David Healy: The Shipwreck of the Singular
Hector Warnes’ comment on Edward Shorter’s comment

                I enjoyed reading Edward  Shorter’s comments;he found David Healy’s essay witty and full of “powerful insights.”  He further agreed  that  psychiatry’s “apparent failure in the  conventional models, the biospychosocial and the medical,”  is  atributed to “specific locus: the randomly controlled clinical trials (RCTs) and the hunger for data from epidemiological studies and from rating scales.”

            Shorter underlines  the fact of the  dehumanizing impact of “seeing the patient as a sack of risk, rather than as a sack of enzymes (in the biological model) or an accumulation of ‘risk factors,’ as in the biopsychosocial model.”  Henoted further  that what was missing in Healy’s overview  was the “disappearance of psychopathology from the discipline’s armamentarium of tools.” 

            The word “armamentarium”was aptly used by Shorter because according to the Merriam-Webster Dictionary it means just what we most doubt in our professional endevour:

            “A collection of resources available or utilized for an undertaking or field of activity, especially: the equipment, methods, and pharmaceuticals used in Medicine.” 

            Certainly if we are not clear about the diagnoses, or at least what is wrong with the individual patient, it is unlikely that we would not  be as effective in the treatment we are providing.  

            Shorter,  with a sense of humor, adds: “don’t tell us that the problem is ‘depression.’” He may be trying to tell us that anxiety and/or depression is so ubiquitous in most psychiatric illnessess that it would be considered a symptom rather than an illness per se unless,of course,clear boundaries are established.  

            Shorter  seems to support the Scandinavian and German type of psychopathology (or study) of the individual patient rather that the measuring of large and disparate  sick populations.  In a sense, he adds that this latter  “method” is like looking for alost key, not where it fell or was lost but where there is more light in the street.

            He is obviously deriding the DSM which is including a growing  number of spectrum disorders looking for “heterogenous clinical populations none of which will respond in a uniform way to any imaginable agent.” Healy was convincing in his assertion that  the “biobabble,”  replacing a “psychobabble,”  reminds us of the inadequacy of both the biological and sociological approaches to psychiatric disease.

            I would interpret Shorter’s comment on Healy’s essay as saying that  the study of the individual patient, unparalled  in its uniqueness,  would be paramount to his care and treatment.  Perhaps the word qualia(from the Latin: “what sort or what kind”) goes further than just the study of psychopathology and enters into the very  subjective  qualitative  experience and beliefs of the patient.

            Rodolfo Llinás , in I and the Vortex,raises the pros/cons of using this concept  in its subtle blending arguing that it is necessary for an organism’s survival and is  the product of neuronal electro-chemical oscillation (Llinas 2002).

            A humane approach to psychopathology and to descriptive psychiatry  is akin to the best  psychotherapy. I seem to read Healy and Shorter in complete agreement  in their overall assessment of our crisis.

Reference:

Llinás RR. I of the Vortex. From Neurons to Self. The MIT Press; 2002.

January 24, 2019