|Year : 2017 | Volume
| Issue : 1 | Page : 64-66
Psychiatry outside the framework of empiricism
Celestine Okorome Mume
Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
|Date of Web Publication||9-May-2017|
Celestine Okorome Mume
Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State
Source of Support: None, Conflict of Interest: None
Science is interested in whatever that is empirical and objective. Any claim that cannot be objectively demonstrated has no place in science, because the subject does not deviate from the role, which it has set out to play in the life of mankind. Psychiatry, as a scientific discipline, plays along these basic principles. In the etiology, symptomatology, and management of psychiatric disorders, the biopsychosocial model recognizes the role of biological, psychological, and social factors. This essay views psychiatry from the biopsychosocial perspective and asserts that certain elements, which may not be readily and empirically verifiable, are important in the practice of psychiatry.
Keywords: Biopsychosocial model, mind, psychodynamics, psychiatry and empiricism
|How to cite this article:|
Mume CO. Psychiatry outside the framework of empiricism. Niger Postgrad Med J 2017;24:64-6
| Introduction|| |
The biopsychosocial model recognizes the role of biological and psychosocial factors in psychiatry. The biological factors include a number of biological variables, which are considered to be relevant in the etiology and management of mental disorders. Findings from the studies of family, twin, and adoption have implicated genetic factors in the etiology of mental disorders. It has been demonstrated that the closer one is genetically to a patient with mental disorder, the higher the individual’s chance of developing the disorder.
Brain damage occurring in utero to the fetus through factors such as toxemia of pregnancy, brain injury to the baby at delivery as a result of obstetric complications, and brain insult post-delivery, which is caused by trauma and infection, may predispose the child to psychiatric disorder later in life.
The observation that these different mechanisms through which injury and insults occur to the brain of the child manifest during the developmental years gave rise to the neurodevelopmental hypothesis of schizophrenia. Further evidence of brain abnormality in the etiology of schizophrenia was obtained from neuroimaging, which showed that patients suffering from schizophrenia have larger third and lateral ventricles than those in the normal population.
The dopamine hypothesis of schizophrenia and monoamine hypothesis of mood (affective) disorders are classical examples of the role of neurotransmitters in psychopathology. Many psychotropic drugs used in psychiatry affect one or more neurotransmitters. The psychoactive substance use has been associated with mental disorders.Sigmund Freud formulated the classical psychoanalytic dimension to the etiology of mental disorders. Psychoanalysis emphasizes the role of unconscious conflict in the etiology of mental disorders. According to Freud, fixation in any of the psychosexual stages of development could lead to psychopathology. Life events such as marriage, divorce, and death of a spouse among others have been found to be associated with psychopathology. It is important to state that favorable life events also lead to psychopathology. For most people, marriage is a favorable life event; so are promotion and festivity, yet each of which can lead to psychopathology.
Empiricism in Psychiatry
With all that is known, not enough is known about the etiology of mental disorders. Many are comfortable with all the empiricism and objectivity of anatomy and physiology. With social issues, there is usually a temporal association between the life events and psychopathology. With psychology, the issue is different. I consider it highly unlikely that any of the etiological factors in psychopathology acting in isolation can bring about an illness. It is also difficult to evaluate the relative contribution of each of the factors. In the present dispensation, some may argue that psychology has the least contribution owing to the fact that some of its variables such as the mind with its various components cannot readily be demonstrated in the objective sense.
This lack of empirical verification, however, may not justify the neglect of factors, which may in the end prove to be very important in the etiology, pathophysiology, and management of mental disorders. At any point in the history of mankind, what is unknown is always far more than the known. It is also correct to say that what is unknown at any point in time is not necessarily the unknowable.
In our search for biological etiology and pathophysiology of psychiatric disorders, we have gone to molecular biology and sophisticated imaging techniques. In our search for psychological etiology and pathophysiology, we must correspondingly get to psychodynamics, and this does not readily yield to empirical verification.
