Loebel Lecture 3 of 3: What is the upshot?
i. The emerging scientific picture of psychiatric illness and treatment is gaining in truth value (within the nexus of scientific understandings).
ii. Explanations of distress and psychopathology based on introspection and phenomenological observations of others generally lacks truth value (from the perspective of science).
iii. The problem for psychiatry is that it must make diagnoses and administer treatments for problems that are deeply involved in subjective experience, introspection, and personal narratives. Psychiatry fails if patients (and their families) are expected to see themselves as machines.
iv. I would add that human subjective narratives and intuitions of agency qualify as more than ‘mere’ illusions: The experience of lacking agency is a well validated and measurable stressor or in other cases a psychotic delusion.
v. Psychiatry must find a way to be better rooted in science, which it should see as provisionally true (in the sense that we will learn more) and to recognize the implications of complexity. At the same time clinicians must also empathize with the human beings who are their patients, and respect their whose direct subjective experience of illness. Unlike the psychiatry of the late 20th century, we must not choose sides; all patients the best outcome of being objects of science and human beings with subjective experience.
vi. I will present a theory that does not elide the differences between mechanistic neurobiology and subjective human narratives, but that requires clinicians to switch their gaze as the situation demands and as they can.