Towards an Ideal Paradigm

Byline: T. Asokan A great deal has changed in the 200 years since Reil coined the term 'Psychiatry' into medicine. The concept of custodial asylum prevailed in the initial period of Psychiatric history during which biological concepts held sway. Then the doctrine of Psychoanalysis came increasingly to the fore. The period between 1970 and the present time is witnessing the emergence of Biological psychiatry again with a vengeance and psychodynamic explanations have largely been unhorsed. The history of Psychiatry reveals jolting changes and discontinuities that are less common in other specialities. This is because, certain details with reference to underlying causes were unidentifiable and un-understandable. With the lack of solid pathophysiology or understanding of the mechanisms of disease, it cannot delineate disease entities on the basis of anatomical pathology. Thus the discipline is subject to faddism-anything could be true and nothing can be disproven. Thomas Kuhn coined the term 'Paradigm' to denote conceptual structure within which scientific work occurs. It is the sum of underlying assumptions. Theories and models which are specific become hypotheses and function within a paradigm. In Psychiatry, no single paradigm is able to explain fully the nature of mental illness, relation of mind to brain, definitions of cause, course and treatment of specific pathologies, guidance on how to cope with mental illness. The medical Philosopher Lawrie Reznek (1987) said, Concepts carry consequences-classifying one way rather than another has important implications for the way we share towards such things Kraepelin was committed to a biological ontology. Neo Kraepelinians gave up this biological ontology, at least overtly but extended Kraepelin's nosology beyond the major psychoses. In the Victorian period there was a challenge to construct knowledge base to underpin a form of medical authority over lunacy. There was an editorial in the Journal of Mental Disease (the former title of British Journal of Psychiatry) in 1858 which in two sentences captures the essence Insanity is purely a disease of Brain; The Physician is now the responsible guardian of the lunatic and must ever remain so For over fifty years, this concept remained in the ascendency about lunacy. The asylum system was taken over by Biodeterminism and contributed to the Zetgeist of eugenic thought of western intellectual culture. There was a fundamental incompatibility between the eugenic view harboured by the Victorian asylum doctors and the grim reality of the fine officers and Gentlmen breaking down with predictable regularity in the trenches of great war. To offer an eugenic view for the neurotic reactions among the traumatised soldiers was tantamount to reason. At this point the monopoly of biodeterminism was broken and neurosis and psychosis came within the ambit of Psychiatry and psychoanalysis. Between world wars a compromise was worked out with medical Psychotherapy and Biological Psychiatry and Eclecticism provided a middle position. Eclectic Psychiatrist is one who practises a moderate type of Psychiatry, using whatever seems likely to work, while deliberately avoiding the more extreme schools. In an Eclectic department of Psychiatry, it is possible to hear the staff talking about one patient in behaviourist terms, about the next from a strictly biological point of view and the third wholly in psychodynamic terms. Practitioners try to fit the theory to the patient, rather than vice versa. Eclecticism became a mark of moderation in an intellectually unstable world. It leads the Clinical Psychiatrist into a good deal of tightrope walking. An eclectic Psychiatry mirrors the diverse world wracked with uncertainty and overloaded with information. Eclecticism means borrowing freely from styles which suffer only in aesthetic grounds. Adolf Meyer's views were stemmed out of British Clinical Psychiatry as a form of psychiatric orthodoxy. …