Is psychiatry science or art?

Is psychiatry science or art? Recently we had some serious scientific discussions with my assistants about a young patient whom I diagnosed with “simple-type schizophrenia”. They did not agree with me. To be honest, I was finding it difficult to prove my view, as I had nothing else to go by than my clinical experience based on years of accumulated observation.

It is a rare disorder, characterised by the fact that it is unlike any other illness and that it has a set of vague diagnostic criteria. Lengthy discussions took us to the question whether psychiatry is a science or an art. To be honest it was a difficult question! I would like to say in advance that in my opinion it is fifty percent science, and the rest is art. As far as it is based on objective criteria it is science, and to the extent that it is based on what used to be called “sans clinic”, in other words clinical experience and the practitioners feeling about the patient, it is an art. Psychiatry can only be partially measured. It is open to debate and it is changeable. Of course there is room for experimental studies. Without a doubt observation plays an important role. It is possible to reason on subjects of interest, these being human thought, behaviour and emotions. But are the subjects of interest by definition really sufficiently objective? Of course not to the degree that we could call physical. It is difficult to arrive at conclusions that do not harbour contradictions, and for this reason it is fairly difficult to produce general rules. This would require one to somewhat move away from objectivity; it is not sufficiently realistic. It cannot be regarded as independent from the subject, or in other words from the characteristics of the practitioner and the patient. This means that it is scientific only to a certain extent. On the other hand, psychiatry is an art because the imagination and creativity of the practitioner and his object the patient in understanding and expressing the problems play a major part in the diagnosis, treatment and follow-up. Based on my personal experience I can say this: Firstly, animal experiments give us only a limited idea about the universal nature of human behaviour. You will appreciate how difficult it is to develop a model on thoughts and emotions. But models are being developed on specific symptoms of the subject for which the patient is being investigated. For example, there is no model on schizophrenia, but a model can be developed on catatonia (a state of immobility and stupor) which is a symptom of schizophrenia. However, no symptom represents the entirety of the whole disease! As far as observations are concerned, expressing the characteristics of a disease on the basis of years and years of observation is of course an indication of being scientific. But if we look at the frequent modifications that over time were made to the diagnostic criteria of DSM (Diagnostic and Statistical Manual of Mental Disorders) which is used all over the world and which contains observation based classifications, we see that here too there are problems. The attempt to place psychiatry on a scientific basis goes back many years. I hope I will not be subjected to a label if I tell you about a justified pride of ours with regard to this matter: Turks and Muslims were at the forefront of the efforts to base cases on science. All I want to say on the subject is that we do not have to look far, a visit to Edirne and the hospital built there for psychiatric patients will be sufficient.

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