Conflicting theories and alternative interpretations of data can be found in most scientific disciplines. Even the so-called exact sciences have their share of disagreements, as exemplified by the differences of opinion on how to interpret the mathematical formalism of quantum theory. However, there are very few scientific fields where the lack of unanimity is so great and the body of agreed-upon knowledge so limited as in psychiatry and psychology. There is a broad spectrum of competing theories of personality, offering a number of mutually exclusive explanations about how the psyche functions, why and how psychopathology develops, and what constitutes a truly scientific approach to therapy.
The degree of disagreement about the most fundamental assumptions is so phenomenal that it is not surprising that psychology and psychiatry are frequently denied the status of science. Thus, psychiatrists and psychologists with impeccable academic training, superior intelligence, and great talent for scientific observation frequently formulate and defend concepts that are theoretically absolutely incompatible and offer exactly opposite practical measures.
Thus, there are schools of psychopathology that have a purely organic emphasis. They consider the Newtonian-Cartesian model of the universe to be an accurate description of reality and believe that an organism that is structurally and functionally normal should correctly reflect the surrounding material world and function adequately within it. According to this view, every departure from this ideal must have some basis in the anatomical, physiological, or biochemical abnormality of the central nervous system or some other part of the body that can influence its functioning.
Scientists who share this view are involved in a determined search for hereditary factors, cellular pathology, hormonal imbalance, biochemical deviations, and other physical causes. They do not consider an explanation of an emotional disorder to be truly scientific unless it can be meaningfully related to, and derived from, specific material causes. The extreme of this approach is the German organic school of thought with its credo that “for every deranged thought there is a deranged brain cell,” and that one-to-one correlates will ultimately be found between various aspects of psycho-pathology and brain anatomy.
Another extreme example at the same end of the spectrum is behaviorism, whose proponents like to claim that it is the only truly scientific approach to psychology. It sees the organism as a complex biological machine the functioning of which, including the higher mental functions, can be explained from complex reflex activity based on the stimulus-response principle. As indicated by its name, behaviorism emphasizes the study of behavior and in its extreme form refuses to take into consideration introspective data of any kind, and even the notion of consciousness.
Although it definitely has its place in psychology as a fruitful approach to a certain kind of laboratory experimentation, behaviorism cannot be considered a serious candidate for a mandatory explanatory system of the human psyche. An attempt to formulate a psychological theory without mentioning consciousness is a strange endeavor at a time when many physicists believe that consciousness may have to be included explicitly in future theories of matter. While organic schools look for medical causes for mental abnormalities, behaviorism tends to see them as assemblies of faulty habits that can be traced back to conditioning.
The middle band of the spectrum of the theories explaining psychopathology is occupied by the speculations of depth psychology. Besides being in fundamental conceptual conflict with the organic schools and behaviorism, they also have serious disagreements with each other. Some of the theoretical arguments within this group have already been described in connection with the renegades of the psychoanalytic movement. In many instances, the disagreements within the group of depth psychologies are quite serious and fundamental.
On the opposite end of the spectrum, we find approaches that disagree with the organic, behaviorist, or psychological interpretations of psychopathology. As a matter of fact, they refuse to talk about pathology altogether. So, for phenomenology or daseinsanalysis, most of the states that psychiatry deals with represent philosophical problems, since they reflect only variations of existence, different forms of being in the world.
Many psychiatrists refuse these days to subscribe to the narrow and linear approaches described above and instead talk about multiple etiology. They see emotional disorders as end results of a complex multidimensional interaction of factors, some of which might be biological, while others are of a psychological, sociological, or philosophical nature. Psychedelic research certainly supports this understanding of psychiatric problems. Although psychedelic states are induced by a clearly defined chemical stimulus, this surely does not mean that the study of biochemical and pharmacological interactions in the human body following the ingestion can provide a complete and comprehensive explanation of the entire spectrum of psychedelic phenomena. The drug can be seen only as a trigger and catalyst of the psychedelic state that releases certain intrinsic potential of the psyche. The psychological, philosophical, and spiritual dimensions of the experience cannot be reduced to anatomy, physiology, biochemistry, or behavior study; they must be explored by means that are appropriate for such phenomena.
The situation in psychiatric therapy is as unsatisfactory as the one just outlined in regard to the theory of psychopathological problems. It is not surprising, since the two are closely related.
Thus, organically-minded psychiatrists frequently advocate extreme biological measures, not only for the treatment of severe disorders such as schizophrenia and manic-depressive psychosis, but for neurosis and psychosomatic diseases as well. Until the early 1950s, most of the common psychiatric biological treatments were of a radical nature—Cardiazol shocks, electroshock therapy, insulin shock treatment, and lobotomy.3
Even the modern psychopharmacopeia that has all but replaced these drastic measures, although far more subtle, is not without problems. It is generally understood that in psychiatry drugs do not solve the problem, but control the symptoms. In many instances, the period of active treatment is followed by an indefinite period during which the patient is obliged to take maintenance dosages. Many of the major tranquilizers are used quite routinely and usually for a long period of time. This can lead to such problems as irreversible neurological or retinal damage, and even true addiction.
The psychological schools favor psychotherapy, not only for neuroses, but also for many psychotic states. As mentioned earlier, there are ultimately no agreed-upon diagnostic criteria, except for well-established organic causations of particular disorders (encephalitis, tumor, arteriosclerosis), which would clearly assign the patient to organic therapy or psychotherapy. In addition, there is considerable disagreement as to the rules of combining biological therapy and psychotherapy. Although psychopharmacological treatment may occasionally be necessary for psychotic patients who receive psychotherapy and is generally compatible with its superficial, supportive forms, many psychotherapists feel that it is incompatible with a systematic depth-psychological approach. While the uncovering strategy aims to get to the roots of the problem and uses the symptoms for this purpose, symptomatic therapy masks the symptoms and obscures the problem.
The situation is now further complicated by the increasing popularity of the new experiential approaches. These not only use symptoms specifically as the entry point for therapy and self-exploration, but see them as an expression of the self-healing effort of the organism and try to develop powerful techniques that accentuate them. While one segment of the psychiatric profession focuses all its efforts on developing more and more effective ways of controlling symptoms, another segment is trying equally hard to design more effective methods of exteriorizing them. While many psychiatrists understand that symptomatic treatment is a compromise when a more effective treatment is not known or feasible, others insist that a failure to administer tranquilizers represents a serious neglect.
In view of the lack of unanimity regarding psychiatric therapy— with the exception of those situations that, strictly speaking, belong to the domain of neurology or some other branch of medicine, such as general paresis, brain tumors, or arteriosclerosis—one can suggest new therapeutic concepts and strategies without violating any principles considered absolute and mandatory by the entire psychiatric profession.