Essential Tensions in the Field of Psychiatry

In this presentation I discuss modern psychiatry, esp. neuropsychiatry, from the perspectives of philosophy and sociology of science. It is argued that there exist a number of tensions and ‘incommensurabilities’ in the field that are hard to overcome, thus giving rise to controversies. I separate four types of tensions, belonging to different ‘boxes.’ The first is called cognitive/internal, comprising the scientific basis of neuropsychiatry´s knowledge claims. The second is called social/internal, involving strategies deployed by the profession of neuropsychiatry. The third is called cognitive/external, pertaining to the cultural context in which neuropsychiatry is situated, in particular, the rising popularity of evolutionary psychology, social Darwinism, and biologism. The fourth is called social/external, signifying various economic and political interests held by social agents such as pharmaceutical companies, patient groups, schools, families. Tensions within and between ‘the boxes’ are explored and mapped out, providing a basis for identifying causal mechanisms explaining successes as well as controversies in the field of neuropsychiatry.