Damian Sendler: When it comes to mental health treatment, it is a complicated undertaking. Patients, caregivers, clinicians, purchasers, and members of the general public are all involved, and each of these groups has its own unique take on mental health care. These points of view can be diametrically opposed, so it is critical to recognize and account for these differences when making a plan. An illustration of this is the contrast between the ideas of evidence-based medicine and the empowerment of users, which can reflect the differences between the modern and postmodern world views1. Postmodern philosophical and cultural shifts are the subject of this article.
Damian Jacob Sendler: The Enlightenment laid the groundwork for modernism, the philosophical paradigm upon which modern science rests. Rationalism, materialism, and reductionism are the three pillars of this philosophy. Nature functions as one cohesive unit. The modernist, instead of relying on non-material sources of truth or revelation, observes and measures. This is how we come up with theories to explain reality: by reducing the world to its measurable components. It is impossible to prove the validity of something that cannot be measured. Bacon, Copernicus, Galileo, Newton, Descartes, Kant, and Hume are just a few of the great thinkers and scientists who shaped our modern worldview. Those who wish to repeat the observations of others have access to a clear model of reality that is open to verification. It is open and accountable in that way. For the past 400 years, it has dominated intellectual thought, leading to revolutions in agriculture, industry, and medicine. One of the most significant contributions of science has been the extension and enhancement of human life expectancy and quality of life.
Dr. Sendler: Modernism, on the other hand, has been criticized. As a result, we have lost sight of our humanity as a whole and as a community. In a universe that denies non-material reality, a solid foundation for moral values has proven elusive. The layperson increasingly relies on the expert’s interpretation of reality as technology becomes more complex and difficult to comprehend. Misuse of scientific knowledge has been a major point of contention for critics of the scientific revolution. New generations are beginning to question whether the benefits of the Enlightenment have been worth the price of its destructive power in military and ecological terms. People’s faith in science has been shaken by some of its more controversial developments, and as a result, the public is paying closer attention to what scientists are up to.
A nebulous term, postmodernism has roots in a wide range of disciplines, from linguistics to literature to architecture. In its reaction to and rejection of certain aspects of modernism’s philosophy, postmodern thought has a distinct pattern.
Friedrich Nietzsche was one of the first philosophers to challenge modernism’s tenets.3 Enlightenment truth, he claimed, is only a collection of fragments if we reject a ‘transcendent being’ who gives us absolute truth and instead value our own observations. There is not a single thing that is the same twice. We create concepts to bring these disparate pieces together into a coherent whole, but these concepts ignore the fact that reality is inherently multifaceted. Trying to understand the world through the combination of these concepts, according to Nietzsche, is an illusion. On the basis that the process of creating reality is arbitrary and individual, he questions the entire enterprise of rationalistic human knowledge.
François Lyotard argued that the postmodern era is marked by the demise of metanarratives (total explanation of reality) and the emergence of micronarratives in their place6. Many people are fed up with the grand narratives offered by science, religion, and politics to explain the way things really are. Local communities and the stories of individuals are more appealing because they are perceived as less oppressive and less requiring of allegiance from the general populace. Post-modern theory celebrates individual difference and non-conformity instead of ignoring those who do not fit into a grand theory of everything. ‘Scientists, technicians, and instruments are purchased not to find truth, but to enhance power,’ says a scientist.
Damian Sendler
The legitimacy of positivist science is constantly challenged by Lyotard. He argues that science does not appear to be a single stream of progress aimed at advancing human knowledge. Irregular clusters of undefined and shifting research areas have developed instead. It is no longer about finding ‘truth’ but about increasing one’s power. ‘ Is it true? No longer, but rather, “What is the point?” Are you able to sell it? Are you able to use it effectively? 6. Scientists’ claims to objective knowledge are criticized by Foucault, who sees them as attempts to establish power through knowledge, which he dismisses as untenable. According to him, “order” does not exist; it is simply the product of human discourse.
