Short note of the history of medicine and the position of psychiatry
Yokohama Research Institute for Disability, Education and Industry
I understand people’s skeptical feeling to medicine as science. The consideration whether medicine is science or not. This question is the problem of philosophy of science. I will refer to English anthropologist, Sir James George Frazer’ “The Golden Bough” (1890). He wrote in this book that magic and science has common mental attitude. These are opposite to the religion in which human being recognize the great, absolute power and obey this existence. Magic and science make their own order in the world and change the world as they desire. The differences are that magic’s world order is arbitrary but in science this consists of the cool, objective, patient observations of phenomenon. Medicine was magic rituals for long time to pray the prolongation of one’s life or maintenance of health. But as Michel Foucault pointed out that the pathological autopsy gave chances to true and scientific observation of the pathological changes of the body. I think from this time, in the medical field pathologist and biologist has more value and prestige than physician.
Certainly the practice of surgery reminds us of the magical rituals but modern surgery are carried out following the theories that are confirmed by the huge amount of observation results. It is true that there is not the self-evidence certainty as mathematics. At present medical science level, medical staff can’t avert uncertainty. Can we say that medicine is not science based on this fact? Also in the statistic, the calculation is mathematically exact and completely scientific but the data, particularly biological or sociological data, is in many times arbitrary. So the results are in many cases not stable but changeable.
To mention about the Michel Foucault’s “La Naissance de la Clinique” (The birth of the clinic) must be more detailed descripted. In this title “clinic” means modern medical clinic. The author wrote the modern medical clinic began during the period of the French revolution when the pressure of the Catholic church weakened and in this time countless pathological postmortem were carried out. The pre-revolution medicine that stand up on semiology (symptomatology) was not called as science but after these physically pathological investigation medicine became one of science for the first time. The name of disease must consist of the place and the quality of lesion, and pathology itself progressed by using microscope, electron microscope and now analysis the gene level.
But one field of medicine that is psychiatry remains to stand on semiology yet because of overwhelming difficulty of investigation to the brain. So the classification of psychiatric disorders was provisional at the age of Pinel. But psychiatric symptoms are sometime socially dangerous, so the factor of the social defense was more or less took account of making classification. From this point also, psychiatry is not natural science but have somewhat social and political matter. Now the research of brain become more ease than before using MRI, PET etc. Revision of DSM and ICD aim to make more refined classification and diagnostic standard to make appropriate clinical sample to investigate pathological basis of the disorders. In near future, I want that we can expect that psychiatry also become one of science.
So in any scientific field we must make effort to continue patient observation and integration of these results.