Past. Present. Future.
Johns Hopkins Press, 2003, 2007
Critical acclaim for The Concepts of Psychiatry:
"The book is intended for thinking psychiatrists, but thinking patients stand to benefit perhaps even more."—John McManamy, McMan's Depression and Bipolar Weekly
"I’m looking for books that provide a coherent conceptual structure for psychiatry--ones that will permit us to advance rather than retreat, toward a future we can eagerly anticipate. Dr. Ghaemi has written such a book. It provides what I seek and what I know students and leaders of this discipline need... Read here and see the future--not darkly and indistinctly hoping for inspiration, but face to face with the methods and practices that will bring the future to pass."
--Paul R. McHugh, M.D., Former Chairman, Department of Psychiatry, Professor of Psychiatry Emeritus, The Johns Hopkins University School of Medicine, Author of The Perspectives of Psychiatry
"Wide ranging and extraordinarily informed, Dr. Ghaemi gives us an indispensable guide to the difficulties and dilemmas of psychiatric work, plus the roadmap for a pluralistic future. A work of truly unusual intelligence."
--Leston L. Havens, M.D.
Professor of Psychiatry, Harvard Medical School
Author of Approaches to the Mind; A Safe Place; Coming to Life; Learning to be Human
"After the narrow confines of most psychiatric writing, it is refreshing to read an author... who can competently discuss topics as diverse as the mind-body problem and the relevance for psychiatry of Epicurus and Sufism. The book is a reminder of the rich banquet of conceptual and philosophical issues that are of relevance to our field but rarely make it into the standard literature."
--Kenneth Kendler M. D. Professor of Psychiatry, Virginia Commonwealth University, book review in Psychological Medicine
"A sensational success when it comes to waking us up from our conceptually impoverished stupors. William James' definition of philosophy is cited early in the book as 'an unusually stubborn effort to think clearly'(p. xix). S. Nassir Ghaemi has given us a book that is not only painfully unusual by today's standards, but so stubbornly and clearly thought out as well... William James would have been proud of his disciple's work."
--Andrés Martin, M.D., M.P.H., Assistant Professor of Psychiatry, Yale University School of Medicine, book review in Journal of the American Academy of Child and Adolescent Psychiatry
"This book is a manifestation of Ghaemi's absorptive and spacious mind as well as his significant capacity to assimilate information from a broad variety of sources."
--Layton McCurdy, M.D., Distinguished Professor and Dean Emeritus, Department of Psychiatry, The Medical University of South Carolina. Book review in Psychiatric Services.
"Nassir Ghaemi's The Concepts of Psychiatry is an important contribution to the literature of philosophy of psychiatry and will be especially useful to psychiatrists and psychologists looking for an introduction to the central issues."
--Christian Perring PhD, Academic Chair of the Arts & Humanities Division and Chair, Department of Philosophy Department, Dowling College, Long Island; Editor Metapsychology Online Review. Book review in www.mentalhelp.net.
Readers might be inclined to ask, “So what?”, when I suggest the benefits of pluralism. Especially as set against the term “dogmatism”, most persons would not want to identify themselves with the latter. But I use the word “dogmatism” as short-hand, whereas in reality it is always a dogmatism about something. Thus, in politics, one might be a conservative, or a socialist, or liberal, and hold all those views dogmatically. Such a person is a dogmatist, and such dogmatists have much more in common than one might expect, despite differing ideologies. And one could be a non-dogmatic conservative, or socialist, or liberal, and such persons would have much more in common with each other than with dogmatists of their own ideology. Similarly, in psychiatry, the content of the ideology can be psychoanalysis or it can be neuroscience, but dogmatism reflects the attitude taken by the adherent. And it is this attitude which is important, more so than the content. Hence, by dogmatism, I mean the dogmatic attitude. Dogmatists do not, as a rule, revel in their dogmatism, and thus it is not up to them to accept or deny this label. They are dogmatists, whether they like it or not. And there are many of them practicing in the mental health professions today.
Besides not wanting to accept the label of dogmatism, many might think of pluralism as a “So what?” option because they identify it with eclecticism. By now, it should be clear that nothing could be farther from the truth. Eclecticism, enshrined in the biopsychosocial model, is the status quo in psychiatry. Pluralism is the ignored pretender to the throne. Distant cousins, they have almost nothing in common besides an opposition to dogmatism. I hope that readers of previous chapters will now simply see that pluralism is not eclecticism, and thus it cannot be easily accepted in the same way that eclecticism can be accepted. A pox on all the schools attitude is the high road to eclecticism; that is easy. Pluralism is hard...
Why is it hard to be a pluralist? What is so bad about the biopsychosocial model? I will describe in this chapter that most clinicians today are dogmatists in practice and electics in theory, and I will lay the fault of this state of affairs at the feet of the biopsychosocial model. I will also argue that accepting pluralism means fighting dogmatism in all the nooks and crannies of psychiatry into which it has seeped, a guerilla war which will be never-ending.
