Psychiatry in Quest after Orientation

Abstract

The traditional gap between scholarly studies of facts and principles on the one hand, and the practical solution of human problems concerning these facts, on the other hand, has in certain fields been considerably narrowed. The mathematical and empirical sciences have been able to directly apply their theories through universal techniques to the needs of human life. The classic discrepancy between theory and practice seems to have been overcome by the latter. Psychiatry, however, remains ambivalent about its ability to integrate psychiatric theory and practice. For example, in spite of enormous advances in the scientific study of human behavior and mental disorders over the past twenty-five years, public mental health services are in disarray.¹ In addition, a proliferation of competing theoretical and treatment programs has emerged. Estimates indicate up to 200 or more “brand names” of psychotherapies.² In 1984, an editorial in a leading medical journal, Lancet,.challenged the psychotherapies to demonstrate their effectiveness.³ The psychiatric field’s difficulties in extending its scientific advances to its practical domain partially lie in its dual nature. Psychiatry simultaneously belongs to the empirical study of mental illness and human behavior as well as to the humanistic study and treatment of the human mind and emotional suffering. In spite of psychiatry’s striving to achieve scientific universality in its practical usefulness, it still remains in reality much closer in its applications to art than to technique.⁴ [This fact generates considerable criticism and controversy.] The humanistic domain of psychiatry brings the scholar and the scientist into a confrontation between lived human experience and theoretical conjecture about it. In fact, reality keeps the scientific imagination in check. For example, empirical approaches provide inadequate solutions to the suffering of the homeless patients living on our country’s streets. Like any technical application of science to the practical needs of human life, psychiatry deals directly with the concrete: in concurrence with the concrete human person. However, while the technical application of science deals with the application of universal principles, psychiatry in radical contrast deals more often than not with unique concrete situations.⁵ For example, although depressive illness might exhibit core depressive symptoms, each individual experiences his or her sadness within a unique and highly personal social and psychological context. However, each situation is a unique and unrepeatable occasion for the practitioner to apply whatever the scientific theories may support. Groping for the appropriate attitude toward the psychiatric patient, the practitioner has to have clearly in mind an aim and a direction toward which to direct his treatment.