Two Upcoming Talks — Aspirations for an Integrative Psychiatry

I have two upcoming invited conference talks with some overlap in themes, both in early October 2023, that will be of interest to readers of this newsletter.

1) I am presenting on the topic “Fault Lines in Biopsychosocial Psychiatry: Integrative Aspirations and the Path Forward” at the Austen Riggs Center 2023 Fall Conference, October 13-14, 2023. Conference attendance is virtual (although presenters will be at the center in person with a small audience), and there is a discounted fee for trainees. https://www.austenriggs.org/events/2023-fall-conference

It has an excellent line up of speakers. My own talk on Oct 13 is sandwiched between talks by two giants in their fields, the anthropologist Tanya Luhrmann, speaking on “Of Two Minds, 30 Years Later,” and the psychoanalyst Nancy McWilliams, presenting on “Diagnosis and its Discontents”! The psychiatrist David Mintz, who is the director of psychiatric education at the center, will be talking about “Psychodynamic Psychopharmacology.”

Austen Riggs is a renowned psychiatric treatment center, established more than a century ago, one of the last remaining psychiatric hospitals in the US providing long-term psychodynamic treatment for complex patients. Erik Erikson (famous for his psychosocial development stages and for coining the phrase “identity crisis”) was a former staff member there, and the center carries on with his insight that treatment needs to be understood as occurring in a social and cultural context. The hospital is completely open and voluntary.

Abstract of my talk: The “biopsychosocial model” in psychiatry is as ubiquitous as it is vacuous. It is commonly invoked and offers the field an aspirational goal, but critics argue that anything specific it has to offer clinicians and scientists is either trivially true or manifestly false. The biological, psychological, and social are all supposed to interact and integrate, but how exactly? Scientific explanations of psychiatric phenomena will invariably include variables at multiple levels in some form or fashion, but that doesn’t by itself constitute a scientific explanation nor does it offer any meaningful guidance for a multidisciplinary approach. The resulting practical outcome, not surprisingly, is a state of affairs characterized by eclecticism and obscured reductionism. This talk will provide an overview of these theoretical, scientific, and clinical challenges, and will argue that tackling them requires: a) Establishing the ontological reality of the psychosocial domains using explanatory pluralism and causal emergence. b) Making progress towards understanding the nature of the interaction between the neurophysiological and the psychosocial, with progress here represented by the predictive processing and 4E cognition (viewing the mind as embodied, embedded, enactive, and extended) approaches in neuroscience. c) Navigating a pluralism of perspectives such that medicine can non-hegemonically co-exist with other psy-disciplines such as psychoanalysis, psychology, social work, and service user led movements.

2) I’m speaking as part of the educational update session “E05 – Psychiatric diagnosis and treatment – concepts, paradigms, controversies” on October 9, 2023 at the 36th European College of Neuropsychopharmacology (ECNP) Congress in Barcelona, Spain. https://www.ecnp.eu/Congress2023/ECNPcongress.

The session consists of a pair of talks, with Dan J. Stein speaking about the topic of “Psychiatric diagnosis and treatment – paradigm shifts, or incremental integration?” and I will be speaking on “Psychiatric diagnosis and treatment – biomedical, or humanistic basis?”

The focus of my talk is on how we can transcend the biomedical vs humanistic binary to arrive at a critical and integrative pluralism. Psychiatric nosology is a scientific and a social process; psychiatric classifications are historically contingent and exist within a particular sociopolitical context, but they aren’t pure social constructions. They are contingent attempts to capture a complex psychobiological reality, reflecting pragmatic and sociopolitical goals as well as an interplay of both facts and values. This pragmatic and pluralist picture of psychiatry, if it is to be successful, needs to be complemented by an emphasis on the sociopolitical dimensions of madness. In order for an integrative critical psychiatry to meaningfully embrace the critical tradition, it needs to have a robust appetite for unmasking the political violence of psychiatric institutions and must tackle the social and epistemic marginalization of individuals with psychiatric disabilities.

I hope to see some of you virtually or in person!

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