EMERGING PARADIGMS IN MEDICINE:IMPLICATIONS FOR THE FUTURE OF PSYCHIATRY James Lake, MD 1,2# The causes of mental illness remain obscure in spite of rapid progress in the neurosciences. This is due in part to the fact that contemporary biomedical psychiatry rests on philosophically and scientifically ambiguous ground. In Western medicine par- adigms, theories from physics, chemistry, and biology form the basis of an explanatory model of illness, including mental ill- ness. Symptoms are conceptualized as subjective descriptions of effects caused by factors characterized in empirical terms. Con- ventional biomedicine asserts that all causes of illness, and by extension, mechanisms of action underlying legitimate treat- ment approaches, rest on biological processes that can be de- scribed in the reductionist language of Western science. How- ever, in contemporary Western psychiatry, there is no single adequate explanatory model of the causes of mental illness. What remains are competing psychodynamic, genetic, endocri- nologic, and neurobiological models of symptom formation re- flecting disparate ideological positions and diverse clinical train- ing backgrounds of mental health professionals. There is no unifying theory in psychiatry because no single explanatory model has been confirmed as more valid than any other. I hy- pothesize in this article that the synthesis of ideas and clinical approaches from Western biomedicine and non-Western sys- tems of medicine based on understandings of human conscious- ness, the neurosciences, complexity theory, and quantum field theory, will lead to rapid evolution of conventional Western biomedical psychiatry toward truly integrative mental health- care. The result will be the emergence of an integrative mental healthcare model that will more adequately address the disparate causes, conditions, and meanings of symptoms combining mul- timodal approaches from Western biomedicine and non-West- ern systems of medicine. Key words: Paradigms, psychiatry, mental health, theories of consciousness (Explore 2007; 3:467-477. © Elsevier Inc. 2007) INTRODUCTION There are reasonable and appropriate roles for both established and emerging ideas and treatments in medicine and psychiatry. There is validity to both empirically derived scientific models and intuitive ways of understanding and treating illness. Western psychiatry rests on a coherent body of theory, research, and clinical data, and continues to benefit from fundamental scien- tific advances in neurophysiology, pharmacology, molecular bi- ology, and genetics. However, the successes of conventional biomedical treatment approaches are limited by many factors, including incomplete or erroneous understandings of the postu- lated mechanisms of action of many drugs, the limited efficacy of many drugs in current use, significant safety problems and related compliance problems caused by toxic side effects or drug-drug interactions, and unaffordability or limited availabil- ity of drugs that are regarded by Western-trained physicians as the most effective treatments for a particular mental illness. These issues have resulted in controversy over the appropriate uses of conventional pharmacological treatments in mental healthcare, and it is the author’s opinion that they result in serious limitations on the potential effectiveness of many con- ventional treatments. In this context, the systematic evaluation of nonconventional treatment approaches is a reasonable—and I believe necessary—response to the inherent limitations of West- ern psychiatry. Although conventional biomedical approaches are often ef- fective, medications alone clearly do not adequately address the complex causes and meanings of mental illness. This is especially true when the broad goal of mental healthcare is to provide lasting symptomatic relief while prioritizing the patient’s safety and overall quality of life. Every system of medicine is con- strained by inherent limitations of its theories and clinical meth- ods, and no single treatment approach is ideally suited to all patients who report similar symptoms. Particular kinds of treat- ments are often ineffective or partially effective because they fail to address the complex causes or meanings of mental illness. Biological treatments are beneficial in many cases but may be of limited value in cases where psychological, somatic, spiritual, or energetic causes or conditions underlie mental and emotional symptoms. CHANGING EXPLANATORY MODELS AND SHARED BELIEFS OF BIOMEDICAL PSYCHIATRY Recent advances in the neurosciences, molecular biology, and genetics suggest that the conventional Western medical model of brain functioning fails to adequately explain normal states of human consciousness, and by extension, mental illness. Basic understandings of neurochemical mechanisms associated with normal brain functioning are changing rapidly, pointing to lim- itations of the neurotransmitter theory and the biopsychosocial model. The neurotransmitter theory was put forward in the early 1 Department of Psychiatry and Behavioral Sciences, Stanford Univer- sity Hospital, Stanford, CA 2 Private practice, Monterey, CA # Corresponding Author. Address: PO Box 222577, Carmel, CA 93922 e-mail: egret4@sbcglobal.net 467 © 2007 by Elsevier Inc. Printed in the United States. All Rights Reserved EXPLORE September/October 2007, Vol. 3, No. 5 ISSN 1550-8307/07/$32.00 doi:10.1016/j.explore.2007.06.003 HYPOTHESIS