Thursday, September 30, 2010

Rerun: Thomas Kuhn, Paradigms, and Psychiatry

This from late January. Enjoy ...

Haters of the word, paradigm, have Thomas Kuhn to blame. His seminal 1962 publication, The Structure of Scientific Revolutions, is a regular on all manner of Top 100 lists for books that rocked the world. In my line of work, you can’t browse a website for five seconds before being paradigmed to death.

My latest close encounter was an online book by Todd Finnerty PsyD on the fine points of Depressive Personality Disorder (see recent blog post). Dr Finnerty thoughtfully summarized Kuhn’s main points, which, together with Wikipedia and other sources, spares me from having reread Kuhn (which I did read way back in college).

Here’s the basics:

Forget about the quest for knowledge being an objective inquiry governed by scientists rationally sifting through the facts. That may be their intention, but in reality they are operating within their own particular conceptual frameworks (paradigms) that govern how they think. Thus, if you are living in an era where the ruling paradigm features the earth at the center of the universe, then your typical 15th century Polish heliocentric firebrand named Copernicus is going to come across as a raving lunatic (okay, make that solartic).

Ironically, says Kuhn, the 15th century scientific community, such as it was, was perfectly correct in rejecting Copernicus, as Ptolemy’s model of the universe still proved a superior predictor of observable planetary motion. Only later, with Galileo and others building on Copernicus, did Ptolemy (pictured here) and his world come crashing down.

During a period of normal scientific development, researchers are working off a shared set of general beliefs, which frees them up for working on specific problems. Anomalous findings either get dismissed or folded into the paradigm. But anomalies have a way of accumulating like unwanted snow. The old guard has a legitimate role as keepers of the paradigm, but history is not on their side.

According to Kuhn, the old and new paradigms are so different that they are “incommensurable.” In essence, there is no common ground by which a scientist working within a new paradigm can prove her point based on the assumptions of the old.

For an example of worlds in collision: At the 2004 American Psychiatric Association Annual Meeting, I heard Jack Barchas MD of Cornell University and a pioneer in the field of how biochemistry and behavior interact, recount how as a young investigator an early mentor challenged one of his ideas on these grounds: “How is this justified in the writings of Freud?”

Not surprisingly, Freud soon became to psychiatry what Ptolemy became to astronomy. But was Freud getting a raw deal? At the following year’s APA, I heard Nobel Laureate Eric Kandel MD state:

“A major need of psychiatry in the future is to put the psychotherapeutic arm of psychiatry on the same solid biological footing as the pharmacological aspect of psychiatry."

Dr Kandel was very much moved by Kay Jamison who said if it wasn’t for lithium she would be dead, but that it was really psychotherapy that gave her a coherent view of her life, that allowed her to tie the various strings of her life together.

"We’re in a fantastic phase of psychiatric thought," Dr Kandel concluded. The biology of the mind is the central scientific challenge of the twenty-first century. Molecular genetics and molecular biology, he said, have given us insights that would have been inconceivable 20 or 30 years ago. These advances will revolutionize psychiatry, but hardly eliminate it. Instead, psychiatry will synthesize with molecular biology into what he describes as "the new science of the mind."

Paradigms, paradigms, paradigms.


Tony said...

“A major need of psychiatry in the future is to put the psychotherapeutic arm of psychiatry on the [b]same solid biological footing as the pharmacological aspect of psychiatry[/b]."

While on the surface I agree with that statement, I really do believe that Psychiatry needs to embrace it's roots rather than throw it out with the bath-water...BUT... I certainly take issue with the notion that the pharmacological aspect is on solid footing.

How does one make such a bold statement when [b]EVERY[/b] FDA Approved medication for these disorders by law has to carry the warning that in effect says: We have no idea how this stuff works, but it does... kinda, sorta a little better than a placebo...

In the 23 years I've been living with my label things haven't been getting better, in fact things have been made worse. At least then there was an effort by Psychiatrists to provide therapeutic interventions in the form of talk therapies. Now it's a 10 minute med check and off you go. If you need therapy, go see someone else... whom the Psychiatrist doesn't even want to know, let alone confer with about your case.

That solid footing Dr. Kandel is speaking about isn't so solid as it is being practiced on the ground. In fact it has created deep divisions.

