Psychiatry and the human sciences

The presentation of the mind-brain problem in leading psychiatry journals

Objective:

The mind-brain problem (MBP) has marked implications for psychiatry, but has been poorly discussed in the psychiatric literature. This paper evaluates the presentation of the MBP in the three leading general psychiatry journals during the last 20 years.

Methods:

Systematic review of articles on the MBP published in the three general psychiatry journals with the highest impact factor from 1995 to 2015. The content of these articles was analyzed and discussed in the light of contemporary debates on the MBP.

Results:

Twenty-three papers, usually written by prestigious authors, explicitly discussed the MBP and received many citations (mean = 130). The two main categories were critiques of dualism and defenses of physicalism (mind as a brain product). These papers revealed several misrepresentations of theoretical positions and lacked relevant contemporary literature. Without further discussion or evidence, they presented the MBP as solved, dualism as an old-fashioned or superstitious idea, and physicalism as the only rational and empirically confirmed option.

Conclusion:

The MBP has not been properly presented and discussed in the three leading psychiatric journals in the last 20 years. The few articles on the topic have been highly cited, but reveal misrepresentations and lack of careful philosophical discussion, as well as a strong bias against dualism and toward a materialist/physicalist approach to psychiatry.

Factitious Disorders: Reformulating the DSM–IV Criteria

The author criticizes and reformulates the DSM-IV criteria in a clinically and nosologically sensitive way. Criterion A, the intentional production of physical or psychological signs or symptoms, emphasizes symptoms and cannot accommodate pseudologia fantastica, voluntary false confessions, and impersonations. Criterion B, the motivation is to assume the "sick role," has no empirical content and fulfills no diagnostic function. The two criteria need reformulating in terms of lies and self-harm, respectively. Criterion C causes misdiagnosis by pushing factitious disorders into the somatoform and malingering categories and should be abandoned. The author discusses the implications for the etiology of conversion disorders and the classification of factitious disorders.

Is psychiatry an art or a science? The views of psychiatrists and trainees

OBJECTIVE

It is generally considered by many practitioners that psychiatry is an art, that is, one of the humanities, as well as being a science. We systematically collected the views of practitioners and trainee psychiatrists regarding the question 'Is psychiatry an art or a science?'

METHOD

Eleven supervisors and nine trainees were interviewed and their responses analysed, using a qualitative method, the modified framework approach.

RESULTS

Several themes emerged from the data: that 'art' and 'science' are different; psychiatry as a discipline is difficult to define; psychiatry demands a broader range of skills than other medical specialties; the relationship of psychology to psychiatry; supervisor cynicism to the 'science' of psychiatry; and the 'art' and 'science' of the assessment process.

CONCLUSIONS

The tension that exists within the profession's identity as a discipline has important implications for teaching, learning, and clinical and research practices.

Somatization disorder: a practical review

OBJECTIVE

This paper reviews the present state of knowledge on the etiology, prevalence, diagnosis, and treatment of somatization disorder (SD).

METHOD

A comprehensive review of the literature on SD is described under the above headings.

RESULTS

SD is a common condition that is not well managed by many physicians. Patients with SD get caught between the cracks of the health care system, with expensive consequences. SD is a psychiatric disorder, but patients are reluctant to see and be treated by psychiatrists. They frequently are managed by nonpsychiatric physicians who have limited understanding of the condition. Cognitive-behavioural therapy (CBT) is the most efficacious treatment in SD, although antidepressants and supportive psychotherapy also have a role for some patients.

CONCLUSIONS

A cadre of clinicians with training in the theory and practice of CBT for SD is required. They need to be based both in the community and in tertiary health care centres, where most patients with this condition are located.