Two Reviews:
Life is a Miracle, by Wendell Berry,
and Spirited Away, by Hayao Miyazaki

As a psychiatrist, I feel pulled in different directions during the day. One moment I am a scientist, gathering data to be analyzed, forming an evidence-based theory of dysfunction, matching symptoms to scientifically-studied groups of "disorders," and prescribing chemicals which alter brain patterns in an effort to help my patient. In another moment, I am a sympathetic listener of a person's "story," helping to find the places where the person is "stuck" or helping a person find a way to weather loss, grief, abuse or launching into adulthood. It is the meeting ground of science and art. It is always a balancing act between what can be known and approached scientifically, and what cannot.

Wendell Berry, eloquent philosopher, writer and farmer from Henry County, Kentucky, writes about science and art, in Life is a Miracle, an Essay Against Modern Superstition, a book which should be read three times by every psychiatrist.

Mr. Berry discusses the way that science has become the religion of our postindustrial era, based on the materialistic belief that all things can be eventually "known" and "understood" through scientific methods. (For example, if we study the brain well and long enough, we should have an understanding of all psychiatric disorders.) Yet the metaphor upon which scientists rely is that of the machine. Observation, study, diagnosis and treatment are based on a view of the human condition as a disordered machine requiring correction. The aim of scientists has always been to arrive at abstract explanations or theories, yet when applying abstract theories to particular humans, dehumanization may result. As Mr. Berry says, "The frequent insultingness of modern (scientific-technological-industrial) medicine is precisely its inclination to regard individuals apart from their lives, as representatives or specimens of their age, sex, pathology...or some other category."

If one believes that science is useful in studying things to a point, what is left is that which can't be understood or expressed in the language of science. "We are alive within mystery, by miracle.... We know more than we can say.... Finally, we live beyond words, as also we live beyond computation and beyond theory."

The reductionism of scientific method permeates many institutions, including academia and managed care. In the mechanistic view, people--provider or patient--are cogs in the wheel. Academic psychiatrists must teach, produce research or writing, and seek funding sources, a grueling sort of social Darwinism. Researchers in science and the arts "follow the patrons." In our case, pharmaceutical companies are major donors to research, awards, and grants. How many donors give funding for things such as "The Effect of Daily Danger Coding by CNN on the Emotional Lives of Children," or "How Does Poverty Relate to Later Needs for Residential Psychiatric/Juvenile Justice Stays?" or "How Can Child Abuse--the most common cause of psychiatric disorders--Be Stamped Out?" Most research tends to be on medication trials. Journal articles focus on imaging, medications, CBT ,or how poorly we are being paid. New labels for various symptoms groups, which coincidentally are treated by a certain medication, appear every few years.

Recently, I talked to a 17 year old girl who has been in residential care for several years, diagnosed with severe chronic PTSD as a result of sexual abuse by a family member. Her parents did not believe her and the perpetrator was still in the family. She has suffered horribly, during and after the abuse. Recently, she has come to a new place in her coping. The abuser apologized sincerely for what he had done, and she forgave him. Now, some chemicals may have changed in her brain, but this was not a biological event. As a profession, we seem reluctant to talk about this sort of thing because it is not "science."

How do we resolve our identity crisis in psychiatry? Mr. Berry argues that "science and art are neither fundamental nor immutable. They are not life or the world. They are tools...But if the sciences and the arts are divided into "two cultures," or into many subcultures, they are nobody's kit of tools." A new paradigm of ethical, particular consideration of the use and abuse of science is needed. Psychiatrists are neither pure scientists nor clergymen. We have many tools: psychotherapy, relationship-building, compassion, knowing the patient particularly over time, understanding common problems, using medications, working on community and national issues to improve people's lives. All of these tools should be embraced as equally important.

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