Eclecticism and Adolf Meyer’s Functional Understanding of Mental Illness

Ghaemi’s Commentary and Meyer’s ‘Eclecticism’

I am not against humanism. How could anyone be against the humanistic wisdom rooted in the worthy writings of Socrates, Hippocrates, Shakespeare, Cervantes, Osler, and the others listed by Nassir Ghaemi? Psychiatry should recognize the dignity and value of all people. The problem is that it may not always do so, coming from a reductionist paradigm as it so often does.

Ghaemi appreciates that Meyer’s compromising attitude meant that he was “unable to inoculate psychiatry from biological dogmatism.” My emphasis is on the challenge of Meyer’s psychobiology to biomedicine. In the same way, Engel’s biopsychosocial model acknowledged the need to neutralize the power of an impersonal and mechanical medicine. Doctors tend to overemphasize physical abnormalities at the expense of dealing with difficult personal issues.

At the risk of oversimplification, I am juxtaposing biopsychosocial and biomedical models in psychiatry. Or in other terms, for our modern understanding, I am asserting a neo-Meyerian approach in contrast to neo-Kraepelinianism. Merely restating the Meyerian perspective will not do, because of Meyer’s ‘give and take,’ and his consequent failure to follow through the implication of his position. At least the ethical ramifications of his conceptual framework need to be acknowledged.

Neo-Meyerianism also needs to be realized in the context of the reaction to anti-psychiatry. After anti-psychiatry’s attack, our modern understanding of mental illness has tended to be been subsumed into the binary opposition of ‘pro-psychiatry’ and ‘anti-psychiatry.’ But neo-Meyerianism is as much pro-psychiatric as biomedical psychiatry. It is in this sense that biopsychological approaches have been undermined by the biomedical reaction to anti-psychiatry.

I also agree with Ghaemi that there is a way in which the failures of the biopsychosocial model allowed the development of anti-psychiatry. For example, even though Laing quoted favorably from psychologically minded psychiatrists such as Manfred Bleuler, as far as I know he never made any reference to Meyer. There was never a systematic Meyerian theory to which Laing could refer. In fact, Laing wished to move beyond an interpretative understanding to abandon the metaphor of pathology (Double 2006). Perhaps if the biopsychosocial model had been more clearly defined, Laing would not have felt he needed to take this step. Or, at least in doing so, he would have been clearer about where he stood on this issue. When labeling Laing’s views as ‘anti-psychiatry,’ biomedical psychiatry would have had to state more precisely how Laing’s position was anti- rather than pro-psychiatric.

My main disagreement with Ghaemi is his view of Meyer as eclectic. Meyer’s willingness to allow ‘anything goes’ in psychiatry meant that he did not oppose or challenge too much the views of those with whom he disagreed. Nonetheless, he did not combine together different sources to create an unintegrated philosophical and conceptual understanding. His theoretical position is internally consistent.

Modern American psychiatry studied by participant observation is “of two minds,” in that there is a divided consciousness created between the practices of drug therapy and psychotherapy (Luhrmann 2000). In this sense, it is eclectic because there is no consistent theory that combines the two practice modes. True, psychiatry often claims that the foundation for this mixture is the biopsychosocial model. It asserts that everyday psychiatry is not as purely biomedical as is often maintained because it takes into account psychosocial factors that may precipitate mental disorders. It, therefore, says that it bring together the biological and psychosocial. This compromise avoids the adoption of any one model and was proposed to neutralize the dogmatism engendered by the anti-psychiatry debate (Clare 1980). I agree with Ghaemi that such eclecticism has outlived its usefulness.

Where I think Ghaemi is mistaken is that he sees Meyer and Engel as the originators of this eclecticism. I regard the Meyerian approach as more genuinely pragmatic than Ghaemi suggests. Meyer’s dynamic psychology sought an integration of mind and brain as a way of dealing with the philosophical dilemma of the mind–body...