By Douglas J. Opler, MD
One afternoon, as a resident on the consultation psychiatry service, I walked into a patient’s room. On her bed was a worn paperback copy of The Gospel of Thomas. I had
come to help the medicine team determine whether she had capacity to refuse treatment of her hyperkalemia, not intending to engage in a historical or theological discourse on apocryphal Biblical texts. Should I ask her about the book and allow myself to be sidetracked from the all-important task of recording her knowledge of the risks and benefits of treatment, her understanding of the alternatives to oral kayexalate, and her cognitive testing scores? Should I be seeking to understand everything about her, or was the book a diversion: a trap that would only make me late for rounds? How comprehensive could my interview be? No one can know everything, and so fields of knowledge and medical practice must be finite. However, ostensibly disparate fields of knowledge are linked and the borders between disciplines are, in large part, artificially, practically, and historically established. It is in the context of this paradox that the psychiatrist works.
The late biologist Stephen J. Gould wrote an essay entitled “Art Meets Science in The
Heart of the Andes” about a nineteenth century scientist named Alexander von Humboldt, who believed that the arts and the sciences are linked and that it is emotion which inspires awe in the natural world, which fuels the intellect anew. Von Humboldt believed that great artists must also be scientists, committed to observation, whose role was the expression of this awe in their works (Gould, 2002a). He was addressing the overlap between the methods and motivations that the scientist and artist both employ. This relationship between the aesthetic disciplines and the sciences noted by von Humboldt is only a specific case of the inseparable nature of all fields of knowledge, where ideas connect directly and indirectly. For example, Gould also suggested in The Structure of Evolutionary Theory that his formulation of the theory of punctuated equilibrium, which posited that Darwinian evolution could occur in rapid fits and starts, was probably at least partially enabled by his familiarity with political philosophy (Gould, 2002b).
Myriad more examples of these connections exist. I was always enormously
perplexed by my college professors’ attempts to define the differences between sociology and anthropology. It eventually occurred to me that this was because there is no clear dividing line between the two—despite one professor’s protestations to the contrary. Not only is there clear overlap between these fields, but lines can be extended from cultural anthropology to physical anthropology, from physical anthropology to biology, and onward in more directions than there are disciplines. Psychiatry can easily be connected to this web at any point. For example, sociologist Emile Durkheim wrote an important early text on suicide, in which he discussed the relationship between socio-economic upheaval and suicide.
In fact, not just psychiatry, but the entire field of medicine is hopelessly intertwined with
other fields, with a famous example of the interdisciplinary nature of medicine being the case of kuru. It required anthropological observations to realize that kuru, a disease ravaging the South Fore people of Papua New Guinea in the 1950s, was spread by ritualistic cannibalism among family members. In this case, knowledge of the cultural practices of those afflicted informed the beliefs of medical scientists and the previous assumption that the familial pattern of spread must have a genetic basis was overturned (Lindenbaum, 1978). Kuru was ultimately ascribed to a contagious prion rather than to an inherited disorder.
However, while medicine begs that a holistic approach be applied to the patient, in day-
to-day clinical practice, it is psychiatrists who employ the most broad-based interdisciplinary approach of all medical doctors. Of all specialists, we most routinely take an extensive social history and routinely refer back to it in patient care. Additionally, because of the strong links between illness, psychology, and the social milieu of the patient, the psychiatrist may be called upon to reference any aspect of the patient’s or the practitioner’s persona, vocation, or avocations. In the psyche, too, all knowledge is connected. Turning my head so the clock was out of view, I glanced again at her book: “So, what are you reading?”
Gould S. J. (2002a) Art meets science in The Heart of the Andes: Church paints, Humboldt
dies, Darwin writes, and nature blinks in the fateful year of 1859. In Gould SJ, I Have
Landed: The End of a Beginning in Natural History. (pp. 90-109) New York, NY: Harmony Books.
Gould, S. J. (2002b) The Structure of Evolutionary Theory. Cambridge, MA: Belknap Press of Harvard University Press.
Lindenbaum, S. (1978) Kuru Sorcery: Disease and Danger in the New Guinea Highlands.
Palo Alto, CA: Mayfield Publishing Company.