Leo Sher, M.D.

Today, we publish an interview with an eminent European psychiatrist, Dr. María Dolores Braquehais Conesa.

María Dolores Braquehais Conesa, M.D., Ph.D. is Medical Director of the Integral Care Program for Sick Health Professionals “Galatea Clinic,” Associate Professor at the International University of Catalonia Medical School, and Researcher at the Vall d’Hebron Research Institute, Barcelona, Spain.

Leo Sher: What is the most important issue in contemporary psychiatry?

María Dolores Braquehais Conesa: Contemporary psychiatry is clearly facing a paradigm crisis. This may be due to several reasons: a) the increasing focus on the individual; b) the hypertrophy of the biological perspective, which ignores the fact that humans can be conceptualized as “embodied minds” engaged in an “enactive” bidirectional interaction with a physical and symbolic environment; and, c) a diagnostic approach based on closed categories that do not stem from a model of an “embodied mind in context”.

We need a multidimensional perspective that integrates the following levels of any human being: biological, behavioral, social, psychic, and spiritual. It is also important to avoid the tendency to explain findings at one level in a reductionist way based on another. This necessary integration should be inspired by complex thinking and promote a new genuinely trans-disciplinary approach.

Leo Sher: How do you see the future of psychiatry?

María Dolores Braquehais Conesa: A change of paradigm is needed. This would allow for fruitful dialogue with other disciplines related to psychiatry, such as social sciences (sociology, philosophy, or anthropology) and body-related fields (neurology, nutrition, physiotherapy, internal medicine, or other medical specialties). Building bridges is necessary to address cases from diverse perspectives, adopting a holistic view of each person. Unfortunately, future psychiatrists are increasingly constrained by reductionist biological approach and by an outdated, DSM-based, lineal causative model for problem analysis.

On the other hand, the challenge for psychotherapies is to move from a “mind” and “ego-centered” perspective to a broader “consciousness” and transpersonal approach. It is also important to consider the impact of contemporary late postmodern culture on the “embodied” and “symbolic” expression of our sufferings. It cannot be ignored that this fact significantly influences addictive and behavioral problems, as well as the incidence of depressive and anxiety disorders, among other mental problems.

Leo Sher: What needs to be done to improve psychological health and reduce suicide rates around the world?

María Dolores Braquehais Conesa: The answer does not lie solely within psychiatry, as various economic and social conditions, along with cultural models, influence the sense of meaning as well as perceptions of life and death (in this case, self-inflicted). The mismatch between the increasing demands for each individual well-being and real-life circumstances, combined with the current highly individualistic paradigm and an accelerated, immediate experience of time, has notably lowered the threshold for frustration tolerance. This, in turn, affects the incidence of suicide in societies shaped by this model.

More specifically, suicide models must complement the understanding of risk and protective factors with a qualitative, phenomenological perspective. In other words, it is necessary to recognize that suicide is the behavioral outcome of a “tunnel mode,” in which the mind of some individuals, experiencing intense internal suffering and unable to consider other alternatives, leads them to end their life. This comprehension, mind-based approach can play a key role in preventing suicidal risk in vulnerable individuals.