The Emergence of Medical Psychiatry

Philosophy, Psychiatry, & Psychology, 2008

George Engel designed his biopsychosocial model to be a broad framework for medicine and psychiatry. Although the model met with great initial success, it now needs conceptual attention to make it relevant for future generations. Engel articulated the model as a version of biological systems theory, but his work is better interpreted as the beginnings of a richly nuanced philosophy of medicine. We can make this reinterpretation by connecting Engel's work with the tradition of American pragmatism. Engel initiates inquiry like a pragmatist, he understands theory and philosophy like a pragmatist, he justifies beliefs like a pragmatist, and he understands the world like a pragmatist. By drawing out these similarities, medical and psychiatric scholars can revitalize the biopsychosocial model, and they can open medicine and psychiatry to a rich philosophic heritage and a flourishing interdisciplinary tradition.

Canadian Psychiatric Association Journal, 1969

Book Reviews psychiatry. E. W. Anderson and W. H. Trethowan. Concise Medical Textbooks. London. Bailliere Tindall & Cassell. 2nd ed. 1967. pp. 319. The first edition of Anderson's text was published in 1964. Since then he has retired from the Professorship of Psychiatry in Manchester, and his successor is co-editor of the second edition. This paperback is an excellent summary of traditional psychiatry from the British and European standpoints. It is well larded with vignettes of British and European psychiatric history. Throughout, wherever possible, the psychopathology is of the existentialist-Jaspers-Kurt-Schneider type. Students will find this a valuable book to scan when they wish to revise the ground they have covered, meanwhile remembering that, however good such summaries are, they cannot cover the whole field. This one skimps much which, on this continent, would be called dynamic and social psychiatry.

Harvard Review of Psychiatry, 2001

The Psychoanalytic Quarterly, 2007

ABSTRACT: Psychiatry is one of the oldest specialty professions in medicine, arising after 1800 in small communities of European, British, and American physicians who were physically, socially, and professionally isolated in asylums for the care and management of persons suffering from severe disturbances of thought, emotion, and behavior (“insanity”). In the twentieth century psychiatry turned its attention to milder psychiatric conditions (e.g.,“neurosis” or “neurasthenia”) in the general population, changing its mission and treatment methods. Competing views of mental disorder as biologically specifiable categories of disease (promoted by Emil Kraepelin), as dimensional psychosocial “reactions” (Adolf Meyer), or as mental mechanisms of personality (Sigmund Freud) have not been resolved by biomedical, psychological, or statistical methods.

Psychosomatics, 2004

The articles published in Psychosomatics, therefore, represent an important element of the scholarship of consultation-liaison psychiatry, and the evolution of this literature should reflect the development of its knowledge base in the past 40 years. This paper analyzes the content of Psychosomatics over this period and discusses the scientific, academic, and social (including economic and political) factors that have influenced the changes in the content of the journal and, thus, the subspecialty.

General Hospital Psychiatry, 1993

Philosophical Issues in Psychiatry III

s insightful chapter provides a deeper look at the operationalist philosophy that so markedly influenced post-1980 psychiatry. Other scholars have framed discussions of contemporary psychiatry with a history of the philosophical antecedents of DSM-III by citing Hempel's 1959 paper-reprinted as (Hempel 1965b)-but Parnas and Bovet further examine the influence of Percy

