From Psychiatry Remains a Science, Whether or Not You Like DSM5
Let’s be clear: not all science is physical science. Although psychiatry is nowadays associated with “biological psychiatry”--with PET scans, MRIs, neurotransmitters and the like--the domain of psychiatry is broader, deeper, and more pluralistic. As my colleagues Nassir Ghaemi MD9 and Michael A. Schwartz MD10 have argued, psychiatry is fundamentally a science of meaning. Wiggins and Schwartz define “meanings” as “…mental processes and their intended objects.”10(p.49)
We acquire evidence of our patient’s mental processes through precisely the “systematic methodology” required by the Science Council’s definition: we take a personal and family history; we perform a mental status exam; we observe our patient’s facial expression, affect, mannerisms, and speech. And we ask countless questions of the patient, aimed at eliciting deeper levels of meaning within the felt experience of the patient’s world. In some instances, we supplement these “office based” methods with projective or neuropsychological testing. In selected cases, we ask the patient to complete screening questionnaires or (rarely) to participate in a structured clinical interview. And, consistent with our pluralistic model of “mind,” we order appropriate laboratory and somatic tests to rule out underlying medical or neurological disorders.
We then form hypotheses based on these methods,regarding the patient’s psychopathology, personality structure, and clinical diagnosis. We test these hypotheses against subsequent observations, and—if we detect inconsistencies—we revisit our initial formulation. What Okasha identifies as “some of the main features of scientific inquiry”7(p. 125)—induction, experimental testing, observation, theory construction—are all part of psychiatric methodology. In short, psychiatry is well within the orthodox definition of “science.”
Do the methods of the DSM5 conform to this paradigm?
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