‘Sciences’ Basic to Psychiatry

It has become customary to construe medicine as based on and emerging from physiology and molecular biology and their derivatives such as immunology, with advances in the understanding and treatment of disease following and sometimes informing advances in these basic biological sciences. Some have also supposed that the subject matter of psychiatry depends on the same basic sciences in essentially similar ways, neurosciences being of particular relevance. However, psychiatric disorders resolutely refuse to succumb to neuroscientific developments. Of course cerebral disturbance underpins some 'psychiatric' disorders, and important advances have been made recently, for example in Alzheimer's and Huntington's diseases. But psychological and social implications of these disease processes are of very great significance to individual sufferers and their relatives and in the planning and implementation of treatment programmes. So also in the 'functional' psychoses such as schizophrenia, where biological faults are suspected but not as yet clearly identified; patients with schizophrenia or manic-depressive disorder, for instance, respond adversely to stressful life events and to particular patterns ofcommunication with their living companions. Very many psychiatric patients with neuroses or personality or relationship problems, and people with psychosocial problems who consult general practitioners, need to be understood almost entirely in psychological and social terms. In medicine generally, of course, it is a truism to say that psychological and social factors are often important, and it seems good practice to expect some relevant biological, psychological and social influence in every case. Even so, it remains difficult for some clinicians, perhaps especially experts in 'high' biological technology and cellular biologists, to remember this. Part of the difficulty may be to remember that psychology and other behavioural sciences have methods and techniques of their own, taking them well beyond folklore and commonplace language to be properly regarded as sciences. Some who will allow this of psychology have difficulty accepting it also of such activities as sociology and perhaps also social anthropology, even if they do not agree with a previous Secretary ofState for Education that 'social science' is inherently contradictory. Such views of social science may be clarified by the distinction between sociology in psychiatry and the sociology of it, of interest to contemporary medical sociologists in the tradition of Foucault (see this issue, p 161). Sociology in psychiatry could claim among its achievements and within its territory recent advances in the study of life events in relation to psychiatric disorder, to mention only one area in which advances have been made since Durkheim made a sociological approach to suicide. All psychiatrists at least would acknowledge the relevance and scientific status of sociology in this sense. Further advances in this tradition are to be expected; current areas of interest include a wide range of social influences on disease and health. Concepts of 'help-seeking' and 'illness behaviour' may be particularly promising, in relation to such continuing practical conundrums as the high prevalence of people with somatic symptoms without somatic pathology to be found in many hospital and primary care settings. The sociologyofpsychiatry poses more problems for practitioners, at least in some of the ways it has been presented since 'anti-psychiatry' emerged in the 1960s. Psychiatry, like all socially organized activities, must have a sociology, and the political polemic of some anti-psychiatrists has sometimes focused almost exclusively on possible implications of Shaw's dictum that 'professions are conspiracies against the laity'. Hence, it has been easy to forget that, for example, inappropriate 'labelling' can cause problems, or that some features of large hospitals can be beneficial. At times the patient (or client).related baby has been thrown out with the sociological bathwater, as by those who assert that all 'labels' are always bad or that everything about a large psychiatric hospital is bound to be harmful. Perhaps the former Secretary of State for Education was responding to the sociology of politics when he renamed the 'Social Sciences' Research Council. Social anthropology also figures, for some, among social sciences, but its continuing interest in psychoanalytic tradition and language, its own tendencies to esoteric language use, and perceived unclarity about what it refers to as 'its methods', make it difficult for psychiatrists to dojustice to it. A question arises concerning the circumstances in which social anthropological jargon ('rite de passage', etc.) may be more useful than psychoanalytic terms to the psychiatrist. It seems likely that anthropologically informed psychiatrists see patients for approximately the same lengths of time as other psychiatrists, but use other words to describe what they are doing, which will be of value to the extent that anthropological language represents one of the many frames of reference from which help-seeker and helpgiver may construct a useful shared language. Methods of enquiry peculiar to anthropology seem to require participant observation as a basic strategy. Anthropologists emphasize the value of doing this so as to constrain or affect the subject matter as little as possible. Results tend to be presented qualitatively and at length, and to provide fascinating accounts' whose affinity may appear to be more with the literary tradition than the scientific. Nevertheless, the anthropologists's interest in the impact of environmental context on the individual is an essential stance for the psychiatrist whose 'bread-andbutter' 'mental state examination' method may itself be a culture-dependent activity which cannot present an individual's experience independently of context as it sometimes purports to do. Arising from meeting of the Section of Psychiatry, 10 February 1987