TO THE BIOMEDICALLY ORIENTED PSYCHIATRIST: PARADIGM REVOLUTION

What are our basic assumptions behind ameliorating psychotic effects? We should check our desire to medicate all extreme states, otherwise we propagate an inadvertent form of communism, a collective ban on abnormality. We know that there are many individuals suffering in extreme states whose processes are potentially mind expanding, whose behavior is highly critical of western technological society and who, given the proper help, could be constructive culture changers. Some may even become future therapists.
If we medicate such people, we may be avoiding our own myth of truly helping. Are we giving medication because it is really the process of the individual or are we sometimes giving it because we no longer want to think about the complex situation of our patient or about the basic premises of our profession?
Paradigm Revolution
Being a psychiatrist today means being part of a revolution in medicine. Psychiatry, more than any other branch of medicine, is faced with the limitations of causality. As a student you once challenged the basis of your profession; its flaws confront you no less glaringly today.

A central term in psychiatry is ‘psychosis.’ In this text psychosis is defined as a process reversal without a metacommunicator. The primary process which was originally adapted to a given family or community is, for a number of reasons, reversed with the secondary process long enough to change the way in which the individual experiencing the reversal is observed by others. Instead of a primary process which is adapted to the reality in which one lives and which is periodically disturbed by a secondary process, we have a new and surprising primary process which is unrelated to the consensual reality and disturbed by reality orientation.
The definition assumes that the individual in an extreme state experiences a highly patterned process and that psychosis is one of many processes characterized by temporary process reversal. This definition requires you to be aware of your own state of awareness and that of your city. It also demands knowledge of the individual client’s idiosyncratic messages and signals.
This definition has cross-cultural applications as well, since it examines the individual’s feeling, thinking and relationship to the world independently of their cause. Specific western terms for an extreme process such as schizophrenia may now be compared with apparently analogous disease entities defined in other cultures, since all psychoses are reversals of a culture’s primary process.
Thus, if law and order, cleanliness, tidiness and hard work are characteristic of a given culture, a person will be psychotic if he tends, for a long period of time, to be unlawful, disorderly, unclean, untidy and lazy. In a culture where intuitiveness is accepted, fantasy is not likely to be considered a symptom of disease.
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