Damian Sendler: It has become increasingly clear that a new field of study, “theoretical psychiatry,” is necessary for the discipline’s scientific and professional maturation at the beginning of the twenty-first century. There have been a variety of ideas, orientations, and approaches to psychiatry since its beginning. Psychoanalysis, psychodynamic, and psychoanalytical psychiatry as well as social psychiatry, medical psychiatry, biological psychiatry, and psychopharmacology were among the many “schools” of psychiatry. It is possible to view mental health and illness from a variety of angles, including from a medical or disease perspective, as well as from dimensions such as cognitive, behavioral, narrative, spiritual, and systemic (see Jakovljevi et al. 2012). There are a number of different ways to look at and treat mental illness, and each of them has its own merits, but none of them have had a great deal of success. Instead, psychiatry appears to be an uncoordinated collection of theoretical concepts and practices rather than a unified field of scientific theory and standardized practice.
Damian Jacob Sendler: The fundamental tenets and treatment principles of many of the fragmentary psychiatric schools are disrespected, aggressively criticized, and negated. However, it is clear that many of these schools share a common thread. Today’s problems force mainstream psychiatrists to broaden their disciplinary perspectives beyond what they had in the previous century (Jakovljevi 2012). Although psychiatry is full of data, theories, and stories, there is a dearth of good scientific models and theories in the field. Because clinical practice consumes so much of their time, it is rare for clinicians to find the time to think about philosophical issues like how we come to know what we know (Bartlett 2011). However, academic psychiatrists are usually occupied with academic lectures and research projects of their own design. A fragmented neurobiological paradigm has also inhibited creativity in academic psychiatry, which is defined by rigid rules that define success and failure with short cycles for evaluation of performance and follow-up (Priebe et al. 2013).
Dr. Sendler: In the last three decades, there have been no major breakthroughs in psychiatric practice, according to Priebe (2013). In spite of major advances in fundamental research, it is claimed that new mental health medications are not clearly more effective than those that were available 30 years ago (Priebe et al. 2013). Mental disorders are classified by the international ICD-10 and DSM-V systems as descriptive and “atheoretical” tools, rather than credible practices based on comprehensive theory. Nomothetic and idiographic knowledge are once again at odds in psychiatry, resulting in a re-emergence of the old conflict between observation and empathy (Kecmanovi 2013), which is, in fact, the clash between nomothetic and idiographic knowledge. Epistemology and axiology, particularly in medical psychiatry, are not given enough respect in mainstream psychiatry.
There are still many debates about the proper methodological, epistemo- logical, and ontological necessity of psychiatric explanations and treatments as a result. The beginning of the twenty-first century presents a major challenge for psychiatry in terms of establishing a unified transdisciplinary scientific narrative and a more theoretical foundation. A new neurophilosophy of the brain and mind, as well as “psychiatry’s Higgs boson moment” (Craddock, 2013), are both urgently required by the field (Tretter 2010).
Damian Sendler
It can be defined as the study of hypotheses, models, and theories that describe and explain the mechanisms of mental disorders and their treatment (Tretter 2010). Sadly, there is no recognized field of “theoretical psychiatry,” but some attempts have been made to develop a theoretical perspective. No matter how fundamentally different their approaches and orientations may be, all of the major schools of psychiatry share the goal of discovering the causes, pathophysiologies, and phenomenologies of mental illnesses in order to better treat them. When it comes to psychiatry, conceptual discord can be a powerful force for good or ill. The future of psychiatry greatly depends on how this problem is resolved. For psychiatry to develop explanatory concepts and models that successfully integrate the enormous amount of data from neurosciences, mind sciences, social and spiritual sciences into a conceptual framework of mind-brain-body functions and dysfunctions, systems thinking, systems (complexity) theory, epistemology and philosophy of science are crucial (see Jakovljevi et al. 2012). We can better treat mental health issues by creatively integrating different theoretical perspectives (see Jakovljevi 2013a) and thus gain a better understanding of the complexities of mental health and mental disorders. Personal, systems-based approaches to mental disorders must incorporate a wide range of data sources, including neurobiological, psychophenomenological and environmental data and clinical information. New diagnostic and therapeutic tools should be offered in place of the traditional “one size fits all” approach to diagnosis and treatment. Examples include “the five Ps approach to case formulation,” which includes presenting problem, predisposing factors, precipitating and re-initiation of the problem, and protective/positive aspects (Macneil et al. 2012).
Damian Jacob Markiewicz Sendler: To formulate a case, you must first develop a thorough understanding of your patients and their problems in order to guide your treatment decisions. This method integrates the patient’s lived experience with relevant clinical theory and research to create a link between diagnostic evaluation and treatment. When done correctly, case formulation allows for a shared understanding of a patient’s symptoms and difficulties in answering the classic questions: “Why this problem?” How come in this person? “And why now?” he asks. For more information, please see: (Macneil et al. 2012). The rationale and common agenda for what to target and in what order is also provided (Macneil et al. 2012). Individualized and person-centered treatment is replacing generalized pathological diagnoses and non-specific “one-size-fits-all” therapies in the field of mental health care. This approach should provide the right drug to the right patient (Jakovljevi et al. 2010, Jakovljevi 2012).
