A Descriptive, Research-Justified Data Base for Clinical Psychiatry: Would It Change Things?

A DESCRIPTIVE, RESEARCH-JUSTIFIED DATA BASE FOR CUNlCAL PSYCHIATRY: WOULD IT CHANGE THINGS? MICHAEL T. MC CUIRE* Of thatfalse power by which In weakness we create distinctions, then Believe our puny boundaries are things Which we perceive, and not which we have made. [William Wordsworth, The. Two-Part Prelude, 1799] These lines were written during a period in which Wordsworth was experimenting with ways of understanding Nature. Toward the end of the eighteenth century he set out to test the "excursive" powers of mind, its capacity to reach out and comprehend the world in a way relatively free of dogma and preconceived ideas. He soon discovered, however, that his test was fraught with difficulties: As he came to understand it, mind was as devoted to perpetuating its own self-created views about the world as it was to experiencing in novel and relatively unpreconceived ways. To this insight, he soon added another: The ways in which the processes of mind—perceiving, thinking, and remembering—were then described were often inaccurate and imprecise. Moreover, one's earlier experiences, personality, and cultural background inevitably played out their influences on one's perceptions and thoughts. Mind was not a refined instrument perceiving and ordering the stimuli impinging upon it; it consisted of several faculties, none of which was ever fully free from the influence of the others. The solution, he felt, was not to seek order in a priori thought or reason but in the phenomena themselves, in which the patterns and truths of nature could then be discovered. Wordsworth's insights into mind's properties, particularly its tendency to hold on to what it imagines independent ofexternal reality, might well be taken as an indication that he anticipated important psychological»Department of Psychiatry/Biobehavioral Sciences, Neuropsychiatrie Institute, University of California, 760 Westwood Plaza, Los Angeles, California 90024. I thank L. Fairbanks and D. McGuire for their contributions to this article.© 1978 by The University of Chicago. 003 1-5982/78/2 102-0007S01 .00 240 I Michael T. McGuire ¦ Data Basefor Psychiatry issues a full century in advance of their becoming formal psychiatric problems (e.g., cognitive inflexibility). It would be stretching this point to suggest further that he foresaw the current state of clinical research in psychiatry. Yet his words apply: We have created distinctions, boundaries , and syndromes; we have claimed knowledge of causes of psychopathological disorders; and we have advocated cures as if we had in hand the formula to explain man's psychological nature. Because his words do apply, his development from a young writer, well inculcated with the ideas of his culture, to the stature of a mature poet, committed to seeking an understanding of the world relatively free of prior cultural , experimental, and theoretical influences, could well serve as a career model for investigators interested in clinical research. But few psychiatrists have chosen his way. Rather, early in our careers we usually embrace one or another theoretical school and spend as much effort perpetuating school distinctions as we do striving to understand behavior in as objective a manner as possible. Our commitment to this or that school is all the more surprising when we realize that anyone who is familiar with clinical psychiatric research—the study of observable and verbal behavior—is exceedingly cautious in accepting explanations concerning the causes ofman's behavior . After nearly three-quarters of a century of research and perhaps a quarter of a million "research" studies, investigators still find few definitions , explanations, or principles of behavior which they can share in common, which they consider other than tentative, or which they believe will last beyond the next turn of this or that theory. Ironically, perhaps the two areas of general agreement are that we lack facts and that much behavior is influenced by yet-to-be-recognized variables. Such agreement not only underscores how little we really believe we know, but it also points to the predicament of clinical research. Background to the Predicament There have been many attempts to explain the predicament ofclinical research. One explanation emphasizes psychiatry's origins. It has been correctly argued that modern psychiatry largely developed in response to clinical demands rather than to findings in the...