Psychiatry must not be separated from its historical and cultural context

Abstract

Byline: Paul. Hoff A.R. Basu's call for a proper implementation of the historical and cultural perspective in research on Indian psychiatry and its history is highly justified.[1] This commentary will mainly reinforce his view. Initially, I shall say a few words about the practical relevance of the history of psychiatry in general, given the present-day debate on psychiatry's identity (I). This will be in line with arguments published previously.[2] Then I shall mention one additional argument concerning the theoretical foundation of psychiatry (II.1) and two debatable issues with regard to the author's position (II.2) before concluding with four theses (III). I. History of Psychiatry Is Practically Relevant The main hypothesis of Basu's paper is that the understanding of the history of psychiatry in India has for a long time been too strongly linked to two western phenomena. These are- on the theoretical side-the project of enlightenment, and- on the political side-colonialism. The author is critical of the global claims of enlightenment ideas, especially the notion of rationalism being the only proper way to develop democratic societies, thus pushing every 'irrational' moment aside or even declaring it dangerous or insane. And he is critical of the willingness of Indian psychiatry to shape its self-under-standing according to the concept and practice of British psychiatry which was brought to-perhaps forced upon- India in colonial times. What has this to do with the practical relevance of research into the history of psychiatry? First of all, the history of psychiatry is a very heterogeneous field. It consists of, or at least deals with, many different, often conflicting scientific cultures and traditions. Nonetheless, the following four arguments should be considered: The historical argument We need the history of psychiatry to collect documents and other historical sources on authors, concepts and institutions of psychiatry, and to understand their position within the different scientific traditions of psychiatry. The practical argument It is not only a theoretical issue to deal with the history of psychiatry, but also a highly practical one. This has to do with the fact that 'mental illness', whatever definition one might apply, will never be just one self-explanatory concept. Different approaches to define 'mental illness' have a significant impact on diagnosis and therapy, e.g. the several controversial concepts on 'borderline states' end up with completely different diagnostic procedures (operationalized v. heuristic) and therapeutic options (interpretation of conflicting personality structures and their development since childhood v. skills training v. mood-stabilizing or other psychotropic drugs). Of course, modern psychiatry increasingly tries to integrate different approaches in order to find the most effective treatment for the individual patient. But the point is that there are indeed significantly different and practically relevant ways to conceptualize major psychiatric issues. And to adequately understand these complex and long-standing developments, we strongly depend on the historical dimension. The theoretical argument This argument is called theoretical because it refers to the risk of any given psychiatric theory to become uncritical, 'narrow-minded' and-in the worst case-dogmatic. If one looks closely at the history of our field it becomes evident that dogmatic positions in fact did occur in every psychiatric line of thought. As discussed elsewhere in greater detail, there are at least three major concepts of mental illness:[3] The biological or naturalistic one ('mental illness is a brain disease'), the psychological or heuristical one ('mental illness is an understandable reaction or development within the patient's biography') and the nominalistic one ('mental illness can at present not be sufficiently defined as a real object, e. …