Pakistan Journal of Neurological Sciences, 2015

Psychiatry is a human science and its subject matter is the individual's psychic reality which defies the degree of certainty and validity required of the discourse in natural sciences. However, modern psychiatry, as we know it, in the 21st century has moved from understanding the psychogenic cause of a symptom to a medical model of controlling and manipulating symptoms. An important reason for this shift was the increasing awareness that some medications (lithium carbonate, antipsychotics, antidepressants, anxiolytics) were of benefit to certain kinds of disorders, and the ongoing research in this area held a promise for better and more effective medications that could target many other mental disorders. Equally important was the dissatisfaction and conflict within the profession, as well as the attacks, in the 1950's, from the antipsychiatry movement that challenged the arbitrariness of psychiatric diagnosis which lacked a pathophysiologic explanation for the illness. An indication of the American Psychiatric Association's (APA) struggle to develop a credible classification system of psychiatric disorders is best reflected in the history of the Diagnostic Statistical Manual (DSM). This manual was first published in 1952, with subsequent revisions, the latest being the publication of DSM-5, in 2013. Until the 1970's the manuals (DSM-I and DSM-II) were conceived on a biopsychosocial model with a psychodynamic tilt influenced by Freud's theory of personality development and intrapsychic conflict, as well as Meyer's psychosocial model, which downplayed psychiatric disorders as discrete, specific pathological entities. This model had a significant impact in teaching and clinical practice with individual psychotherapy becoming an essential feature of psychiatry. However the shortcoming of this approach was that it lacked a clear demarcation between the mentally healthy and sick; this lead to questions about the status and legitimacy of psychiatry as a medical science. Added to the grave doubts about the validity and reliability of psychiatric diagnosis was the embarrassment when in the early 1970's the gay rights movement lobbied against homosexuality being labeled as a disorder in DSM-II, which was later excluded from DSM III published in 1980. So the removal of a disorder was based on political pressure, rather than scientific research. DSM-III (followed by DSM-III-R, 1989) which was a significant turning point in the history of psychiatry in USA, adopted a descriptive, nosological approach which could be supported by research findings that lent greater reliability and validity to psychiatric constructs. Assessment through description of symptoms which were publicly visible was stressed over psychological etiology which by its very nature was private and invisible. This bold and creditable step by the APA was not free from criticisms, many of which were warranted. A most vocal critic of DSM-III-R, Dr. Paula Caplan a clinical and research psychologist, and a human rights advocate, forwarded a trenchant argument against the inclusion of diagnostic labels, such as Self-Defeating Personality Disorder (SDPD) and Premenstrual Dysphoric Disorder (PMDD). Both these disorders were applicable to a majority of women. The former (SDPD), facetiously referred to as "good wife syndrome", included characteristics such a putting needs of others ahead of one's own, feeling unappreciated etc. Interestingly, this "portrait" of SDPD is most germane to the accepted and desirable gender role for Pakistani women as well. The latter's (PMDD) diagnostic features consist of "bloating" breast tenderness coupled with irritability, fatigue, being "on edge" etc. Dr. Caplan questioned the scientific basis of inclusion of PMDD in a psychiatric manual, pointing out that it is just a fancy name for PMS. In lieu of the scathing criticism from feminists, the two diagnoses were not included in the main text of DSM-III-R and DSM-IV-TM (2004) but were instead placed in an appendix titled "Diagnostic Categories Needing Further Study." The publication of DSM-5 in 2013, nine years after DSM-IV-TM was awaited with much anticipation. Surprisingly, mental health professionals expressed concerns while DSM-5 was in the making. Most of these concerns were around newly introduced categories and the lowering of thresholds for many disorders which would invariably lead to over diagnosis of the existing disorders. Allen Frances, who chaired the task force of DSM-IV was the most forceful and potent critic of DSM-5. In his high profile articles he argued that many changes were arbitrary and scientifically untenable and with the expansiveness of diagnostic categories and diagnosis based on checklists of symptoms, would be more beneficial to drug companies than to the client themselves. He also bemoaned the fact that DSM's descriptive and atheoretical approach was biased in favor of medication and downplayed the role of psychotherapy and counseling. While it is not possible to address all the contentious changes in DSM-5, the elimination of bereavement exclusion from Major Depressive Disorder (MDD), increases

Culture Medicine and Psychiatry - CULT MED PSYCHIAT, 2001

This study focuses on the first four decades inthe history of the pioneering journal Psychosomatic Medicine. The goal of thejournal as stated by its founders was to reformmedicine by scientifically reintegrating the``mind'' into medicine. However, from itsinception, the editorial members were hauntedby internal ambiguity regarding the nature ofpsychosomatic knowledge. This led to recurrentidentity crises. This study tells the story ofthe complex interplay between internal andexternal forces shaping PsychosomaticMedicine's institutional transitions andepistemological transformations. Itdemonstrates how, despite this continuousinternal confusion, the level of consistencynecessary for gaining legitimacy increasedduring the process of evaluating papers. Theincreased level of standardization coincidedwith a transition in the psychosomaticmovement's epistemological approach: from causation to correlation. The initialattempt to search for causal mechanismslinking the ps...