A Call for Reliable and Valid Psychophysiological Indices in Daily Practice

Abstract

In daily practice, diagnosis and treatment in psychiatry are usually difficult, ambiguous, doubtful, and more related to “art” than to “applied science.” Four reasons for these difficulties can be stated:

• 1. The theoretical knowledge which is at the basis of psychiatric practice is constantly being extended but it is also in a state of fragmentation, with many conflicting viewpoints. A list of the different trends in contemporary psychiatry is sufficient to prove the truth of this assertion: psychoanalysis, learning theory, behavioral schools, cognitive, gestalt, and other versions of individual psychology, and the many schools of social psychiatry.

• 2. The forms of therapy used in psychiatry display the same diversity: psychotherapy, pharmacotherapy, biofeedback, family therapy, ergotherapy, etc. In most cases it is difficult to assess the efficacy of these methods insofar as, much more than in any other field of medicine, one cannot fail to observe spontaneous recovery irrespective of medical intervention and solely due to changes in life conditions.

• 3. Accurate assessment of psychiatric symptoms by means of structured interviews and newer diagnostic systems has not improved the situation as much as had been hoped, because of the absence of correlations between symptoms and pathogenesis. Accordingly, it is well known that the same symptom may be related to opposite psychopathological conditions; it can be a direct expression of a primary deficit but it can also be the result of a secondary reaction to overactivity of the same function. A good example of this is provided by motor hyperactivity, which may be related either to excessive dopaminergic activity, as has been described in some psychoses, or to a decrease in the arousal level, as has been described in hyperkinetic children. Thus in biological psychiatry, as well as in psychoanalytic theory, it is often difficult to know whether the symptoms with which we are confronted express the “direct effect of morbid processes” or a “compensation.”