Editorial comments 10. Malhi GS, Parker GB, Parker K et al. Attitudes toward psychiatry among students entering medical school. Acta Psychiatr Scand 2003;107:424–429. 11. Sartorius N, Gaebel W, Cleveland HR et al. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2010;9:131–144.
12. Gaebel W, Zielasek J, Cleveland HR. Psychiatry as a medical specialty: challenges and opportunities. World Psychiatry 2010;9:36–38.
Wet minds, dry minds, and the future of psychiatry as a science DOI: 10.1111/acps.12357 Recent progress in the field of molecular psychiatry and neuroscience in a broader sense has brought psychiatry to the group of emerging sciences with greater potential for innovation and paradigm shifts. Psychiatric disorders may be viewed as chronic disorders of the youth (1). Indeed, the molecular pathways activated in chronic psychiatric disorders relate to inflammation, oxidative stress, and changes in growth factors which are highly convergent with the changes seen in other chronic medical conditions such as atherosclerosis (2). Unsurprisingly, patients with severe psychiatric morbidity present higher mortality ratios than healthy counterparts (3). This brings psychiatry closer to the medical field and increases the potential of the specialty to bring innovative approaches to the neurosciences. However, while psychiatry progresses in a rapid pace in regard to the ‘wet’, molecular component of mental illness, the more traditional and theoretical constructs used to understand the ‘mind’ face challenges and scientific questioning. The possibility of superimposing the activities of the mind to the brain tissue has lost much of its credibility. The more advanced ideas in the field consider the activity of the human mind as emergent from the brain, but not tied to its ‘wet’ component. As an example, we can mention the possibility that groups of human beings over the centuries can appreciate the beauty of works of art, theorize in mathematical terms and develop a sense of identity in the context of culture. These are all possibilities of the human mind, but they are not determined by an individual brain tissue. They would be more closely related to the potential that individual minds have to ‘plug’ in the network of meanings and developments created by human minds over time (4). In this sense, the human mind has a
‘dry’ component that in some sense works outside the boundaries of the brain (5). All the fascinating and boundless properties of the ‘dry mind’ have always attracted the attention of clinicians in the field of psychiatry. However, any attempt to deal with the dry mind is bound to be a theoretical exercise. Accordingly, the dry mind cannot be fully explained in naturalistic terms as it is changing over time in its interaction with culture and human achievements. Thus, the dry mind can be interpreted in hermeneutic terms but cannot be translated by the methods of natural sciences. Psychiatry, as the medical specialty devoted to the mind and mental illness, must deal with the ambiguity and fluid nature of emergent mental processes. That created the ideal scenario for psychiatrists and psychiatry as a field of knowledge to drift away from scientific evidence and embrace large explanatory models devoid of scientific demonstration. The points described above shape the way psychiatrist see themselves as well as the views laymen and our colleagues have about our work. That leads to a confusing picture where psychiatrists are frequently called to comment in very broad (and many times superficial) terms on human behavior. And whenever psychiatrists accept this role, our strength as scientists is discredited, and the foundations of our science are challenged. The consequences of a confused understanding of our role as clinicians and the therapeutic possibilities of modern psychiatry are clearly shown in the report on the stigma related to psychiatry in the current issue of Acta Psychiatrica Scandinavica (6). Overall, the understanding of the human mind has been the realm of philosophical inquiry and humanistic endeavors. Much of our sense of selves and human beings has being developed in the light of a ‘dry’ mind disconnected from the body. Maybe, it is not the limitations of psychiatry as a science but the lack of commitment of generations of psychiatrists with the embodied 7
Editorial comments mind (7) that leads many of our colleagues to consider that our field of knowledge is more related to philosophy and social sciences than medicine. It is our impression that this scenario is changing rapidly. Psychiatry is a leading field in many countries, and its prestige is closely related to the scientific achievements in the area. The translational neurosciences as the basis for 21st century psychiatry may help to address many of the challenges raised by our colleagues in their work (6). We cannot call ourselves specialists in neuroscience and, at the same time, call to ourselves the duty of explaining complex human behavior in strictly theoretical terms—as philosophers might. We do not have to convince our colleagues that psychiatry is ‘good’ and that they must think highly of us. What we can do is to focus on our work within medicine and refrain from using psychiatry as a means to provide large explanatory models for human behavior. If we concentrate in our target to help people who suffer from mental disorders using available scientific evidence, our diagnostic and therapeutic achievements shall determine how our colleagues and the community think about us and our work.
