We have to remember that a psychotic individual has, during a psychotic episode, different values from the normal person functioning well in a society. Many severely disturbed people do not feel they are disturbed; they do not come to an analyst of their own accord. They will frequently insist that the city itself is ill. They are forced to go and seek help from the city they live in because they can no longer adapt to the financial or existential requirements of their world. Most have no interest in ‘growing,’ ‘insight’ or ‘development;’ they tolerate visits to a mental health professional in order to get probation, social security, financial or medical support.
Hence, we should be aware of the fact that one reason we may not be able to work well with this ‘non-grower’s-club’ segment of the population is because our assumptions about sickness and health, insight and consciousness may not apply to them. However, it is not the logical inconsistencies in the psychiatric paradigm which inhibit its usefulness, but its inability to fulfill its goals of getting the patient healthy again and behaving like others who do not burden the city. I think it is generally accepted today that cures for the main diseases have not been found. Research based upon the description of symptoms, symptom clusters or syndromes has focused on genetic inheritence, endorphine over or under production, dysfunctional communication systems in the family of origin, neurochemistry, ethology, cognition and learning theory without being able to explain the origins of the non-organic psychoses.
It could be argued that research has still not been able to progress sufficiently to produce the desired results. Certainly inconclusive research is no argument for dropping an organizing paradigm. The above difficulties, however, give us the impression that the mental health sciences are in the midst of a typical ‘pre-science’ stage of development characterized by either too many or insufficient paradigms. Thus, psychiatry is in the midst of a paradigm crisis.
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