Introduction: can we conjecture about the future?

INVITED EDITORIAL

Carmem Keidann; Flávio Shansis

Introduction: can we conjecture about the future?

Editors, Rev Psiquiatr RS

There has been much discussion on whether the paths of current psychiatry are actually the most adequate. This concerns contemporary classification systems and application of research results, as well as the ability of being, in fact, providing the best conditions of life to our patients. Even more debate is raised, in our opinion, when trying to predict where the paths of current psychiatric thought are leading us. In this sense, we decided to invite four colleagues to conjecture about the future: after all, which psychiatry will be waiting for us in the next 50 years?

To Professor German Berrios, from Oxford University, in the United Kingdom, a renowned thinker of the history of psychiatry, we asked whether "in psychiatry, historic knowledge can have a predictive ability." Dr. Berrios starts his text by discussing the complexity of that provocative question, suggesting that the answer depends on the definitions of what we understand as psychiatry, history and predictive ability. He draws attention to the fact that the evolution of psychiatry can be more determined by economic, social and political factors than by scientific justifications. He warns that even its current relationship with medicine could no longer exist if other more "market–based" forms of dealing with mental diseases are discovered.

Dr. Andrew Nieremberg, from Harvard University, in Boston, USA, is an important clinical researcher in the area of mood disorders. He questions the value of many clinical trials being currently carried out, in which negative results and/or risks of their products are omitted due to an unbridled pursuit of profits. He warns against the problem of generalizing the results of those studies, since there is a major difference between patients who participate in researches and those who seek clinical treatment. He comments on the fact that almost all sources of research sponsorship originate from private pharmaceutical companies and, therefore, other sources of research sponsorship of different origins are needed (governmental, NGOs, foundations). He finally acknowledges the importance of research projects on the effectiveness of treatments to promote public health and the consequent need of reducing biases that might compromise their results.

Our colleague Cláudio Eizirik, from Universidade Federal do Rio Grande do Sul, Brazil, and current president of the International Psychoanalitic Association (IPA), reflected on the contribution that the psychoanalytic thought might bring to psychiatry in 50 years time. Professor Eizirik believes that psychoanalysis will continue to allow the understanding of emotions that are part of human life, both at a patient care level and in terms of the intricate relationships within institutions, through concepts such as transference and countertransference, analytical field, intersubjectivity, expanding mind. He stresses the growth of analytic–oriented psychotherapy with benefits that reach the public network and university services. According to Eizirik, psychoanalysis will be present in the formation of new psychiatrists, providing them instruments to understand and treat multi–determined psychiatric disorders. He holds a strong expectation of an effective integration between psychoanalysis and psychiatrists in the future.

To Dr. Gabbard, from Baylor College of Medicine in Houston, USA, we asked whether it will be possible to integrate psychoanalysis and clinical research in the future. He summarizes his position by claiming that the integration between psychoanalysis and research on clinical neuroscience is not only possible, but also essential. He warns against the risk of being seduced by advances in technological knowledge. According to Gabbard, contemporary psychiatry needs two languages – one more suitable for biology and another originated from psychology. This type of psychiatrist, some years ago called "bilingual" by Gabbard, would have an integrating model between mind and brain. Finally, he suggests that psychiatry will follow the right path if, 50 years from now, we can better comprehend man's huge amplitude, escaping a purely psychoanalytical or purely biological explanation of human events.

Predicting the future always carries a large potential of biases. Imagining how psychiatry will be 50 years from now is a purely intellectual exercise. Professors Berrios, Nieremberg, Eizirik and Gabbard accepted our challenge and suggested paths and possibilities to maintain or change what is necessary in our specialty. In the following pages, the reader will have the pleasure of enjoying such well elaborated thoughts provided by our guests. It is a privilege to count on those participations.

Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007