THE BASIC DISCIPLINE OF PSYCHIATRY AS METATEXT

Several disciplines converge on current psychiatric practice and research. Each one is a discourse with its defining objects, its audience and its socialization as specialized text. The psychophysiological triad includes studies of mentation (language), behavior and physiology. Each text is a context for the others. Thus, in and by itself, each one in isolation lacks explanatory power. The basic science of psychiatry is a metatext including those partial texts in a constructive fashion. Such an attempt is more a linguistic enterprise than an empirical one. It should supersede all reductionisms, including those presented in the form of juxtaposition of disciplines (bio-psycho-social, psycho-somatic, etc.).


The basic discipline of psychiatry as metatext -Fernando Lolas
The existence of different bodies of knowledge as foundational for psychiatry has led in the past and continues to lead in the present to proposals of integration (1).The list of hybrid terms to suggest either complementation or juxtaposition is too long to reproduce here (biopsychosocial, psychosomatic, neuropsychiatry).But one of its recent formulations -social neuroscience-has been received with enthusiasm by authors commenting on a paper by Cacioppo et al. (2) in World Psychiatry.This Forum provides an opportunity for a critical appraisal of current thinking and for examining what respondents provide or accept and what they miss or lack.
Three decades ago I proposed the notion of psychophysiology as constituting a basic discipline for psychiatry (3).The word psychophysiology was meant to imply not only macro processes of the brain as a whole (cognition, emotion) but contributions from biochemistry, genetics, and electrophysiology as well.The so-called "psychophysiological triad" (behavior, mentation, biology) was employed for designing constructs built upon an integration of the different languages developed by each specialty area of research.The necessary reductionism could be converted into a constructive process by generating a meta-text in which each partial text (the behavioral, the biological and the linguistic) could be considered a context for the others.After years of working in multi, inter and trans disciplinary fashion, the hope to find electrophysiological correlates or markers to introspective, behavioral or diagnostic categories was abandoned as simplistic.The resulting conclusion was the proposal of a logical and empirical constructivism yielding concepts that could be understood in the contexts of the different disciplines.
The interesting World Psychiatry Forum papers reveal that participating authors, while agreeing on a formal diversity of fields, share the pervasive paradigm of technological values.This leads to the preconception that data from a specialty or subspecialty can be translated to another as a matter of fact.Juxtaposition of methodologies and "facts" amounts to translating data and information.Knowledge, however, is not only information but organized information.This means that the social interest served by the information is constituent of knowledge.What we see in practice is the reiteration of the technocratic paradigm, with specialists arguing favorably for integration within the same paradigm and guided by similar principles.This will not move psychiatry forward to more than another set of semantic artifacts which retain the identity of the specialties and suggest promising successes to still persistent forms of reductionism.
The real task ahead is not to preconize integration (multi-, inter or trans disciplinary) but to indicate how this integration can be achieved.The standard paper does not dwell on this question.Ironically, the real problem does not reside in factual data but in language.The different disciplines are discourses which create their objects of study within a technocratic paradigm.In a sense, disciplines are "ways of talking" about invented realities.The discourse is not only description.It incorporates axiological dimensions, moral and non-moral, that remain hidden in the standard plea for simplistic integration or scientific reductionism.Bracken et al.( 4) cogently argue for expanding the current paradigm towards a nontechnocratic one, while retaining its emphasis on objectivity, reliability and precision.Sometimes, too precise an analysis of human affairs misses the inherently variable course of human life.The language of data and information is neutral and blind to differences, allowing the construction of diverse knowledge, discourses and rationalities depending on who uses it, with what purpose and in which context.Attempts to "harden" psychodynamic speculation with neuroscientific concepts or to give meaning to physiological data with categories of the emotional vocabulary indicate how misleading the idea of disciplinary integration can be if it is accepted in a simplistic frame of mind.
We have to consider the fact that each specialty -or profession-is not an epistemic, value-free enterprise.It is also a social and practical way of accessing to power, prestige, and money.Neuroscientists, as psychoanalysts, constitute an interest group molded after societal demands for practical answers which they claim to formulate and solve.In order to do so, real-life problems have to be reformulated with the concepts of each discipline and profession, inevitably linked to their group interests.Technocracies easily go from serving societal needs to self-serving activities.A historical proof is that prestige in academia is not routinely associated with boundary-crossing or interdisciplinary pursuits (5).
Thus, the metastructure of the social differentiation of labor is ignored.While believing that goals and values are the same, or at least have the same objectives in mind, we are confronted with hidden determinants of current paradigmatic orientations that do not add new insights to what everybody knows and feels.To acknowledge this fact does not imply to reject scientific data and information or to deny their pivotal role in advancing science and practice.It only suggests that the real integration is not "what" (facts, data) is brought together but "how" (linguistic processes or conversations) are they formulated for translation and communication.In order to do this, it is probable fair to consider the contexts of discovery, justification and publication (6).Language is not a decontextualized tool but a tool for constructing realities.In psychiatry what the practitioner receives is not science but instrumentalized science designed to help in decision making.Pro-fessions are social institutions guided not only by scientific reasoning which can be self-correcting but to a greater extent by societal forces and power struggles.Their attempts at legitimation often ignore the fact that they may reproduce conventional knowledge of a society in a different guise without adding content.
We should look at everyday practices and language competencies.These are structural human invariants; data are formal embodiments of method-dependent observations.A key notion to validate attempts at hybrid prophecies of integration is outcome or result.The search for a basic science of psychiatry, up to now, has not provided a foundation.The "object", despite all hybrid terms, continues to be elusive.Not even "mental illness" can be said to constitute a universally accepted notion for everyone.Perhaps we should develop a basic discipline for psychiatry as a meta-text that permits the construction of complex and heterogeneous ways of handling expectations and wishes of researchers, caregivers, and people in need of help."The test of the pudding lies in the eating".