Adam Blatner

Words and Images from the Mind of Adam Blatner

Psychiatry History

Originally posted on May 7, 2014

Yesterday I put up some ideas about permeability that in their implications, metaphysically, may challenge the entire materialistic and positivistic paradigm of the modern era. Lest I seem grandiose, it’s only speculation. I might well be mistaken. But still, that’s my role, to fool around, to explore, to draw cartoons, dance, joke, get serious, get half-serious half joking: there is a spectrum, you know.

To put it all in context, in two months I’m giving a talk to our lifelong learning program for people in my age group, Senior University Georgetown: The title is “We don’t do that any more.” Actually, it’s about all sorts of advances in medicine and in the future a similar title might  involve a series of lectures about the wider field. I’m accumulating material. This coming lecture, though, focuses on current (or at least this century’s) advances and mis-steps in one field: psychiatry (which was my specialty for most of my career, before I became a “contemplateur.”).

What’s awkward is that some things we do not do at all, for sure; other things are still done rarely. Some folks who did mis-steps were way out of the mainstream, even then. That they were allowed to get away with it at all is both tragic and a commentary on the permeability of practice. It applied to many fields, industries, economic practices. It’s not just psychiatry, medicine, etc. But Medicine aspires to higher standards, and as authorities we get a lot of parental transferences.

Parental transferences? Well, you know, our parents should have known how old-fashioned they were, how out-of-date their notions. But they didn’t! Was this willful blindness? No, times change. Our grandchildren may reproach their parents, our children, for not doing certain things we didn’t even know could be done, and for doing certain other things that everyone did, we thought it was okay, but it turns out to have been wrong, or partly wrong. Such goes the way of the world in a transition from post-figurative (hundreds of years ago) to configurative (last several generations) to pre-figurative (the present), as the terms are used by Margaret Mead in her 1970 book, Culture and Commitment. Anyway, the nature of authority, expectation, disappointment, blame—all these are in flux.

Back to the contemporary history of psychiatry: It’s a funny balance. For those who think about it, we are making progress, yet not so apparent is the degree to which we have not made very much progress. It’s a fine balance: I want to say, “Yay for us and what we’ve done!” and also “Whoa, don’t get all arrogant: We still know so little compared to what we will yet learn!” I want to encourage and yet be humble.

I’m impressed with the many ways we have made great advances, but it must be noted that the professional specialty of medical psychology (as they call it in Great Britain—“psychiatry” here) has ventured into blind alleys and what has been criticized (fairly) as pretty bad stuff. Also, we (since I confess to being somewhat identified with this field, it having been my own professional specialty until the turn of the millennium) may be venturing into other blind alleys even as I speak. I do think that the field has over-reached itself in some ways, or gotten prideful about certain dimensions while ignoring our deep ignorance about yet other dimensions. It’s a complex and vast field and few if any generalizations should be made.

There are many psychiatrists who are pursuing these other dimensions, but they are small in proportion. I hesitate to condemn “the art” while finding it easy to judge those who are making mistakes. But then I might hesitate to judge, too, because those folks are again a mixture of the foolish and the wise, the latter bravely trying and knowing that their knowledge is limited. This last is a heroic edge that I want to recognize. I fear that I’m also on such an edge, that I may be mistaken in part, and right in part, but even to the extent I’m right, I’m aware—knowing history—that whatever I’m right about will need to be modified. “Yes, Adam was right about x, but he had no idea how right he was, now that we know that x is part of x+y. And Adam was wrong about z, but if we realize that z is a sub-theme of w, well, then… though of course, there was no way Adam knew about w.”   Or maybe, “Well, there were people talking about u for years, and Adam knew about double-u (w), but we now know that both u and double-u are part of alphabetese. But back then no one knew there was such a thing as alphabetese.”

Such goes history, and no doubt history will continue. More, we are recognizing increasingly that history branches and interacts. In the olden days history was “one damned thing after another,” as some commentator put it; but now we know that history is inter-penetrating on multiple, perhaps infinite dimensions. Sometimes it has been the person who has driven a trend, and often people follow the trend. But on closer examination, people are themselves a complex mixture of temperament, cultural context, ability, taste, etc.—so complex indeed that any summarized judgment of the person as a genius or a fool, a saint or a scoundrel, has become more obviously a foolish over-generalization! Judgments are not necessary, and even interpretations are likely to be partial.

Or as Hippocrates put it in the second line of his aphorisms for doctors, “Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult (”.

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