Entrenched reductionisms: The bête noire of psychiatry.

Abstract

Like Hannah Decker, I too deplore the destructive battle of psychosocial and biological reductionisms that has bedeviled psychiatry. When I started my psychiatric training almost 50 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel and Freud, brought to and adapted in America by Adolph Meyer. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature. Unfortunately, the mental health field has since degenerated into a civil war between the biomedical and psychosocial models with little room for compromise or finding middle ground. The inflexible biological reductionists assume that genes are destiny and that there is a pill for every problem: they take a "mindless" position. The inflexible psychosocial reductionists assume that mental health problems all arise from unpleasant experience: They take a "brainless" position. I have spent a good deal of frustrating time trying to open the minds of extremists at both ends, though rarely making much headway. In my view, however, and where I differ from Decker, the reductionisms do not sort so neatly into alternating historical periods.