The Neurohermeneutic Forum
Neuroscience and Psychiatric Residency Training
by Donald Mender, M. D.
In recent years it has become an article of faith among academic psychiatrists that all mental phenomena arise from processes in the brain.
The rise of neurological reductionism to paradigmatic dominance has coincided with a decline in dedicated public funding for academic psychiatric departments. University-based researchers over the past two decades have increasingly needed the financial support of drug companies, and the ideology of cognitive neuroscience has helped justify funding applications submitted by investigators. Meanwhile, more and more educators have been forced to underwrite residency training programs through the clinical revenues of academic departments, and portrayal of psychiatric interventions in neurological terms implying parity with purely medical services has proliferated in order to safeguard third party remimbursement.
These and allied pressures, combining to enthrone neuroscience and the medical model at academic centers, have commandeered the curricula of psychiatric residency training programs. Consequently, views of mental illness offered to trainees are increasingly restricted to brain-based models.
However, if future psychiatrists are to make up their own minds about the nature of the psyche in health and disease, they must be exposed to a broad range of outlooks on the subject. Materialistic perspectives should be supplemented by coherent presentations of equally tenable ontologies, including idealism, interactive dualism, parallelism, and neutral monism. Empirical research epistemologies should be balanced by an understanding of phenomenology, hermeneutics and semiotics, so that the psychodynamics, meta-economics, genealogy and power-structuring symbolism of neurobiological psychiatry are understood.
In particular, clinical trainees need to comprehend the crucial place occupied by psychoanalysis in the hermeutic arsenal of critical social theory. Because of its psychoanalytic tradition, American psychiatry has both the ability and solemn duty, unique among the medical specialties, to inform others, starting with its own junior ranks, about dangerous flaws in market ideologies now degrading patient care. In particular, psychoanalytic insights can help to expose the multifarious meanings of money, the pathological nature of collective greed in corporate life, the complicating role of masochism in consumer models of mental hygiene, and the existential conflict between security and risk inherent in all concepts of health insurance. Hence, psychoanalysis, through its constructively subversive potential, can provide a prospective practitioner with good reasons to defend his or her autonomous clinical integrity.
Beyond clinicians-in-training, residents who plan research careers might find radical departures from today's neuroscientific orthodoxies creatively liberating. Nascent investigators may benefit by seeing beyond currently received limits on our understanding of the mind-brain nexus as digital molecular computation. Equally rigorous quantum-formalistic and field-theoretical approaches could prove highly relevant to those seeking fresh avenues of inquiry. For example, isomorphisms between quantum computation and Heidegger's philosophy, recently pointed out by Globus, Awret and others, might generate productive long-range lines of future research that transforms the meaning of "biopsychosocial" psychiatry in revolutionary ways.
We will jeopardize the future of our specialty unless budding thinkers are given a broad foundation from which to grow. Residency program directors must remove the blinders of standard cognitive neuroscience so that psychiatrists in training can see the larger context in which their still young field might mature.