Bile, Magnetism, and Dopamine: Simple Answers to Difficult Problems

BILE, MAGNETISM, AND DOPAMINE: SIMPLE ANSWERS TO DIFFICULT PROBLEMS T. J. O'GRADY* In societies, recurring patterns of behaviour can be identified that are similar to those in individual case histories, and a historical perspective in modern medicine is as essential a key to the evaluation of current practice as is a full history in formulating a diagnosis. In the history of development of ideas, perhaps medicine has been that branch of science most subject to the dictates of fashion. And as with fashion—that uneasy mixture of uniformity and originality—perhaps there is nothing new in medicine. It might be prudent to hoard one's old clothes in case they ever "come back in," yet somehow this never seems to happen. Whether the issue be stiletto heels orjacket lapels, the rag trade is shrewd enough subtly to alter an old idea—usually by stylisation— enough to make the new version identifiably different, so that the theme is recurrent but not the detail. The analogy of fashion in clothes is introduced in an attempt to illuminate the possible mechanisms by which ideas repeatedly raise their ugly—or beautiful—heads, as opposed to showing a genuine creativity and evolution of form. One might expect true science to enjoy the latter property of growth, yet most scientific establishments would recognise recurrent developments in their corpus of knowledge. Medicine provides many examples of repackaging in its theory and practice, yet within medicine perhaps psychiatry shows the most whimsical and fickle adherence to ideas. As do economists and philosophers, psychiatrists may belong to schools. Freud, Jung, Klein, Sullivan, Berne, Rogers, Beck, Ellis, Eyesenck—all could have devout adherents within a single hospital or university. As in economics and politics, radically different interpretations of data are made by oppositely oriented practitioners, such that their views can be predicted accurately in advance. Opposed *Senior Registrar in Psychiatry, Midland Nerve Hospital, Birmingham B 15 2NJ, United Kingdom.© 1987 by The University of Chicago. All rights reserved. 0031-5982/87/3002-0526$01.00 Perspectives in Biology and Medicine, 30,2 ¦ Winter 1987 \ 201 factions may still engage in bitter argument of a rhetorical and emotional quality that has long since been dissipated in mathematics or chemistry. Again, fashion and faction forming run hand in hand. Such a process is seen in young people, for whom belonging to a gang or cult of some kind involves a package of opinions, behaviours, and visual appearance pursued with amazing intensity yet usually with notable transience. Another property descriptive of fashion might be falsity: it is dramatic and illusory—it distorts, hides, or amplifies true characteristics. In science fashion does not mean consensus—it means factionation and a belonging that transcends the sharing of an interpretation of reality. As medicine lags behind science, so psychiatry lags behind medicine in its ability to form sober consensus axioms and grow. The frontier character of psychiatry could be related to the nature of its domain: both the human brain and human behaviour show an infinite complexity that reduces experimental work to a snail's pace and dwarfs the collected and tested ideas that can safely be called knowledge. Yet, such a situation might be expected to leave psychiatrists humble and apologetic, helplessly cautious about developing hypotheses into theories . The actual demeanour and beliefs of psychiatrists are more sociologically complex than can be explained by the nebulous nature of their work. Any study of recurrent themes in psychiatry, if it is to explain the form of recurrence rather than merely describe the content of the theme, must look at the structure of the psychiatric profession itself, at the inter- and intraprofessional relationships that can promote radicalism , factionalism, and fashions in practice and belief. Much has indeed been written about the sociology of the medical profession, yet, as regards psychiatry, perhaps sociologists have been more interested in the mental patient than in his doctor. Social deviance, institutionalisation, and stigma have been more immediate issues than the study of how professionals form and convey attitudes toward the mentally ill. Medical history has tended to follow two different paths in explaining progress. Most commonly a biographic approach is used, one that traces the lives of men of genius...