«Forschungsobjekt Mensch» - über wissenschaftstheoretische Defizite in der Psychiatrie

Abstract

Two hundred years ago psychiatry began to establish itself as a practical and scientific institution. The views about the causation of and potential therapies for mental diseases were riddled with speculative metaphysical and religious thoughts. Around the middle of the 19th century psychiatry was integrated into medicine - taking over most of the methodological positions of natural science. Certain scientific findings - for example Wernicke's discovery that particular lesions in the brain are associated with aphasia - encouraged physicians in their confidence that medicine should become more or less exclusively a natural science. As a result of the increasingly scientific professionalisation of psychiatry, the philosophical and theoretical preconditions thereof were less reflected. Psychiatry positioned itself as a natural science, in which every form of scientific explanation could be based on the principles of mathematical physics. This socalled monistic approach emerged at the beginning of the 20th century and found strong support among scientists and philosophers. Two examples of this monistic position are logical empiricism, founded by Rudolf Carnap and Otto Neurath, and critical rationalism of Karl Popper. According to this point of view human behaviour could - and should - ideally be explained exclusively through general laws. On the other hand, a hermeneutic point of view developed - held for example by Wilhelm Dilthey - which contained a dualistic conception of science integrating processes of understanding. From the hermeneutic point of view every method used in science must adapt to its object. In this article several arguments are given in favour of a dualistic view of psychiatry. It is emphasised that psychiatry has uncritically adapted to behaviouristic psychology, ignoring arguments arising from phenomenological or cognitive psychology, among others. Some of the rare German-language publications by psychiatrists on the philosophy of science are presented. They show that the current debate on this issue has received little notice. Particularly the insights of the philosophy of language arising from the ideas of Ludwig Wittgenstein are completely neglected. It is pointed out that it is rather problematic that these papers, which do not reflect the discussion between the exponents of the monistic and the dualistic view, are presented in a textbook representing the state-of-the-art of psychiatry. Finally, proposals for the method one may use to complete current research are put forward. It is emphasised that psychiatry should integrate philosophical considerations and reflect on the assumptions upon which it has been founded.