One of my favourite psychiatry books is ‘The History of Mental Symptoms. Descriptive psychopathology since the nineteenth century.’ by Professor German E Berrios (1).
This is a scholarly work covering the breadth of psychiatry across two centuries. It’s difficult enough to write a book about psychiatry and about psychopathology but to then cover the history of these subjects over the centuries as well, is an incredible endeavour. Psychiatry is a combination of the natural and human sciences and it seems fitting that the subject of the book is the history of psychiatry itself. Along the way, Berrios in his erudite exposition of the subject provides dense material that is clinically useful as well as contextualising the development of the understanding of descriptive psychopathology.
I was revisiting this book in particular to look at the contextualisation of Jaspers following the previous posts on Jaspers and Schneider. In Chapter 2 ‘The Object of Inquiry’, Berrios makes the case for the influence of Kant’s notion of form and content on Jaspers’ psychopathology work. Berrios also references semiology, the Aristotelian notion of ‘eidos’ and the work of Chaslin which I found interesting as points for further reading.
Along the way, in the introduction on p.2, Berrios writes:
“The problem with the ‘epistemic’ view in its strongest interpretation is that events only have meaning and value with a given period and cannot be compared with events from a different episteme“.
Berrios is discussing the hypothetical situation of two opposed camps, one viewing a strong epistemic view and the other a ‘trans-epistemic’ view. Berrios is clear on what he means by epistemic here:
“It is here used to name (more or less) autonomous ideological domains contained within some temporal boundaries. These ideological systems feed, so to speak, meaning into historical events.”
The reason i’m mentioning this is that it strongly reminds me of something Kuhn had written about in “The Structure of Scientific Revolutions” (2). In my previous review of this book, I wrote about Chapter 11:
“Kuhn suggests in this chapter that revolutions are invisible because of historical revisionism in science textbooks. His argument runs along the following lines. Firstly assuming that scientists and laypeople use textbooks as the primary source of learning about a scientific field then the presentation of the field within the textbooks is of central importance. Secondly Kuhn suggests that there is a central assumption that science is independent of the historical context (note that he himself does not hold this view). Thirdly Kuhn argues that when a revolution has occurred there is a need to rewrite the science textbooks. This rewriting follows a pattern. Thus the central problems which were solved in order to create the paradigm change are reframed as the only problems that existed prior to the paradigm change. The main scientific players are then described in relation to this problem solving exercise. Fourthly through this revisionism science is presented as a cumulative endeavour whereby incremental improvements in solutions to central problems lead to the paradigm change. In this manner the subtleties around the scientific revolution become invisible. Kuhn gives examples to support his argument about the importance of historical context in scientific revolutions. This chapter addresses an important criticism of Kuhn’s central arguments namely that scientific revolutions are portrayed as cumulative developments of scientific knowledge rather than transformational paradigm shifts. Kuhn’s response is to characterise the simplistic narratives as examples of historical revisionism and he emphasises the importance of context in interpreting scientific revolutions.”
Kuhn specifically mentioned that his work doesn’t relate to medicine. Looking back on this, he was most likely referencing the distinction between the natural and human sciences. Nevertheless, my interpretation is that the authors are saying something very similar here, namely that when we have a nice theory that is well presented, there is a common, almost automatic process of assuming that this “truth” is independent of the historical journey. Apart from the human/natural sciences distinction, the main difference is that Berrios suggests that there is a way to demonstrate the value of the ‘trans-epistemic’ view but it would be up to the proponents of this view to demonstrate this with evidence.
Reflecting on this further, the reason for the distinction between the historical journey and the neatly packaged theory is that successful dissemination of a theory probably doesn’t benefit from historical narrative although that might not always be the case.
Returning to the history of mental symptoms, psychiatry is a rapidly changing field. There have been and continue to be so many developments and transformations that there is value for a time and space to take stock of what has happened over these longer time scales.
References
(1) Berrios GE. The history of mental symptoms: descriptive psychopathology since the nineteenth century. Cambridge: Cambridge University Press; 1996.
(2) Thomas Kuhn. The Structure of Scientific Revolutions. Audible. 2009. Narrated by Dennis Holland. (Paperback originally published in 1962).
Notes on the Preparation of this Post
In the age of generative AI, great care is needed to also promote the work of human artists in the various media. WordPress have made available the option of using photos from a range of sources including Pexels. This is a great reminder of the value of human creativity.
I’ve previously tended to use Harvard referencing but recently switched to Vancouver. In terms of the Vancouver style, the references are cited numerically within the text. I note that in PMC which is quite popular, AMA, APA, NLM and MLA are used for citations when I checked now. The numerical referencing is convenient in the text but a bit of a headache for revisions as it may involve revising the numbering. Nowadays the LLM’s can be used to automate the ordering of references (of course with the HITL (human in the loop)). I’ll start to use AI to work out how to use the referencing software which i’ve not really fully got to grips with previously although explored various solutions. I was listening to the audiobook of Kuhn’s ‘The Structure of Scientific Revolutions’ which again is okay to reference in Vancouver although the audiobook is obviously based on the original work – Kuhn TS. The structure of scientific revolutions. Chicago: University of Chicago Press; 1962.
So in reference (1), i’ve got the 2002 reprint but apparently the reprint isn’t typically of interest in the Vancouver referencing style. I may be rather pedantic on this point, but in an age of digital books there is something important about the first edition of a physical book – a little piece of history that from my perspective at least is different from the reprint. But I guess if there is no substantial difference between the original and the reprinting, then it’s easy to see how this detail can be lost in the efficiency of the referencing system.
Disclaimer
The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.