In 1995, psychiatrists J. Alexander Bodkin, Harrison G. Pope Jr, and Robert Klitzman, conducted a fascinating study that proves that most clinicians are dogmatists in practice. They sent a questionnaire to 435 academic psychiatrists to assess whether they were primarily biologically oriented or primarily psychotherapeutically oriented, or whether they demonstrated evidence of mixing both approaches. Most clinicians claim to be open to both approaches and to mix them, consistent with the biopsychosocial model. The researchers found that they could classify 27% of practitioners as biological and 37% as psychotherapeutic. These practitioners spent more than of their time solely working in their approach. Hence 64% of practitioners limit their practice to one approach or the other, and their perspectives on psychiatry usually follow their approach. 64% of psychiatrists are dogmatists. 36% were “eclectic” practitioners who spend almost equal time practicing in both approaches. These are the biopsychosocialists.
These numbers may seem suprising to some readers. The psychotherapeutically-oriented dogmatists were greater in number than the biological dogmatists in 1995. This largely reflects the fact that psychiatry was so dominated by psychoanalytic dogmatism for so many decades. It will take decades for these practitioners to leave the field and be replaced by newly minted clinicians without older biases. Further, the 36% eclectic group may seem small. But I think this finding highlights how psychiatrists do not practice what they proclaim. Bodkin and colleagues did not ask their respondents to describe their own philosophies of psychiatry, but it is my experience that most psychiatrists claim to be biopsychosocial eclectics. Yet in practice, only 1/3 are in fact eclectics. Most clinicians are eclectics only in theory, but dogmatists in practice...
Johns Hopkins Press,
This book is the first historical critique of psychiatry’s mainstream ideology, the biopsychosocial model.
Unique features include:
1. Analysis of the original works by the founders of the BPS model in psychiatry, George Engel and Roy Grinker. This is the first description of Grinker’s unique role in founding the BPS view in psychiatry
2. First book length history or critique of the BPS model
3. Engages larger conceptual and philosophical questions about the psychiatry
4. Examines the nature of medical practice in general
5. Provides a discussion of the ideas of William Osler, a leading founder of modern medicine, and relates his ideas to psychiatry
6. Provides the philosophical analysis of the concept of mental illness
7. Critiques evidence based medicine as applied to psychiatry
8. Shows how the core of the BPS model conceptually is eclecticism
The BPS model, contrasted with the “medical model”, is the mainstream ideology of modern psychiatry. Today, the BPS is seen as an antidote to an overly biological psychiatry; yet it might equally be a cause, failing to provide convincing conceptual or empirical grounds to resist the biologization of psychiatry. The problem exists, perhaps, in a failure of the model itself, not failure to implement it, as many presume.
He shows that the ultimate raison d’etre for the BPS model is eclecticism, the ability to “individualize treatment to the patient,” which, in practice translates into being allowed to do whatever one wants to do. This eclectic freedom borders on anarchy and produces the ultimate paradox: free to do whatever one chooses, one enacts one’s own dogmas (conscious or unconscious). Like a Hegelian tragedy, eclecticism produces dogmatism; anarchy leads to tyranny.
Developed in the 20th century as an outgrowth of psychosomatic medicine, the BPS has served as a ceasefire between the extremes of biological and psychoanalytic approaches to psychiatry. Like any cease fire, however, it has outlived its purpose, and psychiatry needs a new constitution. As a model for medicine, there is a better third alternative to the biomedical and BPS models: medical humanism, with its basis in literature and the humanities as a central feature of medical practice, a seriousness about the humanistic aspect of the “art” of medicine. As a model for psychiatry, there is another better alternative, a method-based psychiatry, that is consistent with modern science and incorporates humanities-based knowledge. This book explores the ideas of important medical and psychiatric thinkers like George Engel, Roy Grinker, William Osler, and Karl Jaspers, among others. It also addresses the claims of evidence-based medicine as well, and shows how these alternatives are better.
Although the BPS model had value as a reaction to biomedical reductionism, its historical role has played out. Mental illness is complex; biology is not enough; but the BPS model does not thereby follow. Other less eclectic, less generic, less vague perspectives exist. This book shows how psychiatry would do well to look to them, rather than revisit an outworn label.
Cambridge University Press, 2009
In the course of writing and teaching about mood disorders, I often discussed the results of research studies with clinicians and patients. In the process, I found that clinicians and patients needed, and wanted, to learn about the methods used to conduct these studies. In other words, one could not understand the results unless one understood more about the research methods, i.e., statistics. Yet I could find no simple book about statistics which I could recommend to the average clinician or patient, no book which was written in plain English, without excessive mathematics, and which explained the relevance of statistical concepts for the practitioners. So I decided to write it.
This book is, I think, the only book directed to the mental health clinician, and to educated patients, which covers the whole range of statistics in a way that is directly clinically relevant, with many clinical examples along the way.
Using clear language in favour of complex terminology, limitations of statistical techniques are emphasized, as well as the importance of interpretation - as opposed to 'number-crunching' - in analysis. Uniquely for a text of this kind, there is extensive coverage of causation and the conceptual, philosophical and political factors involved, with forthright discussion of the pharmaceutical industry's role in psychiatric research. By creating a greater understanding of the world of research, this book empowers health professionals, and informed patients, to make their own judgments on which statistics to believe - and why.