Thomas Kuhn7 further challenged the established concept of steady scientific progress, arguing that shifts in scientific theory are not merely an additive process whereby new research adds to previous knowledge. Science, on the other hand, is a dynamic historical phenomenon. There is a scientific theory, and it appears that reality supports that theory. As new research challenges the prevailing theory, someone finally comes up with a new explanation that better explains the anomalies. Paradigm shift was his phrase for what was taking place. Rather than being a mechanical process, science, it turns out, is a social discourse. There is no way for science to provide definitive statements about what is truly real. It is impossible to conduct an experiment without the input of a group of people. A scientist’s paradigm influences how he or she views reality, as well as his or her choice of instruments and measurements. Questioned are claims of impartiality.
Damian Jacob Markiewicz Sendler: There are those who are concerned about the implications of science as a social discourse who are following Kuhn’s ideas. How political power, the method of selecting problems, prejudice and value systems in scientific communities, and how these affect science8 have been questioned by researchers. Then there is the question of how science is linked to risk and uncertainty. The BSE crisis, the safety of genetically modified foods, and the onset of global warming are all good examples of this. The scientific paradigm that promised certainty is losing its credibility. Scientists like Silvio Funtowicz and Jerry Ravetz believe we are entering a postnormal phase of science.9
It is said that in postnormal science, “facts and values are uncertain, stakes are high, and decisions must be made immediately. When the stakes are low and the level of risk and uncertainty is low, conventional, normal science may still be valid, but it is no longer valid when the stakes are high and the system uncertainty is high. Chaos and complexity theories have had a direct impact on the development of these ideas. Many fields, such as economics, meteorology, and medicine, have been impacted by the recognition of such intricate systems.
Damian Jacob Sendler
It is necessary for postnormal science to expand its boundaries to include different validation processes, viewpoints, and types of information. In order to address public concerns, scientific expertise is required in particular. It is time for all parties to get involved in the conversation. Scientists, social scientists, journalists, activists, and members of the general public may all fall under this category. Research’s quality is not just judged by a small group of experts; it is evaluated by an entire network of peers who use a wide variety of data sources, including first-hand accounts and statistics compiled by the entire community as well. Truth has been replaced by quality as the guiding principle of the organization. In an integrating social process, good quality traditional science is not rejected; it is repeated or fed back. It is this democratization of science that makes it possible for everyone to participate in the discussion of science’s impact on society and culture.
Damien Sendler: The philosophy of science has been challenged by postmodern thought in a number of ways. Many of the basic tenets of scientific method have been challenged in this way, including the idea that scientists are unbiased in their interpretations of their data and that they are not influenced by the power that comes with the accumulation of new information. Discourse within the scientific community is an essential part of scientific discovery. The search for an absolute truth is viewed with skepticism in postnormal science, which holds that in complex systems, uncertainty is unavoidable. The emphasis shifts away from accuracy and toward quality instead. Scientific experts should not be the only ones who are involved in evaluating the quality of the results. However, scientists’ opinions are not ignored, and science is not rejected. Despite the importance of scientific research, scientists’ beliefs can be contested.
For our own specialty, psychiatry, we now examine the implications of postmodern thinking and postnormal science. It is true that psychiatry exhibits traits typical of a postmodern worldview. Many different theoretical models are employed to understand and explain the mental experiences and behavior of patients. Biological, psychological and social views of reality are all included in one framework. Because of this, we may use biological reasoning when prescribing a medication to a patient with depression-like symptoms and a history of the disorder in the family. An abusive childhood, on the other hand, may point to a psychological issue that benefits most from talk therapy. Then, it becomes clear that the patient’s health was fine until he was laid off and his family’s finances became strained. Further worldview differences are possible even within these different frameworks. Is it better to use a cognitive-behavioral model or a psychodynamic one when conducting therapy? In the modernist tradition, a response to these divergent viewpoints is to draw these theoretical threads together into a ‘biopsycho-social model’. Postmodernists reject the idea of constructing a meta-narrative from disparate realities in order to arrive at a single universal truth.
Philosophical, legal, sociological, criminal and basic science disciplines all interact and draw from psychiatry. Psychiatry is not an isolated discipline. As a result, disciplines with a strong emphasis on values are included.
