Known Unknowns: The Difference Between Science and Scientism in Psychiatry

Ronald W. Pies, MD


May 05, 2016

In This Article


The notion that science is pristinely objective, value-free, and the product of necessary and certain truths is a misleading vestige of logical empiricism(also known as "logical positivism"), the philosophical school that emerged from the Vienna Circle of philosophers during the 1920s and 1930s. After the devastating critique of W.V.O. Quine and other philosophers, logical empiricism was largely discredited by the 1960s.[12]

Yet in the public consciousness, the notion of a purely objective, value-free medical science has persisted, as have attempts to segregate psychiatry from the rest of medicine. Thus, we often hear critics of psychiatry claim that "unlike other medical specialties, psychiatry has no objective, biological tests" or that "psychiatrists, unlike other doctors, simply vote their diagnoses into or out of existence."

These fallacious claims are expressions of both scientism and an outdated triumphalist account of science, not science as it understood by most modern philosophers concerned with this topic. The philosopher Adam Morton notes that the idealized image of science as the objective discoverer of nature's truths is largely fiction. Rather, as we have just seen with respect to thyroid cancer, "most scientific theories are eventually rejected and replaced with alternatives; and in retrospect, the reasons given for their adoption often do not look very impressive... [Moreover,] contemporary science is a large and rambling structure, incorporating many different disciplines from theoretical astronomy to sociology and psychology."[13]

Psychiatry, like all medical disciplines, aims at discovering useful facts about the human condition, in order to reduce suffering and incapacity and enhance life. Like all of the other medical specialties, however, psychiatry must use judgment and interpretation in the service of these goals, knowing that scientific "truths" are always tentative—and often temporary.

Acknowledgments: I wish to thank Dr Bernard J. Carroll and Dr Jose de Leon for helpful comments and references related to this article.

Suggested Reading

Ghaemi SN. Existence and pluralism: the rediscovery of Karl Jaspers. Psychopathology. 2007;40:75-82.

Marková IS, Berrios GE. Epistemology of psychiatry. Psychopathology. 2012;45:220-227.

*For some interesting comments on Cartesian dualism by Dr Carroll and others, see

Also see Dr Glen Gabbard's comment[9]:

Related to this unfortunate tendency toward dichotomization is a widely held but poorly supported view of treatment: namely, that psychotherapy is a treatment for 'psychologically based' disorders, while 'biologically based' disorders should be treated with medication. This view is related to a Cartesian dualism that splits people into a mind and a brain. While the two constructs represent domains that have their own languages and can be separated for purposes of discussion, they are always integrated. What we call 'mind' can be understood as the activity of the brain...although the complexity of one's unique subjectivity is not easily reducible to chemistry and physiology.