The Perspectives of Psychiatry, 2nd ed.,

This second edition expands on our original effort to describe psychiatric thought—written now after our department has matured and after more than a decade of comments, criticisms, and questions about the book’s thesis and specific components. We have revised those portions of the text that proved obscure and have added new chapters to illustrate our ideas.

If the mind-brain issue is the first and most fundamental problem facing psychiatrists, then the longstanding factionalism dividing psychiatric practitioners into party-like blocs, or “camps,” according to their beliefs about mental disorder is the second—and perhaps the more distracting—issue obstructing progress. Over the last hundred years, psychiatry has spawned many schools, or denominations, within its ranks. The result is that psychiatry is the only discipline in medicine in which it seems appropriate, even logical, to ask of a practitioner his or her “orientation” or “philosophy.” Such questions denote that a professional identity is not sustained from one psychiatrist to another in the way, for example, it is sustained from one surgeon to the next.

We hold and teach that psychiatric factionalism is actually an aspect of the more general divisiveness over truth and human nature that has emerged over the last 200 years in Western thought. Because we also believe that the same reasoning circumventing the mind-brain problem (and described in the prior chapter) will help transcend factionalism, we now provide a brief discursion into factionalism’s historical background—into the separate sources of ideas behind psychiatry’s denominations—so as to demonstrate how these problems came about.

Briefly, we see factionalism as derived from three major themes in Western thought that have affected psychiatry since the work of René Descartes in the seventeenth century. We shall refer to them as the modern, postmodern, and antimodern ideas and expand on them in the text that follows. Crucially, each has its own background, its own set of leading historical figures, and its own contributions to intellectual history in general and to psychiatry in particular.

Although, as will be apparent, they are at a fundamental level at odds with one another, no one of them has overthrown the others. Rather, they coexist competitively to this day, have strong champions, and contribute mightily to the denominations of psychiatry. Any proposal that hopes to unite the reasoning and practice of psychiatry in order to provide its practitioners with a common foundation and a professional identity must understand these ideas and know what each has to bestow.