The epistemological basis of psychiatric controversies.

Dear Editor, Prof. Kecmanovic (in press) raises interesting questions about several points of discord within the psychiatric enterprise. His paper has a great value because it reminds to clinicians and researchers that the philosophical basis of their model has always a strong influence on their practical activity, even in those (quite frequent) cases in which they are unaware of it, and take their model for granted, as a " simple " description of reality. The importance of a philosophical clarification in order to understand current polemics in psychiatry is intrinsic to psychopathology since its Jaspersian foundation and it is the major aim of more recent programs in philosophy of psychopathology (e.g., Aragona 2009a). Because there is substantial agreement with Kecmanovic's account on many arguments, I choose to focus on possible misunderstandings that deserve to be clarified. Prof. Kecmanovic is right when asserting that the existence of so many contrasting models puts psychiatry at risk of being perceived as a non scientific activity, and that even the communication between psychiatrists is hampered if they scotomize the ideas and scientific achievements of those that do not share their own model. However, the exigency of one integrating paradigm to oppose fragmenting forces is at risk of conducing to a reductionist model (see for example the reductionist stance inspiring previous proposals of consilience models: Wilson 1998). Accordingly, the risk is that instead of Kendler's frame of reference for multiple perspectives, the " conceptual centre " evocated in the script would act as an attraction force reducing all the different perspectives to a unique model, namely the biomedical model. I see such a risk because I notice in the argumentation about the scientific credibility of contemporary psychiatry the same arguments already advanced in the Seventies when the biomedical, neokraepelinian school imposed the North-American operative diagnostic criteria as the unique credible model in psychiatric nosology. At that time it was said that the existence of alternative models of psychiatric diagnosis, and the fact that psychiatrists trained in different schools were likely to diagnose the same patients differently, were a scandal putting at risk psychiatric credibility. Considering that after thirty years of DSM-based research the promises of that model have remained elusive (Kupfer et al. 2002) and that a return to a more historically-sensible psycho-pathological model has been recommended (Andreasen 1994), caution about replying the same schema for the present-day psychiatry should be suggested. In the end, …