John McManamy said...

Hey, Tony. I thoroughly agree. The pharmacological aspect of psychiatry, in my opinion, is highly suspect scientifically. My guess is Dr Kandel was being gracious, in regard to the audience he was addressing. He has spent his whole life as a brain scientist, thinking outside the box, and the efforts of his work and that of other brain scientists is obviously challenging the psychiatry-DSM-pharma paradigm.

That paradigm is also being challenged by the recovery movement, which questions the whole disease mindset of psychiatry and its "treatments."

I think we're on the same page here, and I think we're in general agreement on the point of the piece: Namely that psychiatry is not going to be changed by psychiatrists. The change will come from those outside of psychiatry, such as brain scientists (Dr Kandel is technically a psychiatrist but he is obviously a brain scientist), and from jaded patients and family members sick of hearing the same thing. But I don't preclude the possibility of enlightened psychiatrists aligning themselves with the brain scientists and the recovery movement.

Tony said...

"That paradigm is also being challenged by the recovery movement, which questions the whole disease mindset of psychiatry and its "treatments."

You could probably guess where I fall on that line :)

I'm completely on board with the recovery movement and dispelling the "disease" model.

To be honest in my mind it comes down to bridging the gap between people who have made it their life's work dealing with disease and those who have made their life's work dealing with language and psychology.

Could we as successful "patients" bridge that gap?

John McManamy said...

Hey, Tony. I hope so. The catch is we have to yell very loudly or one of us needs to win the powerball lottery to set our own research agenda. I'd love to be in a position to bankroll a new age of enlightenment. :)

mark said...

There is another paradigm emerging, that is in direct conflict with the biological paradigm and that is the so called Transpersonal psychology, which embraces and expands the findings of Freud, Jung, Maslow, Grof and many others discoveries in the psychology in the last century.

What I'm saying, the biological paradigm is only one viable option for a future of psychiatry among many. Yes, it's leading the race at the moment, but as any other paradigm it's only one of many possible frameworks of interpretation.

My personal view is that the biological researchers are trapped by their paradigm to look only at the brain. They cannot conceive the possibility of mental disease having any other source than the physical matter of the brain itself. By their paradigm, they not only believe that but refuse too look at any other evidence which would point to the contrary.

But the race is on. Let the best emerging paradigm win.


John McManamy said...

Hey, Mark. I take your point, but I think the brain science is going to crack it wide open by validating what you say here. Here's my take:

Every brain scientist these days to my knowledge is operating off a genes-environment paradigm. Thus the meat inside our skulls cannot be regarded in a vacuum. Our genes affect how our brains react to what's going on around us. Likewise, our environment impacts our brain. Since both can be changed, each influences the other.

This validates the old diathesis stress hypothesis. It also opens the way for bringing back Freud and drawing attention to the transpersonal advocates. In the past, psychiatry regarded the mind and brain as separate. SZ and other illnesses were regarded as maladaptive "reactions." That got replaced by a biology model which was very incomplete.

Now we seem to have a grand unified theory developing, where every point of view can be folded in and validated according to the new emerging paradigm. Those who thought the brain science was simply going to validate biological psychiatry are intellectual dinosaurs.

John McManamy said...

One more point, Mark. Since the new paradigm I referred to is a paradigm, it is doomed sooner or later to be overthrown by yet a newer one, one, of course, that we have no conception of.

abrahammer said...

Regardless of what Kuhn thinks about the nature of scientific development and if it somehow fits with what is happening nowadays, the daily experience of interacting with psychiatrists at least in my country leaves little doubt that its the politics of this intellectually parasitic profession what has stopped this "emerging paradigm", what i mean is that it could have happened earlier if they had allowed it to.

They have made everything in their power to stop this "emerging paradigm" that supposedly no one saw coming, but has roots in much older thinking than freud, makes much more sense for the common folk, is developed in philosophical thought about the nature of the mind and the brain AND now also is backed by scientific findings.

IMO in the analysis of what has happened in the development of psychiatry, the cynicism, neglect and professional interests of these so-called experts will be much more relevant themes that what kuhn proposes in such general terms... or maybe such themes should be integrated in a new account of how scientific (or scientistic) discourse evolves in a political context