F. Kapczinski1,2 and I. C. Passos1,2 Psychiatry, Federal University, UFRGS, Porto Alegre, Brazil and 2 University of Texas at Houston, Houston, TX, USA E-mail: [email protected]
1
References 1. Gore FM, Bloem PJN, Patton GC et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 2011;377:2093–2102. 2. Berk M, Kapczinski F, Andreazza AC et al. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2011;35:804–817. 3. Osby U, Brandt L, Correia N, Ekbom A, Sparen P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58:844–850. 4. Popper K. Three worlds, the tanner lecture on human values, Delivered at The University of Michigan, 1978. 5. Clark A. Supersizing the mind: embodiment, action, and cognitive extension. Oxford UK: Oxford University Press; 2008. 6. Stuart H, Sartorius N, Liinamaa T. Images of psychiatry and psychiatrists. Acta Psychiatr Scand 2015;131:21–28. 7. Shapiro L. The mind incarnate. Cambridge, MA: MIT press, 2005.
Future perspectives on psychiatry DOI: 10.1111/acps.12360 In this issue of Acta Psychiatrica Scandinavica, Stuart et al. (1) investigate and report a bad reputation of psychiatry. The paper reports a high rate of stigma and negative attitudes toward psychiatrists, psychiatric patients, and psychiatry as a medical specialty. However, these discouraging findings are based on statements and attitudes from the medical faculty and not the future generation, that is, the medical students. The students’ perceptions of the specialty matter as recruitment has long been impeded by the negative reputation (2). We believe the former misgivings of psychiatry are changing among the youngest in the medical field: the medical students. The number of initiatives within the field of psychiatry is increasing. While some of these initiatives are instigated by trained psychiatrists and local authorities, some of them are organized by medical students for medical students; for example, in Denmark, the Psychiatric Association of Medi8
cal Students sees growing numbers of members and attendants to their activities. The latest debate session about psychopharmacology hosted by the association attracted more than 600 attendants. Another Danish initiative, The Locomotive, is a group of medical students who teach the oldest children in primary school not to stigmatize persons with mental illnesses. The authors of this comment are all members of The Psychiatric Research Academy (3, 4), which mainly consists of medical students doing psychiatric research as extracurricular activities. Since its birth in June 2012, the academy has gained many members, now counting 18 dedicated students, a doctor, and a professor. Despite what could be feared, the many different initiatives have a synergistic effect; that is, the above-mentioned initiatives do not steal members from each other, instead, more medical students seem to find an interesting niche in the wide array of psychiatric research and practice. Similar innovative ideas emerge internationally, for example, a summer school combining teaching
12. Gaebel W, Zielasek J, Cleveland HR. Psychiatry as a medical specialty: challenges and opportunities. World Psychiatry 2010;9:36–38.
Wet minds, dry minds, and the future of psychiatry as a science DOI: 10.1111/acps.12357 Recent progress in the field of molecular psychiatry and neuroscience in a broader sense has brought psychiatry to the group of emerging sciences with greater potential for innovation and paradigm shifts. Psychiatric disorders may be viewed as chronic disorders of the youth (1). Indeed, the molecular pathways activated in chronic psychiatric disorders relate to inflammation, oxidative stress, and changes in growth factors which are highly convergent with the changes seen in other chronic medical conditions such as atherosclerosis (2). Unsurprisingly, patients with severe psychiatric morbidity present higher mortality ratios than healthy counterparts (3). This brings psychiatry closer to the medical field and increases the potential of the specialty to bring innovative approaches to the neurosciences. However, while psychiatry progresses in a rapid pace in regard to the ‘wet’, molecular component of mental illness, the more traditional and theoretical constructs used to understand the ‘mind’ face challenges and scientific questioning. The possibility of superimposing the activities of the mind to the brain tissue has lost much of its credibility. The more advanced ideas in the field consider the activity of the human mind as emergent from the brain, but not tied to its ‘wet’ component. As an example, we can mention the possibility that groups of human beings over the centuries can appreciate the beauty of works of art, theorize in mathematical terms and develop a sense of identity in the context of culture. These are all possibilities of the human mind, but they are not determined by an individual brain tissue. They would be more closely related to the potential that individual minds have to ‘plug’ in the network of meanings and developments created by human minds over time (4). In this sense, the human mind has a
