Review: Research in The Field of Psychiatry

The article reviewed here is ‘Research in the Field of Psychiatry’ by Michael Sheperd and freely available here. This is a look back in time to 1969. The authors starts by discussing the importance of the European psychiatrists in laying the groundwork for ‘modern’ psychiatry. He challenges a view raised by Rumke, that there should be an all encompassing theory within psychiatry which would allow the psychiatrist to integrate the many approaches that are involved in practice and to bring this to bear on clinical practice thus

‘In too many quarters this warning has been least heeded in psychiatry…the payment having been exacted in terms of an excessive preoccupation with the minutiae of symptomatology and with sterile arguments about classification which are reminiscent more of mediaeval schools of theology than of modern schools of medicine‘

He goes onto discuss observations that clinicians had widely varying interpretations based on the same clinical data and suggested that the introduction of a glossary of terms by the WHO might remedy this problem. Furthermore he brings other disciplines to bear on this

‘In every branch of medicine the pharmacologist and the medical statistician can now supplement, and often contradict, the authoritative pronouncements of clinical experience with expert knowledge of not only the principles of pharmacodynamics but also of experimental design‘

He goes onto detail the advent of the clinical trial pioneered by  Professor Sir Austin Bradford Hill and the benefits of the epidemiological approach to psychiatry. He notes that Kraeplin’s conception of the sciences basic to psychiatry was incomplete before stating that

‘The experience of the past 50 years has now confirmed that these sciences are broadly divisible into two large categories: the biological group……and the psychosocial group‘

He then quotes from Aubrey Lewis thus

‘When psychiatrist are closely in touch with people conducting research in other medical or scientific fields, and are not isolated in groups wholly engaged in clinical routine, and when they are men whose training and interests are of a kind to make them ready to consider new information and to see old information in a new light, the chances that a train of discovery will be fired are high‘

Lewis refers to men and perhaps this might be a reflection of the proportion of women in psychiatry in that period (the Lewis comment is cited from 1963). Finally Sheperd outlines some details of the MRC research program. While the ‘minutiae of symptomatology’ have many subtle benefits that extend into numerous disciplines and give invaluable insights it is interesting to see the firm division into the biological and psychosocial domains by Sheperd as well as an optimism for the success of the empirical approach. In some ways, very similar issues are discussed today in various forums but Sheperd is in effect considering a centralisation of the research process which is compartmentalised from clinical practice as per the introduction. Some of the most significant develops have occurred however in routine clinical practice by sharp clinician’s who have documented their observations, understood their significance and disseminated their findings without the benefit of significant resources. There is much to be said for both approaches though particularly when they are integrated in a meaningful way.

How will this paper read in 2049? That will be an interesting question.

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