Psychodynamic Psychiatry, 5th Edition – Glen O. Gabbard, M.D.

what's playin' in Plato's cave?

what’s playin’ in Plato’s cave? (Photo credit: Don J Schulte)


p. 8


Dynamic psychiatry is further defined by contrasting it with descriptive psychiatry.  Practitioners of the latter approach categorize patients according to common behavioral and phenomenological features.  They develop symptom checklists that allow them to classify patients according to similar clusters of symptoms.


The patient’s subjective experience, except as used to report items in the checklist, is less important.  Descriptive psychiatrists with a behavioral orientation would argue that the patient’s subjective experience is peripheral to the essence of psychiatric diagnosis and treatment, which must be based on observable behaviour.  The most extreme behavioral view is that behavior and mental life are synonymous (Watson 1924/1930). Moreover the descriptive psychiatrist is primarily interested in how a patient is similar to rather than different from other patients with congruent features.


In contrast, dynamic psychiatrists approach their patients by trying to determine what is unique about each one – how a particular patient differs from other patients as a result of a life story like no other. Symptoms and behaviours are viewed only as the final common pathway of highly personalized subjective experiences that filter the biological and environmental determinants of illness. Furthermore, dynamic psychiatrists place paramount value on the patient’s internal world – fantasies, dreams, fears, hopes, impulses, wishes, self-images, perceptions of others and psychological reactions to symptoms.


Descriptive psychiatrists approaching an occluded cave nestled in the side of a mountain might well describe in detail the characteristics of the massive rock obstructing the cave’s opening, while dismissing the interior of the cave beyond  the rock as inaccessible and therefore unknowable.  In contrast, dynamic psychiatrists would be curious about the dark recesses of the cave beyond the boulder.  Like the descriptive psychiatrists, they would note the markings of the opening, but they would regard them differently.  They would want to know how the cave’s exterior reflected the inner contents. They might be curious about why it was necessary to protect the interior with a boulder at the opening. ”



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