‘dry’ component that in some sense works outside the boundaries of the brain (5). All the fascinating and boundless properties of the ‘dry mind’ have always attracted the attention of clinicians in the field of psychiatry. However, any attempt to deal with the dry mind is bound to be a theoretical exercise. Accordingly, the dry mind cannot be fully explained in naturalistic terms as it is changing over time in its interaction with culture and human achievements. Thus, the dry mind can be interpreted in hermeneutic terms but cannot be translated by the methods of natural sciences. Psychiatry, as the medical specialty devoted to the mind and mental illness, must deal with the ambiguity and fluid nature of emergent mental processes. That created the ideal scenario for psychiatrists and psychiatry as a field of knowledge to drift away from scientific evidence and embrace large explanatory models devoid of scientific demonstration. The points described above shape the way psychiatrist see themselves as well as the views laymen and our colleagues have about our work. That leads to a confusing picture where psychiatrists are frequently called to comment in very broad (and many times superficial) terms on human behavior. And whenever psychiatrists accept this role, our strength as scientists is discredited, and the foundations of our science are challenged. The consequences of a confused understanding of our role as clinicians and the therapeutic possibilities of modern psychiatry are clearly shown in the report on the stigma related to psychiatry in the current issue of Acta Psychiatrica Scandinavica (6). Overall, the understanding of the human mind has been the realm of philosophical inquiry and humanistic endeavors. Much of our sense of selves and human beings has being developed in the light of a ‘dry’ mind disconnected from the body. Maybe, it is not the limitations of psychiatry as a science but the lack of commitment of generations of psychiatrists with the embodied 7
Editorial comments mind (7) that leads many of our colleagues to consider that our field of knowledge is more related to philosophy and social sciences than medicine. It is our impression that this scenario is changing rapidly. Psychiatry is a leading field in many countries, and its prestige is closely related to the scientific achievements in the area. The translational neurosciences as the basis for 21st century psychiatry may help to address many of the challenges raised by our colleagues in their work (6). We cannot call ourselves specialists in neuroscience and, at the same time, call to ourselves the duty of explaining complex human behavior in strictly theoretical terms—as philosophers might. We do not have to convince our colleagues that psychiatry is ‘good’ and that they must think highly of us. What we can do is to focus on our work within medicine and refrain from using psychiatry as a means to provide large explanatory models for human behavior. If we concentrate in our target to help people who suffer from mental disorders using available scientific evidence, our diagnostic and therapeutic achievements shall determine how our colleagues and the community think about us and our work.
F. Kapczinski1,2 and I. C. Passos1,2 Psychiatry, Federal University, UFRGS, Porto Alegre, Brazil and 2 University of Texas at Houston, Houston, TX, USA E-mail: [email protected]
1
References 1. Gore FM, Bloem PJN, Patton GC et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 2011;377:2093–2102. 2. Berk M, Kapczinski F, Andreazza AC et al. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2011;35:804–817. 3. Osby U, Brandt L, Correia N, Ekbom A, Sparen P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58:844–850. 4. Popper K. Three worlds, the tanner lecture on human values, Delivered at The University of Michigan, 1978. 5. Clark A. Supersizing the mind: embodiment, action, and cognitive extension. Oxford UK: Oxford University Press; 2008. 6. Stuart H, Sartorius N, Liinamaa T. Images of psychiatry and psychiatrists. Acta Psychiatr Scand 2015;131:21–28. 7. Shapiro L. The mind incarnate. Cambridge, MA: MIT press, 2005.
Future perspectives on psychiatry DOI: 10.1111/acps.12360 In this issue of Acta Psychiatrica Scandinavica, Stuart et al. (1) investigate and report a bad reputation of psychiatry. The paper reports a high rate of stigma and negative attitudes toward psychiatrists, psychiatric patients, and psychiatry as a medical specialty. However, these discouraging findings are based on statements and attitudes from the medical faculty and not the future generation, that is, the medical students. The students’ perceptions of the specialty matter as recruitment has long been impeded by the negative reputation (2). We believe the former misgivings of psychiatry are changing among the youngest in the medical field: the medical students. The number of initiatives within the field of psychiatry is increasing. While some of these initiatives are instigated by trained psychiatrists and local authorities, some of them are organized by medical students for medical students; for example, in Denmark, the Psychiatric Association of Medi8
cal Students sees growing numbers of members and attendants to their activities. The latest debate session about psychopharmacology hosted by the association attracted more than 600 attendants. Another Danish initiative, The Locomotive, is a group of medical students who teach the oldest children in primary school not to stigmatize persons with mental illnesses. The authors of this comment are all members of The Psychiatric Research Academy (3, 4), which mainly consists of medical students doing psychiatric research as extracurricular activities. Since its birth in June 2012, the academy has gained many members, now counting 18 dedicated students, a doctor, and a professor. Despite what could be feared, the many different initiatives have a synergistic effect; that is, the above-mentioned initiatives do not steal members from each other, instead, more medical students seem to find an interesting niche in the wide array of psychiatric research and practice. Similar innovative ideas emerge internationally, for example, a summer school combining teaching
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