Psychiatry

Psychiatry (and other sciences of psychopathology)

Psychiatry is sometimes defined as the science of mental disorders (or psychopathology). However, also other fields, such as clinical psychology, sociology of mental health and psychiatric anthropology may claim to be sciences concerned with mental disorders. In spite of such overlapping subject fields, the disciplines may tend to be rather isolated:

Eugene Garfield wondered that psychiatry journals were very rarely cited by psychology journals, and he opined: "I would not go so far as to say that psychologists and behavioral scientists work in a closed tower, but very obviously they seem not to look too much at the research world elsewhere. If they do, they seem not to have found much that is helpful. If they have, they aren’t admitting the fact in their citations". (Garfield, 1975, p. 9)

It may be suggested that psychiatry is about mental disorders from the perspective of natural science, while clinical psychology and sociology is about mental disorders from psychodynamic, behavioral, cognitive or social perspectives. The problem with this understanding is that some psychiatrist may subscribe to the psychodynamic way of understanding, while some psychologists subscribe to biomedical ways of understanding. Disciplines have become heterogeneous as suggested by Dogan (2001, p. 14851): “The process of specialization has tended to disjoin activities which had previously been united, and to separate scholars belonging to the same formal discipline, but who are interested in different fields.” Thus, psychiatrists, psychologists, sociologists and other scientists and scholars subscribing, for example, to the psychodynamic way of understanding, tend to be much more theoretically united compared to colleagues subscribing to other ways of understanding.

Attempts have also been made to differentiate, for example, psychiatry and clinical psychology by ontological criteria. Thus psychiatry is claimed to be about diseases, while psychology is said to be about normal behavior or about maladjustment. Such claims have little support in actual practices within the disciplines. Also, such a view is depending on the understanding of the causes of psychopathology, which cannot be decided a priory, but which it is a task of the involved disciplines to clarify.

A part of the problem is the kind of professional status, legislation and power associated with the different disciplines. In many countries are psychologists, for example, not allowed to prescribe medical drugs, why this approach is not an option for them. In Denmark, for example, has to job market for psychologists been much bigger in the educational sector compared to the health care sector, in which the psychiatrists have had a controlling influence. Such issues may be relevant to consider when understanding the subject matter of a discipline such as psychiatry. (This is the kind of understanding which is often uncovered by researchers informed by epistemologies related to social constructivism).

When clinical psychology was being established as a new field in Denmark around 1945, where psychologists not allowed to provide any kind of therapy. They were mainly employed as administrators of psychological tests and had to deliver the test results to the psychiatrists, who then prescribed and carried out the treatment (be it psychological or medical treatment). This early division of labor between psychiatrists and clinical psychologists is reflected in library classification.

In the DK5-system is clinical psychology defined as the field about describing psychopathology and diagnosis, while psychiatry is defined as treatment (including psychotherapy and behavioral therapy). Such a classification may be relatively easy to administer. But beside being anachronistic it is not reflecting the conceptual structures in the disciplines. A user may be confused by finding psychiatric concepts placed under psychology and at the same time psychological concepts and conceptions placed under psychiatry.

Within psychiatry has the development of DSM been a major success as strengthening the disciplinary status and power of the field. It is also, however, a system of serious criticism and debate.

Literature:

Berrios, G. E. (1999). Classifications in psychiatry: a conceptual history. Australian and New Zeeland Journal of Psychiatry, 33(2), 145-160 [Abstract].

Caplan, P. J. & Cosgrove, L. (Eds.). (2004). Bias in Psychiatric Diagnosis. Northvale, NJ: Jason Aronson, Inc.

Cooper, Rachel (2005). Classifying Madness: A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorders. Berlin: Springer.

Dogan, M. (2001). "Specialization and Recombination of Specialties in the social sciences" (pp. 14851-14855). International Encyclopedia of Social and Behavioral Sciences. Edited by Smelser, N. J. & Baltes, P. B. London, Pergamon-Elsevier Science.

Garfield, E. (1975). Journal citation studies. 19. Psychology and behavior journals. Current
Contents, 9, 5–9. (Reprinted in Essays of an information scientist, vol. 2, 1974–76, pp. 231–
235.) Retrieved September 27, 2003, from

http://www.garfield.library.upenn.edu/essays/v2p231y1974-76.pdf

Mills, J. & Broughton, V. (1978): Bliss Bibliographical Classification. 2. ed. Class I: Psychology and Psychiatry. London: Butterworth.

Reznek, L. (1991). The philosophical defense of psychiatry. London: Routledge.

Rosenbaum, B. (2004). Psykiatriens aktuelle videnskabelighed. IN: Videnskabens ansigter. Ed. by Lars Aagaard & Steen Brock. Århus: Philosophia. (pp. 78-95).

Sadler, J. Z. (Ed.). (1994). Philosophical perspectives on psychiatric diagnostic classification. Johns Hopkins University Press.

Woods, D. J. (1979). Carving nature at its joints? Observations on a revised psychiatric nomenclature. Journal of Clinical Psychology, 35(4), 912-20.

World Health Organization (1978). Mental disorders; glossary and guide to their classification in accordance with the ninth revision of the international classification of diseases. Geneva: World Health Organization (WHO).

Birger Hjørland

Last edited: 07-10-2009

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