Psychiatrist, heal thyself

17^th July 2023

I was left with some reflections (and doubts) after the psychiatry lectures I received over my first year in medical school. I have been putting off writing them up, but in the interest of populating this blog with something, below lie some disorganised impressions on the topic. Take seriously at your own caution.

The word “biopsychosocial” comes up a lot in lectures, which is directionally good, but the supposedly equal treatment of these factors seems a bit nominal and epistemologically confused. The unspoken implication of a lot of this teaching is that the psyche is the substrate of neuroanatomy and neurochemistry, which is no doubt defensible, but nonetheless establishes a hierarchy in which the psychosocial component is secondary to the biological.

I wouldn’t have an issue with being taught in this way so long as these assumptions were articulated. But they can’t be, because accepting the causal primacy of the brain implies the induction-aptness of the mind, which conflicts with the "enclosed" nature of phenomenology. And this too I could accept, so long as psychiatric diagnosis was similarly induction-apt, if it was simply identifying neuroses on an fMRI. But the diagnostic protocols hinge on the reality of subjective experience, returning us to the initial problem.

So it seems to me that “biopsychosociality” functions as a conversational stopping point - instead of allowing the resolution of these factors into a coherent model, it holds them in an unstable superposition of “perspectives”, never allowing them to make contact with reality.