Paradigms of Psychiatry: Eclecticism and Its Discontents

Seyyed Nassir Ghaemi


Curr Opin Psychiatry. 2006;19(6):619-624. 

In This Article

Pluralism: Neither Eclectic nor Dogmatic

A final paradigm is pluralism, which is often confused with eclecticism. The paradigmatic thinker in this approach is Karl Jaspers,[42] about whom I have written in great detail elsewhere.[2] The basic idea here is that no single paradigm can explain all of psychiatry; no dogma is sufficient. Combining all methods on whatever grounds (pragmatic or otherwise) is, however, barely a step forward; more is not better. Anything goes is not sufficient; sometimes some things go, and other times other things go. Unlike eclecticism, there is a truth to the matter and a reason to argue for a certain method in some circumstances but not others.

Thus, pluralism agrees with eclectic paradigms by rejecting any one paradigm as sufficient; yet it also rejects eclecticism as too confused and watered-down. In the pluralist model, each method or paradigm has strengths and weaknesses, and that method or paradigm is best which has the most number of strengths and fewest limitations for the subject under scrutiny. For example, in the case of a primarily biological disease like schizophrenia, the postmodernist paradigm applied purely is simply wrong; the biological paradigm is most effective and appropriate (though again, all paradigms have limitations). For posttraumatic stress disorder in poverty-stricken inner cities, however, the social/political approach is perhaps the strongest, whereas the biological approach explains little. Simply adding approaches does not always necessarily explain more or takes one closer to the truth, although sometimes this may be the case. Examples of works along these lines include that of McHugh and Slavney, Havens, and other recent efforts.[2,43,44**,45] Jaspers[42] proposed two basic methods to psychiatry: Erklären (causal explanation) versus Verstehen (meaningful understanding); McHugh and Slavney identify four perspectives (disease-related, dimensional, behavioral, and on life story); and Havens describes four schools (objective-descriptive, psychoanalytic, existential, interpersonal). These pluralist models give coherence to the varieties of psychiatry, allowing space for different methods while providing a rationale for the use of certain methods versus others in specific conditions or circumstances. Pluralism offers a perspective that can allow us to get beyond our current confused eclecticism, while also rejecting dogmatisms of any kind, be they biological, psychoanalytic, or postmodernist.

Unfortunately, pluralist models have not been as popular as other alternatives. William James once commented that for a philosophy to become popular it must tap into some deep inner need of humanity. The continuing popularity of dogmatism (even in its postmodernist incarnations) speaks to the human wish for easy answers to life's complex problems. Eclecticism is the next simplest alternative, a road of little resistance that allows one to avoid having to think hard about the dilemmas of psychiatry. Pluralism requires a willingness to commit oneself to specific methods while remaining flexible about methods in general. It is, in fact, identical to scientific method, which is a difficult vocation. In the technical definition provided here, it is rarely practiced. Yet one can hope that, as with the progress of science in general, easy but wrong answers will eventually give way to recognition of the conceptual clarity and practical benefits of the pluralist paradigm.


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