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  • 1. Paradigm Shifts in Psychiatry Mansoor Malik MD Howard University Washington DC
  • 2. What is a Paradigm∗ Paradigm: A set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them, especially in an intellectual discipline.
  • 3. Paradigm is Thinking inside the box
  • 4. ∗ The paradigm, or world view, that the earth was fixed at the center of the universe is the classic example of how difficult it is to "Think Outside the Box", and how persuasive current paradigms are in maintaining themselves
  • 5. Paradigm Shift is Slow and Gradual
  • 6. Paradigm Shift∗ Paradigm shift is the term first used by Thomas Kuhn in his 1962 book The Structure of Scientific Revolutions to describe a change in basic assumptions within the ruling theory of science.∗ It has since become widely applied to many other realms of human experience as well.
  • 7. Paradigms & Paradigm Shifts∗ In “The Structure of Scientific Revolutions” Thomas Kuhn argued that science is not a steady, cumulative acquisition of knowledge.∗ Instead, science is "a series of peaceful interludes punctuated by intellectually violent revolutions" [Nicholas Wade, writing for Science], which he described as "the tradition-shattering complements to the tradition-bound activity of normal science."∗ After such revolutions, "one conceptual world view is replaced by another" [Wade].
  • 8. ∗ A scientific revolution occurs, according to Kuhn, when scientists encounter anomalies which cannot be explained by the universally accepted paradigm within which scientific progress has thereto been made.∗ The paradigm, in Kuhns view, is not simply the current theory, but the entire worldview in which it exists, and all of the implications which come with it.
  • 9. There are a number of "classical cases" given for examples of Kuhnian paradigm shifts in science ∗ The transition from a Ptolemaic cosmology to a Copernican one. ∗ The acceptance of Plate tectonics as the explanation for large-scale geologic changes. ∗ The transition between the worldview of Newtonian physics and the Einsteinian Relativistic worldview.
  • 10. ∗ During periods of normal science, the primary task of scientists is to bring the accepted theory and fact into closer agreement.∗ As a consequence, scientists tend to ignore research findings that might threaten the existing paradigm and trigger the development of a new and competing paradigm.∗ For example, Ptolemy popularized the notion that the sun revolves around the earth, and this view was defended for centuries even in the face of conflicting evidence.∗ In the pursuit of science, Kuhn observed, "novelty emerges only with difficulty, manifested by resistance, against a background provided by expectation."
  • 11. Psychiatry Current Paradigm∗ Consciousness is a product of the physical body, and∗ it plays no role in physical illness.∗ Illness and healing are processes that follow physical laws.
  • 12. ∗ In ancient times and the middle ages there was a belief that spiritual disturbances caused disease.∗ The development of early Greek Medicine and the advent of the Renaissance brought about a focus on physical causes for disease.∗ Scientific advances in microscopy and human anatomy further advanced medicine.
  • 13. Biomedical Model∗ Dominant model for the past 300 years∗ All illness can be explained on the basis of aberrant somatic processes.∗ Liabilities of the Biomedical Model∗ Reductionism – Illness is reduced to microlevel processes i.e. chemical imbalances.∗ Single-factor model – Illness is due to one factor: a biological malfunction.∗ Mind-body dualism – The mind and the body are separate entities.∗ Emphasis on illness over health
  • 14. Mind Body Dualism∗ So called “mind body duality” has plagued the field of neuroscience for generations.∗ The idea of Phase Transition derived from quantum physics can be important to avoid this Cartesian dualism.∗ Just like water can exist in the form of ice, liquid and steam,∗ similar phase transition ideas have been invoked to understand the emergence of elementary∗ forces on a quantum level. Likewise brain and mind can be seen as the two phases of same reality. It is because of the methods of observation used that we detect one phase or∗ the other (mind or body).
  • 15. Problem of Consciousness∗ One of the basic questions in psychiatry is that of consciousness.∗ An essential feature of this “occasion of experience” is noncomputability which distinguishes our minds from computers.
  • 16. Circular Paradox∗ The reductionist Helmholtzian model of mind implicates that thought process and consciousness is a function of the chemical machinery of the brain.∗ This reductionism forces the paradox of circularity of self-observation. If we take mind as a reduction of electro-chemical processes, then the mind is made of the conglomerization of the very process it describes
  • 17. Quantum Paradigm∗ Quantum logic can avoid this paradox by producing a level of indeterminacy.∗ Philosophically this can allow the possibility of freedom of will. Indeed, it is very hard to preserve free will in the classical model of mind, because classical physics presumes that once all the initial coordinates of a system are known, final coordinates can be determined.
  • 18. Psychgenic Causality∗Concept of psychogenic causality is very complex,∗Meaning could be assigned to internal experienceslong after such experiences took place (for exampledelusional memories in a psychotic state).
  • 19. Quantum Paradigm∗ It has been shown that there is a delay between the stimulus and the time the brain takes to evoke a conscious event (Libet, 1992).∗ In this delay of about half a second it seems that brain can affect the past in a sort of “Backward Causality”. This apparently bizarre idea makes some sense intuitively with the psychiatrists working with the patients
  • 20. Quantum Paradigm∗ Long range quantum coherent phenomena in brain (for example in psychoskletal microtubules and in nerve junction) can be a possible explanation (Penrose,1994).
  • 21. Quantum Paradigm and Psychotherapy∗ Process od Psychotherapy remains mysterious∗ Often it is hard to pinpoint the psychic events that lead to clinical improvement. It may be that the difficulty is in part due to methodological issues. Nevertheless, it may also be true that something in this paradigm is inherently incalculable
  • 22. Quantum Paradigm and Psychotherapy∗ A therapeutic paradigm based on quantum mechanics can go a long away in relieving the feelings of anxiety, helplessness and dependence on part of the patient.∗ This “existential anxiety" as described by Yalom reflects the deterministic consensus of early 20th century (Yalom, 2005).
  • 23. Statistics and Psychiatry∗ Psychiatry has developed a dogmatic reliance of inferential statistics in psychiatry.∗ The critics have argued that the statistical inference now aims to replace judgment in the name of objectivity (Gigerenzer, 1989).
  • 24. Statistics and Psychiatry∗ Quantum physics reminds us that we can only predict the nature of the course based on statistical inference but never quite determine it. The overly reliant use of statistics should be thought over again.
  • 25. Quantum Insights Used By Psychiatrists? Psychiatrists (N = 382) at universities around the UnitedStates were asked to answer a questionnaire thatcontained clinical scenarios reflecting mental,interpersonal, or therapeutic processes correspondingto quantum or classical physical principles. Respondents(N = 191) were significantly more likely to rate scenariosreflecting quantum principles as being consistent withtheir experience than they were those reflectingclassical principles (p < .0005). ( Lee 1999)
  • 26. New Paradigm in PsychiatryConsciousness is not a product of the physical body, andit plays a role in all illness.Illness and healing have a spiritual dimension to themwhich strongly influences the underlying physicalprocessesWe should look beyond the narrow biomedical modeland to quantum physics for inspiration