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News Gram™ February 2007

February 2007 ~ Volume 13, No. 7

Today, we are accustomed to regard psychiatry as a medical specialty, much like surgery, internal medicine and pediatrics. There are advantages to this perspective. It conveys – indeed, demands – a rigorous approach to its subject matter, a requirement that it employ hard evidence to support its claims and an ability to use information from other medical specialties. On the other hand, many people believe that psychiatry has limited its horizons excessively. The idea that people’s problems can be fit into a series of diagnostic categories seems ludicrous to them. There was a time, they say, when psychiatry addressed the deepest problems of the human soul. These days the soul has been forgotten entirely. Actually, this complaint is not without substance – and there is no better figure than Socrates, one of the most important figures in world history.

Socrates (470-399 BCE), the father of Greek philosophy, lived in Athens and grew up at a time when the city-state was flowering. Athens had grown enormously from its leadership (particularly at sea) during the Persian Wars. While the Spartans had made the largest contribution in men and arms to defeating the Persians, Athens had provided the sea power that destroyed the Persian effort to extend its worldwide hegemony to the Greek peninsula. Unfortunately, the Athenian ascendancy was short-lived and conflict broke out between it and Sparta – the Peloponnesian War. The war lasted many years and finally ended in 404 BCE, with Athens admitting defeat.

The Athenians then faced a critical decision, namely, how to rebuild their beloved city and the civilization it expressed. Most Athenians believed that the city should develop its army and navy to an even greater degree than it had before the Great War. Socrates, though, begged to differ. In his view, the fortifications, ships and materiel were not the issue. Instead, he argued that Athens should look inward – toward its soul. It was the internal essence of Athenian life that had to be addressed, the ideas that animated the life people built for themselves, that required illumination, examination and perhaps, revision. So Socrates, previously a soldier in the Athenian military, set out to look into the soul of the city he loved so much, to speak with its citizens and learn how they thought, in particular, to find out how they regarded such issues as justice, piety and goodness.

Socrates wrote nothing. All we know about him comes from the Dialogues of Plato, the writings of Xenophon and a number of comments by Aristotle. Typically, Socrates would run into someone on the street and strike up a conversation. In Plato’s Republic, for instance, Socrates engages several people who quickly become preoccupied with the idea of justice. What is justice? they ask. His two young interlocutors offer some ideas and Socrates suggests that their respective definitions are inadequate. Then Thrasymachus, a third party to the conversation, asserts that justice is simply the power of the stronger. Such a figure exemplifies Thrasymachus’s belief that might makes right. Socrates shows Thrasymachus the error of his thinking, but is not entirely successful. Thus, the conversation proceeds in this way through ten books of the dialogue that has become a bedrock of Western thought.

For all his efforts to reform the Athenian soul by urging people to rethink their ideas, Socrates was condemned to death for corrupting the young and introducing new Gods into Athenian life. But his message was clear and was not lost in the long pathway of history. He insisted that real victory resided in the examination of the soul, in understanding the way people thought about themselves and each other and, above all, how they considered the problem of right and wrong, good and evil.

When it comes to psychiatry, the tendency in medicine is not to take the moral character of a person into account. Physicians treat all kinds of people, from angelic little girls to serial killers and place their moral values aside. For Socrates, such a way of doing things is absurd, largely because the person is a person by virtue of his moral capacity. Absent that ability, we would be hard pressed to think of people as free agents with aspirations, plans, values and the like. All of which means that contemporary psychiatry is poorly prepared to deal with the uniquely human part of each patient he or she confronts.

Rather than think of psychiatric patients as suffering from various illnesses, psychiatry could see them as individuals whose souls need careful attention. People who haven’t refined their sense of right and wrong have probably not internalized those people – usually parents – who commonly impart those sensibilities to their children. In adult life, sitting and talking with someone about problems with one’s soul is a way of coming to terms with who and what one is. It is also a way to bring about important changes in one’s identity. Perhaps psychiatry might reconsider its  role in the broad quilt that makes up medicine today.

photo credit: http://library.thinkquest.org/17709/wars/peloponn.htm

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