Research in Psychiatry

In reviewing the present status of research in the broad field of psychiatry, one must accept the general principles which apply to all kinds of scientific investigation. In addition, there are special principles, particular to psychiatry and often different from those of medical research, which must be recognized. I shall present some of them briefly. In the detailed discussion, I shall illustrate with examples from current and past investigations of the group at the Payne Whitney Psychiatric Clinic. Psychiatric disorders are not so well defined or circumscribed as physical pathologic changes. The individual aspect of the person involved will give its coloring to all psychopathologic manifestations, sometimes markedly, sometimes little. The picture becomes more obscure when we consider psychiatric illnesses, and not mere groupings of symptoms or syndromes. These illnesses are not readily acceptable entities. They lack clear boundaries and their essential characteristics are disputed. The best known examples are schizophrenic illnesses, but even the manic-depressive psychoses and other affective illnesses frequently present individual features which make a definitive diagnosis difficult, if not impossible. Furthermore, the diagnostic evaluation depends on the observer's theoretical concepts. It is therefore quite possible that an excitement with elation, some fear, confusion, and projection may be considered by some a manic excitement, by others, a schizophrenic excitement with affective features, and by a third group, a paranoid excitement. It is obvious that one cannot merely study a group of patients who have a common diagnosis without attempting to clarify and describe what they have in common, in what way they differ, and individual patterns of normal and pathologic behavior.