Humanity and biology in psychiatry

Further to our previous letter (Owen et al, 2003) we are writing to respond to Dr Turner's assertion (Turner, 2003) that biological psychiatrists secretly want to take the humanity out of the humanities. This highlights a conceptual division within psychiatry and one partisan misunderstanding that stymies the debate.

It can be argued that academic psychiatrists are divided into two camps. The first is those who were drawn to the higher functioning of the brain as a conceptual frontier, and see logico-deductive empirical methodology as leading to the accumulation of universally applicable valid evidence. The second is those who were attracted to psychiatry (often away from other branches of medicine) because of its shared space with the humanities. The latter group focus on the difficulties of applying scientific method to the interpretation of meanings and intentions, emphasising cultural relativity, and issues of power and politics.

Highlighting the above division is not new. What we suggest is that the proponents of both camps, by their unwillingness to engage with or understand the field of the other, risk conceptual disaster at both extremes.

The argument from the humanities is of relevance to any scientist. The late-20th century critique of the hubris, historicism and relativity of science strikes at the core of the assumptions of biological psychiatry. Unfortunately, it is an argument that many do not even feel to be relevant. This seems to be an opinion based largely on a lay view that anything within the humanities is of little utility.

This is the very hubris that leads to the name-calling that Dr Turner exemplifies in his response to our perceived ‘biological’ letter. However, this assumption, among many in the humanities, that the biological psychiatrists are all washed up – applying a suspect statistical method in suspect circumstances – has led to them dangerously disengaging from any medical aspect of their profession. If our assertion is right, and this is a motivation for coming to psychiatry in the first place, this is hardly surprising.

The worrying thing is, of course, that despite the shortcomings of current approaches to categorisation, aetiology and treatment, mental illness does exist, and hence psychiatry has a role to play in its understanding and treatment. Our job, if we remain interested in being doctors, is to see (based on what evidence we have) where the medical model can add to the care of someone mentally unwell.

If this is hopeless, as some (e.g. Szasz, 1960) have argued, then what are we doing in psychiatry? Given this position, the responsibility for looking after the mentally unwell is surely better handed to others. The irony is that many of the most nihilistic psychiatrists prescribe psychotropics; either this amounts to extreme hypocrisy, or the methodology and results of biological research do matter after all.

With biological research becoming increasingly specialised and complex, a new technology will only be understood by relatively few. In the humanities, the language remains esoteric and hard for the uninitiated to engage with. If the proponents from both ends of the debate do not see the worth in the others’ business, when will the results or arguments of one ever be valid for the other?

In essence, in response to Turner's assertion (2003) that biological psychiatrists wish to take the humanity out of the humanities, we fear that he hints at a desire within the humanities to take the medical science out of psychiatry. If this is the position, then we fear a psychiatrist is left adding nothing to the multidisciplinary team other than personal opinion. Although much empirical research is burdened with vested interests, criticised for not being conscious enough of its assumptions, and maladapted to studying the profound experimental suffering we see in mental illness, it remains the only way to replace opinion with anything more certain.

The humanities help us to see what mental illness is, but there will always be an accompanying biology and we have always known that modulating the biology can modulate the illness. If we value the treatment of mental illness, we must value both humanistic and biological investigations.