Postmodern psychiatry focuses on the relationship between science and power, which is the most striking aspect. Rarely are professional organizations with a strong scientific foundation given such sweeping authority over the lives and liberties of their own members. People are given the power to force psychiatric treatments on others by society because they claim to be able to cure illnesses through scientifically based methods. In a society where freedom of expression is guaranteed, this license will be challenged. Coercive treatment debates will include not only scientific arguments, but also moral and ethical ones. As a result, non-material viewpoints must be taken into account.
Psychiatry could benefit from the concepts of postnormal science. There is no doubt that the practice of mental health delivery entails significant risk and uncertainty. In patients’ environments, in family systems, in services and even at the molecular level of the brain, non-linear systems are everywhere. For those working in psychiatry, the extended peer community is already present through user groups and other interested groups. There is an extensive peer review process for psychiatric professionals, which includes both legal and lay members of the panel. Individuals and communities alike want a say in how evidence is interpreted as well as in which treatments are offered. There is no way they will be satisfied with just the opinions of experts who have never had to deal with a medical condition themselves. There is a sense of fairness in an extended peer review process. It appears, at long last, that the wishes of people seeking mental health treatment align with the pursuit of quality rather than an illusive “truth.” People who have lived with mental illness openly rejected the need for objective observers, making the study’s findings even more compelling. The study found that patients were less satisfied with scientific treatments that group patients according to current diagnostic categories than they were with approaches that emphasized the individual and unique nature of each patient, including their spiritual needs11.
Numerous other medical fields could benefit from addressing some of these issues, as well. Postmodernism can also be applied to general practice, which has long-term relationships between doctors and patients. Extensive peer review of the MMR vaccine controversy demonstrates the importance of a paternalistic instruction in favor of evidence-based decision-making. In the end, a request for the Prime Minister’s youngest son’s immunization records was made as evidence. However, less reductionist concepts like patient choice and dignity are also critical in palliative care.
Do we measure the quality of psychiatric services? In the last decade, this has been a key question, and scientific methodology is one answer to that question. If enough research is done, an absolute answer will be found, which is why evidence-based medicine (EBM) has been given so much attention in recent years. A debate over quality still rages within the field of evidence-based medicine (EBM): which study designs provide the highest quality data, and which studies are conducted to adequate standards? As a result of EBM, the National Institute for Clinical Excellence (NICE) was established in the United Kingdom to evaluate the efficacy of medical procedures. Considerable criticism has been leveled at NICE’s early decisions, particularly by those who are most directly affected by the disorders in question. Concerns about pharmaceutical companies’ commercial interests have been raised, while drugmakers fear political interference in the National Health Service to reduce costs. Detachment from commercial and political interests makes scientific objectivity difficult to maintain. National Institute for Mental Health was established in England with the goal of involving patients and working with NICE to ensure evidence-based services. It appears that potential conflicts are not recognized and that consensus can be achieved is assumed.
In order to improve the quality of mental health care, it is necessary to take into account the wishes of the patients. However, in a centralized service, it is difficult to see how this can be achieved.. There are two reasons for this: First, the center has a limited budget and can not provide unlimited services to everyone. There is no reason why the user should not demand unreasonable demands on a limited resource, given that treatment is free at the point of delivery. There are two major challenges in a nationalized system: controlling taxation, which means cutting services, and fulfilling promises made in an election. Individual freedom is curtailed in both of these capacities. Experts in scientific medicine or ‘user involvement’ will be sought out by centralized decision makers. People’s freedom of choice is subordinated in favor of the wishes of the majority.
Commercial interests will move in if the government cuts back on clinical services or research funding. With the goal of making money, private medicine will provide clinical services, and the pharmaceutical industry will fund research. Individuals will gain greater control over their lives as a result of both systems’ reliance on individual choice in providing services. Although the wealthy have more options, the poor may not have any. Ethics and science are inseparable.
Postmodernism permeates many aspects of modern psychiatry. Even though it is one of its foundations, scientific modernism. Science has an important role to play in psychiatry’s future, but it needs to be evaluated in a more democratic way. Postnormal science offers this option. Because of this, psychiatry does not need to overemphasize EBM or biology in order to be considered ‘modern’. Increased patient and user group dialogue with politicians and other bodies is a valid way for psychiatry to build on its foundations as a postnormal clinical science.
