{"id":49283,"date":"2014-09-02T20:31:28","date_gmt":"2014-09-03T00:31:28","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=49283"},"modified":"2014-09-02T23:14:10","modified_gmt":"2014-09-03T03:14:10","slug":"that-maturity","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/09\/02\/that-maturity\/","title":{"rendered":"that maturity&#8230;"},"content":{"rendered":"\n<ul>\n<div align=\"justify\" class=\"small\"><em>We shall not cease from exploration<\/em><\/div>\n<div align=\"justify\" class=\"small\"><em>And the end of all our exploring<\/em><\/div>\n<div align=\"justify\" class=\"small\"><em>Will be to arrive where we started<\/em><\/div>\n<div align=\"justify\" class=\"small\"><em>And know the place for the first time&hellip;<\/em><\/div>\n<div align=\"center\" class=\"small\">Little Gidding&nbsp; T.S. Eliot 1942<\/div>\n<\/ul>\n<p align=\"justify\">I hate being so repetitive with my quotes. This one has had many re-runs here. But I guess that&#8217;s the way it is with the good ones. Maybe next time I&#8217;ll use the story of the Holy Grail or the Wizard of Oz to say the same thing. Or maybe it&#8217;s just part of the experience of being an old man, to begin to see how cyclic human life can be. I came to psychiatry interested in psychotherapy at a time of transition. The psychiatry of the time was operating at its most &quot;eclectic,&quot; or so I thought. There were models galore &#8211; psychodynamic, biological, medical, existential, social, behavioral, etc. Come one, come all. I thought that was great, myself. And then things changed dramatically and one was apparently supposed to choose &#8211; specifically choose biomedical. So those of us who didn&#8217;t moved to the side [because there was no place else to go]. At least that&#8217;s how it seemed. But that&#8217;s ancient history, albeit my own. I sure didn&#8217;t start writing well into retirement to rehash those days. I started writing because I woke up to the fact that a dominant paradigm in psychiatry throughout my career &#8211; psychopharmacology &#8211; had been invaded by industry and was more corrupt than I could&#8217;ve imagined. So I exhumed skills from a former career in hard-science-medicine and began to look at what I consider the carnage that resulted from an academic-pharmaceutical alliance that has afflicted a too-big sector of psychiatry.<\/p>\n<div align=\"justify\">It appears I came along at another time of transition. Now, there are real moves to clean up some of the side effects that came during the neoKraepelinian revolution that swept through the specialty of psychiatry in my early days. Industry had its day in the sun and seems for the moment moving on to greener pastures. The Clinical Trial world, seat of some of the major corruption is under a microscope and the target of a growing movement for Data Transparency. And people at least say &quot;<em>bio-psycho-social<\/em>&quot; model now frequently &#8211; a term that has long been only whispered. Then today, I look over the new <strong><font color=\"#004400\">American Journal of Psychiatry<\/font><\/strong> and read this:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24833193\" target=\"_blank\">The Structure of Psychiatric Science<\/a><\/div>\n<div align=\"center\" class=\"small\">by Kendler KS<\/div>\n<div align=\"center\" class=\"middle\"><strong><font color=\"#004400\">American Journal of Psychiatry<\/font><\/strong>. 2014 May 16. [Epub ahead of print]<\/div>\n<p>        <\/p>\n<div align=\"justify\">This essay addresses two interrelated questions: What is the structure of current psychiatric science and what should its goals be? The author analyzed all studies addressing the etiology of psychiatric disorders in the first four 2013 issues of 12 psychiatry and psychology journals. He classified the resulting 197 articles by the risk factors examined using five biological, four psychological, and three environmental levels. The risk factors were widely dispersed across levels, suggesting that our field is inherently multilevel and already practicing empirically based pluralism. However, over two-thirds of the studies had a within-level focus. Two cross-level patterns emerged between 1) systems neuroscience and neuropsychology and 2) molecular or latent genetic factors and environmental risks. The author suggests three fundamental goals for etiological psychiatric research. The first is an eclectic effort to clarify risk factors regardless of level, including those assessed using imaginative understanding, with careful attention to causal inference. An interventionist framework focusing on isolating causal effects is recommended for this effort. The second goal is to clarify mechanisms of illness that will require tracing causal pathways across levels downward to biological neuroscience and upward to social factors, thereby elucidating the important cross-level interactions. Here the philosophy of biology literature on mechanisms can be a useful guide. Third, we have to trace the effects of these causal pathways back up into the mental realm, moving from the Jasperian level of explanation to that of understanding. This final effort will help us expand our empathic abilities to better understand how symptoms are experienced in the minds of our patients.<\/div>\n<hr width=\"75%\" size=\"1\" \/>\n<div align=\"justify\"><em>Conclusion: &#8230;A vigorous debate between different scientific perspectives on psychiatric illness is to be valued. More problematic has been our tendency to develop &ldquo;fervent monism.&rdquo; This position, at times strongly advocated by psychoanalysis, early biological psychiatry, social psychiatry, and most recently, molecular psychiatry, is that their approach was the only valid one. Fervent monism, especially when applied to the field of human behavior, reflects epistemic hubris. It is helpful, in concluding, to revisit an old but central question: Is there a single &ldquo;best&rdquo; level at which to address the causes of psychiatric illness? Do we expect that over time one specific level of explanation for psychiatric illness will &ldquo;win&rdquo; the scientific competition and beat out all other kinds of explanations? I think that the mere posing of this question illustrates its implausibility. We are &ldquo;stuck&rdquo; with the dappled causal world for psychiatric disorders. In the introductory epigraph to this essay, Chang makes a point worth re-emphasizing. It is only the immature fields of science that advocate monism. Tolerance for diversity and humility come with scientific maturity<\/em>.<\/div>\n<\/blockquote>\n<div align=\"justify\">Saying that &quot;<em>risk factors were widely dispersed across levels, suggesting that our  field is inherently multilevel and already practicing empirically based  pluralism<\/em>&quot; may well be a bit of an exaggeration, if he&#8217;s referring to psychiatric practice or research. As an aging pluralist, it has felt and still feels pretty monistic to me &#8211; even with a break in the clouds. My point is only that it has been a long time since I&#8217;ve seen an essay in the <strong><font color=\"#004400\">American Journal of Psychiatry<\/font><\/strong> that acknowledges the &quot;<em>dappled causal world for psychiatric disorders<\/em>&quot; and adds &quot;<em>It is only the immature fields of science that advocate monism.  Tolerance for diversity and humility come with scientific maturity<\/em>&quot;. We could use some of that maturity&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time&hellip; Little Gidding&nbsp; T.S. Eliot 1942 I hate being so repetitive with my quotes. This one has had many re-runs here. But I guess that&#8217;s the way it [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-49283","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49283","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=49283"}],"version-history":[{"count":13,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49283\/revisions"}],"predecessor-version":[{"id":49300,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49283\/revisions\/49300"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=49283"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=49283"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=49283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}