María Dolores Braquehais Conesa, M.D., Ph.D.
Friedrich Wilhelm Nietzsche (1844-1900) was one of the first thinkers who started to critique reason as the will to instrumental power. The French Philosopher, Michel Foucault (1926-1984) also believed that knowledge was inextricably linked to power 1. More recently, Jürgen Habermas (1929- ) has stated that scientists tend to ignore that their science is not “innocent” but it is deeply shaped by different psychological and socio-cultural interests 2.
According to professor G. E. Berrios, although we can admit that mental disorders have a “neurobiological” underpinning, this fact does not make them more stable than any other world denizen 3. Like the rest of conceptual objects, their descriptions and categorizations change over time, although we may not notice it because we live in a short time frame and we tend to believe that our time is unique and our updated beliefs are, with no doubt, right. However, historians of psychology and psychiatry remind us that behavioral descriptions in general, and mental symptoms and diseases, in particular, are constructs changing in time and therefore, they require periodic calibration. Undertaking the later happens to be the role of the clinicians but, at the same time, Berrios reminds us that irrespectively of the changing or unchanging nature of the objects themselves, the descriptions of mental disease categories themselves are not sub specie æternitatis: the way we talk about mental health and symptoms is closely related to the socio-cultural needs of our time 3.
Therefore, it is crucial to ask ourselves what human interests lay behind the raising importance given to some specific approaches (neurobiological and cognitive-behavioral paradigms) in order to understand the complex phenomena related to mental suffering we are dealing with. Because some conscious or unconscious psychosocial forces may be playing a critical role in the theoretical models we currently use. Recent discussion about the way in which the Task Force of the fifth edition of the Diagnostic and Statistical Manual (DSM-V) of the American Psychiatric Association (APA) is being conducted can also be related to some specific socio-economic interests linked to different expressions of power.
(1) Foucault M. Historia de la locura en la época clásica. 1ª ed. ed. Madrid: Fondo de Cultura Económica de España; 1979.
(2) Habermas J. Conocimiento e interés. Madrid: Editorial Taurus; 1989.
(3) Berrios GE. Towards a new descriptive psychopathology: A sine qua non for neurobiological research in psychiatry. Brain Res Bull 1999;50(5/6):457-8.
Dr. María Dolores Braquehais Conesa is affiliated with the Department of Psychiatry, Fundació Institut de Recerca del Hospital Universitario Vall d’Hebron, Barcelona, Spain.