Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities, and Neuroscience

Vincenzo Di Nicola, MD, PhD

Drozdstoj Stoyanov, MD, PhD

Springer Publishing

New York
2018 

Premise of the volume:

The field of academic psychiatry is in crisis, everywhere.

It is not merely a health crisis of resource scarcity or distribution, competing claims and practice models, or level of development from one country to another, but a deeper, more fundamental crisis about the very definition and the theoretical basis of psychiatry.

Is psychiatry a social science like psychology or anthropology?

Is it better understood as part of the humanities like philosophy, history and literature?

Or is the future of psychiatry best assured as a neuroscience?

From psychiatry in crisis as a medical discipline to critical psychiatry casting for a new model …

What will be the result?

The “end of psychiatry” or its renaissance as something new and different, either as a more comprehensive theory and practice of human being or as a new branch of medicine called the neurosciences?

Principal authors:

The two principal authors are both professors of psychiatry with mainstream academic training, activities and appointments in respected university departments of psychiatry. Both also share professional training and engaged activities in the philosophy of psychiatry. Both Europeans, one working in Europe, the other in North America, Professors Stoyanov and Di Nicola are active in national and international organizations and together bring varied international expertise to this study. From these informed perspectives, Di Nicola and Stoyanov pose some fundamental epistemological and ontological questions about the crisis of psychiatry, what they imply, and how to go about resolving them to renew psychiatry today.

Vincenzo Di Nicola, MPhil, MD, PhD

Full Professor, Dept. of Psychiatry

University of Montreal

Drozdstoj Stoyanov, MD, PhD

Professor, Dept. of Psychiatry and Medical Psychology

Medical University of Plovdiv

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Proposed Table of Contents:

Foreword (by a psychiatrist or a philosopher)

Preface/Introduction by Drozdstoj S.Stoyanov & Vincenzo Di Nicola

Part I: Psychiatry in Crisis as a Medical Discipline

Drozdstoj S. Stoyanov

1.     Methods for clinical evaluation in psychiatry: quantitatve decomposition of narratives vs. qualitative approach. Reconstruction of the methodological discrepancies based on an exemplary case: Major Depressive Disorder

2.     Psychiatric nosology revisited: at the crossroads of psychology and medicine. Categorical vs. dimensional; nomothetic vs. ideographic classification and nomenclature; post-modern perspectives

3.     Psychiatry and neuroscience: at the interface. How to incorporate scientific data from neuroscience without turning psychiatry into an applied branch of neurology

Invited commentary/commentaries

Part II: Critical Psychiatry

  Vincenzo Di Nicola

1.     The Beginning of the End of Psychiatry: A Philosophical Archaeology

Psychology: Introspection and Consciousness

Foundations of Modern Psychiatry

Schizophrenia: The Worm in Psychiatry’s Apple

Excursus: The History of Psychiatry is Not the History of Madness

2.     The End of Phenomenology

“Who Killed Ellen West?”

A Critical Review of Ludwig Binswanger’s Foundational Case of Existential Analysis

3.     The End of Psychiatry

“Psychiatry Against Itself”

A Philosophical Archaeology of Antipsychiatry

Invited commentary/commentaries

Part III: Renewal in Psychiatry

   Drozdstoj S. Stoyanov in Dialogue with Vincenzo Di Nicola

Invited commentary/commentaries

Afterword (by a psychiatrist or a philosopher)

Excursus – Schizophrenia: “The Sublime Object of Psychiatry”

Excursus – Schizophrenia: “The Sublime Object of Psychiatry”[1]

For more than a century, from Emil Kraepelin (psychiatry’s Linnaeus) and Eugen Bleuler (who coined the term schizophrenia) to Kurt Schneider (who tried unsuccessfully to establish “pathognomonic” signs and symptoms that separate schizophrenia from other diseases or disorders) and then onto to the APA’s DSM project, especially after DSM-III (1980), defining schizophrenia has defined psychiatry. The tension is not just in the nomenclature and the issue of what is normal and what is pathological, but also whether the experience of psychosis is alienating for the patient and for the psychiatrist. That is to say, is the psychotic experience part of a range of normative, widely shared experiences and therefore amenable to explanation, or is it a cut, a separator, a chasm between normal and abnormal, as Karl Jaspers established with his hugely influential phenomenological approach to psychiatry? Now, the biologically-oriented psychiatrists have tended toward seeing psychosis in the guise of schizophrenia as the modern madness, abnormal and unintelligible. In spite of Jaspers, many phenomenological and humanist psychiatrists and those following the psychoanalytic movement have tended to see psychosis and schizophrenia as accessible and treatable predicaments. The latter include Silvano Arieti, R.D. Laing and Jacques Lacan as psychoanalytic psychiatrists and a host of other approaches in anthropology, family therapy, and sociology.

And yet, as Angela Woods concludes, we have already moved into another era.[2] The subject of  “madness” and debates in the academy between clinical and cultural theorists no longer move the public or remain priorities for research funding. Just as Laing was responding to the notion of schizophrenia after several generations of efforts to grapple with it, the traumatized and displaced populations resulting from world wars, global conflicts and terrorism became the emblematic social and psychiatric predicament of the latter third of the 20^th century, a period I have dubbed the “Age of Trauma.”[3]  Yet, more disquieting still is the genuine possibility that in its pursuit of positivist science and its rewards, psychiatry has all but abandoned such debates and simply moved on to understanding the brain through neuroscience and genetics. Consciousness, language and their vicissitudes have already been ceded to cognitive psychology while therapy has been subcontracted to psychologists who administer cognitive behaviour therapy (CBT) and family therapists and social workers who attend to the family and social aspects of mental illness. Accordingly, anthropologists, historians, and philosophers have shifted their investigations to these latter domains, as witnessed by the contemporary work of Patricia Churchland[4] and Catherine Malabou.[5]

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[1] The subtitle comes from Angela Woods, The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory (2011). A parallel point was made more polemically by Thomas Szasz, Schizophrenia: The Sacred Symbol of Psychiatry, 2^nd ed. (1988). Laing was unquestionably the psychiatrist who most advanced schizophrenia as an accessible and necessary predicament to understand. See: R.D. Laing, The Divided Self: An Existential Study in Sanity and Madness (1965). Allan Beveridge, Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R.D. Laing, 1927-1960 (2011). Theodor Itten and Courteney Young, eds., R.D. Laing: 50 Years Since The Divided Self (2012). Andrew Collier, R.D. Laing: The Philosophy and Politics of Psychotherapy (1977).

[2] Angela Woods, op.cit., pp. 220-224.

[3] Vincenzo Di Nicola, Trauma and Event (2012b).

[4] Patricia Smith Churchland, Neurophilosophy: Towards a Unified Science of the Mind/Brain (1986) and Touching a Nerve: The Self as Brain (2013). See the review of the latter book by Colin McGuin, “Storm over the brain,” The New York Review of Books, April 24, 2014, and the exchange between Churchland and McGuin, “Of brains & minds: An exchange,” NYRB, June 19, 2014.

[5] Catherine Malabou, The New Wounded: From Neurosis to Brain Damage (2012).