In cases where psychology is considered to play little or no role in the etiology of mental disorders, there is no doubt that it may play a major role in the expression of the features of such psychopathological states. Perhaps, two individuals may be suffering from bipolar affective disorder, but their symptoms may have wide variations in the sense that while one, for example, may consider himself the holiest person on earth, the other may believe himself to be the greatest person in academics to have lived on this planet. These beliefs are simply psychological states and may not be related to genetics and other factors that are generally considered to be etiologically important. One may not understand the basis for the differences in the contents of grandiose delusions without the benefit of psychodynamics. The effect of culture on the contents of hallucinations and delusions can be understood from the fact that the mind imbibes the cultural characteristics of people.
Psychodynamics is concerned with the psychological forces behind human behavior. Developed by Sigmund Freud, it emphasizes the interplay between conscious and unconscious mental mechanisms.
We may argue that there is no empirical proof for the existence of unconscious mechanisms or unconscious motivations, but what evidence do we have in favor of their nonexistence? When we dream, we see and participate in events and activities, which have no existence in our world of objective reality. Many times, we wake up from nightmares with features of autonomic disturbance, and yet what we see in dreams have no existence in the objective sense.
There are controversies with respect to the mind–brain situation. Some workers argue that what others call the mind either has no existence or if it does, is one entity with the brain. The argument often presented by these identity advocates is that perception, sensation, imagination, and other activities that constitute mental states are actually brain processes, and can, therefore, not be different from the brain. I prefer to say that they are the results of brain activities.
It is worthy of note that these mental states, which are the results of brain activities, occur only in the living individual. When an individual dies, such an individual is no longer of any use to the psychologist, psychiatrist, and philosophers. As long as an individual can no longer be associated with behavior (i.e., dead), the body is at best only useful to the anatomist or the pathologist. What is the difference between an individual who is alive and a dead body? Is the difference quantitative or qualitative? I respond that the difference is qualitative, because there is something in a living person which is not in a corpse − that is life.
Life and Psychiatry
We can at best have very limited description and components of life. Life is immaterial; the evidence for its existence is circumstantial. We are able to say that somebody has life when such a person can demonstrate or exhibit at least some of those criteria, which we refer to as characteristics of living things. Scientific procedures such as electroencephalography and electrocardiography also provide circumstantial evidence for the existence of this immaterial element called life.
As a result of the immaterial nature of the mind, it lies outside the range of scientific empiricism. It can understandably be criticized, but such a criticism does not constitute a proof that it does not exist. If there is no life in a body, such a body cannot experience psychopathology, and where there is no body, life cannot express itself. Since mind accompanies life, as I would like to propose, there can be no psychiatry without mind, even in the presence of an intact brain.
In conclusion, it is recognized that the brain (matter) is the immediate organ or substance of consideration in terms of psychopathology. However, materialism alone cannot account for all that is known in psychiatry. Consequently, if we dispense with all that cannot yield themselves to immediate empirical verification (such as mind), psychiatrists would be functioning at a disadvantage bearing in mind that psychotherapy is a treatment method that is directed at the mind and not at correcting any physical lesion in the brain.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Craddock N, Jones I. Genetics of bipolar disorder. J Med Genet 1999;36:585-94.
Woods BT. Is schizophrenia a progressive neurodevelopmental disorder? Toward a unitary pathogenetic mechanism. Am J Psychiatry 1998;155:1661-70.
Suddath RL, Casanova MF, Goldberg TE, Daniel DG, Kelsoe JR Jr, Weinberger DR. Temporal lobe pathology in schizophrenia: A quantitative magnetic resonance imaging study. Am J Psychiatry 1989;146:464-72.
Howes OD, Kapur S. The dopamine hypothesis of schizophrenia: Version III − The final common pathway. Schizophr Bull 2009;35:549-62.
Hirschfeld RM. History and evolution of the monoamine hypothesis of depression. J Clin Psychiatry 2000;61(Suppl 6):4-6.