1016/j.apnu.2005.01.001
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With the collapse of the psychoanalytic and the behaviorist models, and the failure of reductive biologism to account for mental life, psychiatry has been searching for a broad, integrative theory on which to base daily practice. The most recent attempt at such a model, Engel's 'biopsychosocial model', has been shown to be devoid of any scientific content, meaning that psychiatry, alone among the medical disciplines, has no recognised scientific basis. It is no coincidence that psychiatry is constantly under attack from all quarters. In order to develop, the discipline requires an integrative and interactive model which can take account of both the mental and the physical dimensions of human life, yet still remain within the materialist scientific ethos. This paper proposes an entirely new model of mind based in Chalmers' 'interactive dualism' which satisfies those needs. It attributes the causation of all behaviour to mental life, but proposes a split in the nature of mentality such that mind becomes a composite function with two, profoundly different aspects. Causation is assigned to a fast, inaccessible cognitive realm operating within the brain machinery while conscious experience is seen as the outcome of a higher order level of brain processing. The particular value of this model is that it immediately offers a practical solution to the mind-brain problem in that, while all information-processing takes place in the mental realm, it is not in the same order of abstraction as perception. This leads to a model of rational interaction which acknowledges both psyche and soma. It can fill the gap left by the demise of Engel's empty 'biopsychosocial model'.
Research advances in psychiatric genetics have raised expectations that genetic findings might lead to major breakthroughs in psychiatric nosology. The author reviews the plausibility of these claims. Four areas are addressed. First, it is argued that familial aggregation of a single putative psychiatric syndrome provides at best limited evidence for the validity of that syndrome. Second, both traditional and molecular genetic strategies can supply important insights into major diagnostic conundrums. However, evidence that one or a few individual genes impact on risk for two disorders is not likely to resolve definitively the nosologic relationship between the two syndromes. Third, while gene-based essentialist models for psychiatric disorders are conceptually appealing, they are not well supported empirically. Gene discovery in psychiatry is, on its own, unlikely to allow us to "carve nature at its joints," thereby validating categorical psychiatric diagnoses. Fourth, the project to ground "messy" psychiatric categories on the firm foundation of genes-as an archetypal natural kind-may be fundamentally flawed because the very concept of "the gene" as a discrete entity is itself increasingly in doubt. Whereas psychiatric genetics has and will continue to provide important insights into the etiology of psychiatric and substance use disorders, it is not likely alone to provide deep answers to the complex and multifaceted problems facing psychiatric nosology.
The future of psychodynamic psychotherapy in residency training is in jeopardy. New priorities and forces currently aligned in academic psychiatry challenge the importance of psychodynamic psychotherapy and, by extension, its core concepts of the unconscious, defense and resistance, transference and countertransference, and the past repeating itself in the present. The exit of psychoanalysts from academic centers in the last quarter of the past century was propelled by forces including biological psychiatry, managed care, and competition from other mental health disciplines. ACGME psychotherapy competencies introduced in 2001 renewed the focus on psychotherapy training in residency and set a residency training standard for psychotherapy competency. A recent shift in academia prioritizing evidence-based medicine and a shortage of psychiatrist researchers may threaten those gains.