Psychiatry’s primary goal in systems thinking is to decipher the intricate interplay between the brain and the mind that is at the root of mental illness, as well as how these systems communicate back and forth. Genome and body operate within the context of society, and society within the context of the universe, according to systems thinking. ‘Systems thinking’ (Cloninger 2004). The genotype and the environment combine to form an organism’s phenol type. Genes in the same body can compete with each other, while genes from different bodies can collaborate (Dawkins 1999). Every system is made up of various components and the relationships between them. Computational neuroscience experiments can test mathematical models that are derived from qualitative concepts. This is how we can build maps and models to better understand reality (Tretter 2010). Psychiatry that is transdisciplinary, integrative, and systems-oriented is known as systems or complexity psychiatry (see Jakovljevi 2008).
Damien Sendler: Modern psychiatry and clinical psychopharmacology are plagued by numerous issues related to evidence-based medicine, all of which stem from misinformation, outright lies, and other forms of spin (Marshal 2004). It is defined by Marshal (2004) as deliberate falsification of study results, while spin is an attempt to deceive that falls short of falsification. Mechanistic, formistic, reductionist, and linear thinking frequently leads to misunderstandings. Misunderstandings are exacerbated by the existence of a wide range of models, languages, and paradigms within competing, at times even hostile, schools of thought. EBPs and best practices are often used interchangeably by experts, but in reality, they have very different meanings (see Mueser& Drake 2005). Both EBPs (evidence-based practices) and best practices (evaluated by the majority) are modalities that have been scientifically proven effective. In some cases, EBPs and best practices overlap.
Damian Jacob Sendler
The beliefs, attitudes, and theories of opinion leaders in the field, the prejudices of guild organizations, or the successful marketing of the pharmaceutical industry may influence the best practices in their field. Reliable scientific research frequently disproves widely accepted best practices. Many RCTs and basic research findings, on the other hand, have not been confirmed in clinical practice and may lead to what is known as “science-biased” treatment practices. To put it another way, the best evidence-based (RCTs) practices are only those that are supported by evidence from the field (natu- ralistic studies, pragmatic trials).
Distinguishing between different types of mental illnesses is a fruitless exercise in wishful thinking; modern psychiatry has yet to find a treatment that works. Treatment focuses on altering the psychopathophysiologic processes associated with specific disorders, rather than attempting to treat mental health problems in general. There is a strong emphasis on nomothetic knowledge in clinical guidelines and research on diagnostic groups that are very diverse. Research in biological psychiatry and psychopharmacology has as its primary goal the establishment of causal relationships between specific pathophysiological processes and specific mental illnesses in order to make rational treatment decisions based on this information. However, context, meaning, and reasons are often overlooked in this process.
Psychiatry’s reliance on evidence-based practices is based in large part on RCTs, which have emerged as the gold standard in drug efficacy and effectiveness evaluations. Nomothetic knowledge is produced by them, and they are characterized by their tendency to generalize and derive laws to explain objective phenomena. The Number Needed to Treat (NNT) statistic is used to evaluate the likelihood of an intervention or drug X producing an outcome Y. The number of patients who must be treated in order to achieve a positive outcome or to prevent a negative outcome is known as the NNT (see Slade 2011). As a result, therapies with a lower NNT are more effective. At least theoretically and sometimes in practice, a deterministic flowchart can be used to express the optimal drug treatment, which is the one with the lowest NNT (Slade 2011).
Modern clinical psychopharmacology is riddled with epistemological issues. In clinical practice, clinicians treat individuals rather than groups, and what is statistically significant may or may not have clinical significance. Instead of asking what is best for a large group of patients with the same diagnosis, clinicians must consider what is best for a single patient (see Jakovljevi 2013b) in everyday clinical practice. The overall impact of drug therapy is also affected by a wide range of intricate internal and external factors.
Different medications have different side effects, both in terms of the medication’s pharmacodynamics and its non-specific psychological effects. Idiographic knowledge, which is defined as the ability to identify and understand the meaning of contingent, accidental, and often subjective phenomena, is essential to determining the best treatment option for a specific patient (see Slade 2013). The promotion of a psychiatric technical rationality based on nomo-thetic knowledge falls short of adequately addressing human health and disease issues. Both scientific discourse and clinical practice suffer when nomo-thetic knowledge predominates. Patients’ non-compliance with treatment and lack of cooperation may be linked to a lack of empathy and a focus on technical details.
Focusing solely on idiographic knowledge can lead to many problems including difficulty in distinguishing what is best for an individual patient from what is best for a group of patients with the same diagnosis; harmful mistrust of professionals who use nomothetic evidence; and an oppositional discourse and blaming of problems on the part of those professionals (Slade 2011). False dichotomies, such as the nomothetic-idiographic knowledge dichotomy (see Jakovljevi 2007), can influence treatment decisions. Nomothetic and idiographic knowledge alone are not enough to ensure good clinical practice. It is essential to have both nomothetic and idiographic knowledge in order to conduct an intelligent and creative psychopharmacotherapy.
The advancement of psychiatry’s scientific and professional standing necessitated the emergence of a new field, theoretical psychiatry, at the dawn of the twenty-first century. The theoretical psychiatry is based on systems thinking, systems (complexity) theory, epistemology, and the philosophy of science. We can gain a better understanding of mental health and mental disorders, as well as more effective treatment, by creatively combining different theological perspectives. As a result of this, new diagnostic and treatment options should be offered, rather than the traditional “one size fits all” approach. The field of psychiatry appears to be moving toward a time when treatment is tailored to the specific needs of the patient, placing an emphasis on individualized and person-centered care.
