Sándor Kalmár, M.D., Ph.D.
Although the psychiatry is an important branch of the medical science, this one contains the most subjectivity. Several reasons prevent us from solving the present accumulated problems in psychiatry.
- Nowadays the structure and the function get confused and mixed with each other in everyday life in the psychiatry. We can see the function, the signs and symptoms, the behaviour of the patients, etc. but cannot see the structure, the nervous system, the mind (the consciousness, the internal EGO, the unconsciousness). The function is always depends on the structure. In everyday practice we can conclude from the function to the structure, but this conclusion is not always perfect.
- We leave the fact that the Personality, the Human Being, the Mind, the Health, the Nutrition, the Education, the Mental Disorders, Classification, etc. have always at least four characteristics out of consideration:
- Physical, somatic, biological, biochemical (objective, genetic, abnormality or injury in the body, especially in the Central Nervous System)
- Mental and psychological, (partly objective partly subjective. The basis of every psychopathological symptoms is the disturbances of perception)
- Cultural, social, environmental (mainly subjective, environmental effects)
- Spiritual characteristics. (always subjective: lack of spiritual protective factors, lack of faith, hopelessness, lack of love, lack of charity, unloving, inability to love, despair, feelings of guilt, torment, self-incrimination, lack of desire of life, lack of vital force, etc.
- We leave the duality of human being, personality and mind, psychopathological signs and symptoms, mental state and disorders out of consideration:
- The human being, the personality, the mental symptoms and disorders are partly based on biological structure and function which is objective and can be examined with scientific methods, (quantitative research)
- Partly based on culture, which are mostly subjective, social, spiritual, mythological, and can only be examined indirectly, hermeneutically (qualitative research).
- The considerable part of the population has
- a considerable somatic, mental, cultural and spiritual illiteracy especially among parents, teachers and healthcare workers.
- lack of (mental-) health education in the schools
- self-injurious behaviour,
- high alcohol consumption,
- exaggerated smoking,
- low levels of health and mental prevention combined with high mortality rates,
- high suicide rate.
- Psychiatric and social service are insufficient.
- Lack of National Mental Health Strategy.
- Psychiatric Professional Board and Psychiatric Association are weak and cannot enforce their interest against the government.
According to E. Kraepelin the pathology, the aethiology, the genetics, the symptoms and syndromes, the disease process, the outcome, the end state and the treatment of the Mental Disorders are exceptionally diverse, although there are evidences for the reasons of biochemical changes and receptor modifications inside the nervous system.
In the latter years, the scientific research has focused primarily on the different algorithms and classification systems, nearly not dealing with the accurate definition of the different symptoms and signs. This has made the validity of the diagnostic systems uncertain. The new diagnostic systems show this uncertainty. That is why it is even more important to improve and specify the psychopathology, the elimination of the mistakes of the subjectivity and to work out the correct diagnostic system.
Nosology and Psychopathology is the foundations of modern psychiatry. The two disciplines are intrinsically linked with each other. Nosology deals with diseases- entity, and classification of diseases entities. Psychopathology deals with subjective symptoms and objective signs.
The final reason of all the psychopathologic symptoms and Psychiatric Disorders is the disturbance of perception. Earlier the disturbance of perception was considered as a consequence at the affective illnesses.
I think an urgent change of paradigm or ”paradigm shift” is indispensable in the research of psychiatry because of several reasons
- There is no adequate psychiatric diagnostic system.
- Countless definition, classification and theories of personality arose in the last centuries. The structure and the function of personality get confused and mixed with each other. We can see the function of personality, the signs and symptoms, the behaviour of the patients, etc. but cannot see the structure. According to the Hindu Psychology the Personality and the Mind differ from each other. The BODY consists of Elements and Constitution, the PERSONALITY consists of Constitution and the Action and Cognitive/Sensitive Instruments. The structure of MIND consists of Consciousness, Internal Ego and Unconsciousness. The GOD is different from the Mind, because we have no sense-organ to perceive the Supernatural Being. We can perceive the SUPREME LORD with the Faith, so, the Faith is the sense organ of the Supernatural or Supernormal Perception. The psychiatry does not really study the spirituality, the religion and the superstition, although here we can meet the disturbances of perception that we can accept with our faith. For the Christian people absolutely acceptable and normal that the bread is transformed into the body of Jesus Christ and the wine is transformed into the blood of Jesus Christ, but these are incredible for an atheist.
- In the most psychiatric textbook not only the psychopathological symptoms and signs, but the structure and the function get confused and mixed with each other as well.
- The disturbances of perception are not always psychopathological symptom or sign. We know vast number of examples. Aristotle (384-322 BC.) mentioned the first tactile illusion in Metaphysics: When the fingers are crossed, one object seems to be two. Touch says there are two objects when we cross our fingers, while sight says there is one. According to Kelleher et all. psychotic symptoms are relatively common in young people, especially in childhood without mental disorders. The median prevalence of psychotic symptoms among children aged 9 to 12 was 17% and among adolescents aged 13 to 18 was 7.5%. Prevalence is higher in younger (9 to 12 years) compared to older (13 to 18 years) children. (Kelleher et al. 2012)
PARADIGM SHIFT is a fundamental change in the basic concepts and experimental practices of a scientific discipline. Thomas Kuhn (1922–1996)
Figure 1. It is a quadrangle. How can we connect the nine stars with only four direct lines if one star is allowed cross only once? At first sight five lines need.
When we make a paradigm-shift, we can see, think, feel and behave differently.
Figure 2. A paradigm shift is a way of looking at something differently. We must step outside from the box. When we change our paradigms, we make visible what we couldn’t imagine before.
Paradigm-shift is indispensable at least in the following areas:
- The role of the brain in the Psychiatric Disorders
- Concept of Personality
- Development of Personality
- Child psychology
- Psychology of X, Y, Z generation
- Psychopathological symptoms
- Child psychiatry according to the different age groups
- Nosology (Diagnostic Classification)
- Mental Therapy
- Mental Prevention
Psychiatry is mainly subjective but has objective roots. This particularly valorises the importance of the disturbances of perception, and the personality in the clarification of the psychiatric symptoms and mental disorders.
The disturbances of perception have a greater significance at the people suffering from psychiatric disorders or illnesses than it is known in the common knowledge. Paying attention to the disturbances of perception may transform the research of the psychopathologic and psychotic symptoms, disorders, and the system of the psychiatric classifications. The theory, that the psychopathological and psychotic symptoms developed by the consequences of the disturbances of perception, would be the basis of the paradigma-shift in the psychiatry.
Héjas I. Ókori Indiai Bölcselet. Orient Press. Budapest. 1994.
Kalmár S. (2010) The role of the different disturbances of perception in the development of the psychiatric signs and symptoms. www.internetandpsychiatry.com
Kalmár S. A nevelés szerepe az egészséges magatartás kialakításában és az önpusztító magatartás megel?zésében. Medicina Könyvkiadó ZRT. Budapest, 2017.
Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M. (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. 2012; doi:10.1017/ S0033291711002960
Kelleher I, Corcoran P, Keeley H, Wigman J. T. W, Devlin N, Ramsay H, Wasserman C, Carli V, Sarchiapone M, Hoven C, Wasserman D, Cannon M. (2013) Psychotic Symptoms and Population Risk for Suicide Attempt A Prospective Cohort Study. JAMA Psychiatry. 2013;70(9):940-948. doi:10.1001/ jamapsychiatry. 2013.140 Published online July 17, 2013.