Cleaning the House of Psychiatry

Psychology and psychiatry have generated multiple models with competing claims. Changes that are part of knowledge accumulation come under different names – paradigms, theories, and revolutions. Medical and social sciences are replete with binary oppositions and false dichotomies which distract real progress. A framework is outlined for breaking down different psychiatric theories and practices into “fast” and “slow psychiatry.” Another way to map these differences is to examine centrifugal (dispersion) versus centripetal (integration) impacts of psychiatric theories and practices. What eludes all such dichotomies is complexity. Contemporary culture finds subjectivity and complexity unwieldy leading to reductionism. Three examples of reductionism in medicine and psychiatry are discussed: (1) depression and the “chemical imbalance” myth, (2) schizophrenias and their reductions, and (3) “anorexia multiforme” as a cultural chameleon. These problems have led to the “bracket creep” of ever-expanding diagnostic criteria of DSM-5 contrasted to the slim promises of neuroscience-based criteria. Attempts to apply neuroscience to aesthetics and the arts reveal its limitations compared to the humanities and social science and richer narrative models in psychotherapy and psychiatry.