1. Paradigm Shifts in Psychiatry
Mansoor Malik MD
Howard University Washington DC

2. What is a Paradigm
∗ Paradigm: A set of assumptions, concepts, values, and
practices that constitutes a way of viewing reality for
the community that shares them, especially in an
intellectual discipline.

3. Paradigm is Thinking inside the box

4. ∗ The paradigm, or world view, that the earth was fixed
at the center of the universe is the classic example of
how difficult it is to "Think Outside the Box", and how
persuasive current paradigms are in maintaining
themselves

5. Paradigm Shift is Slow and Gradual

6. Paradigm Shift
∗ Paradigm shift is the term first used by
Thomas Kuhn in his 1962 book
The Structure of Scientific Revolutions to describe
a change in basic assumptions within the ruling
theory of science.
∗ It has since become widely applied to many other
realms of human experience as well.

8. Paradigms
&
Paradigm Shifts
∗ In “The Structure of Scientific Revolutions” Thomas Kuhn argued
that science is not a steady, cumulative acquisition of
knowledge.
∗ Instead, science is "a series of peaceful interludes punctuated by
intellectually violent revolutions" [Nicholas Wade, writing for
Science], which he described as "the tradition-shattering
complements to the tradition-bound activity of normal science."
∗ After such revolutions, "one conceptual world view is replaced
by another" [Wade].

9. ∗ A scientific revolution occurs, according to Kuhn,
when scientists encounter anomalies which cannot
be explained by the universally accepted paradigm
within which scientific progress has thereto been
made.
∗ The paradigm, in Kuhn's view, is not simply the
current theory, but the entire worldview in which it
exists, and all of the implications which come with
it.

10. There are a number of "classical cases" given for examples
of Kuhnian paradigm shifts in science
∗ The transition from a Ptolemaic cosmology to a
Copernican one.
∗ The acceptance of Plate tectonics as the
explanation for large-scale geologic changes.
∗ The transition between the worldview of
Newtonian physics and the Einsteinian Relativistic
worldview.

11. ∗ During periods of normal science, the primary task of scientists is
to bring the accepted theory and fact into closer agreement.
∗ As a consequence, scientists tend to ignore research findings
that might threaten the existing paradigm and trigger the
development of a new and competing paradigm.
∗ For example, Ptolemy popularized the notion that the sun
revolves around the earth, and this view was defended for
centuries even in the face of conflicting evidence.
∗ In the pursuit of science, Kuhn observed, "novelty emerges only
with difficulty, manifested by resistance, against a background
provided by expectation."

12. Psychiatry Current Paradigm
∗ Consciousness is a product of the physical body, and
∗ it plays no role in physical illness.
∗ Illness and healing are processes that follow physical
laws.

13. ∗ In ancient times and the middle ages there was a
belief that spiritual disturbances caused disease.
∗ The development of early Greek Medicine and the
advent of the Renaissance brought about a focus on
physical causes for disease.
∗ Scientific advances in microscopy and human
anatomy further advanced medicine.

14. Biomedical Model
∗ Dominant model for the past 300 years
∗ All illness can be explained on the basis of aberrant somatic
processes.
∗ Liabilities of the Biomedical Model
∗ Reductionism – Illness is reduced to microlevel processes i.e.
chemical imbalances.
∗ Single-factor model – Illness is due to one factor: a biological
malfunction.
∗ Mind-body dualism – The mind and the body are separate entities.
∗ Emphasis on illness over health

15. Mind Body Dualism
∗ So called “mind body duality” has plagued the field of
neuroscience for generations.
∗ The idea of Phase Transition derived from quantum physics can
be important to avoid this Cartesian dualism.
∗ Just like water can exist in the form of ice, liquid and steam,
∗ similar phase transition ideas have been invoked to understand
the emergence of elementary
∗ forces on a quantum level. Likewise brain and mind can be seen
as the two phases of same reality. It is because of the methods
of observation used that we detect one phase or
∗ the other (mind or body).

16. Problem of Consciousness
∗ One of the basic questions in psychiatry is that of
consciousness.
∗ An essential feature of this “occasion of experience”
is noncomputability which distinguishes our minds
from computers.

17. Circular Paradox
∗ The reductionist Helmholtzian model of mind
implicates that thought process and consciousness is
a function of the chemical machinery of the brain.
∗ This reductionism forces the paradox of circularity of
self-observation. If we take mind as a reduction of
electro-chemical processes, then the mind is made of
the conglomerization of the very process it describes

18. Quantum Paradigm
∗ Quantum logic can avoid this paradox by producing a
level of indeterminacy.
∗ Philosophically this can allow the possibility of
freedom of will. Indeed, it is very hard to preserve
free will in the classical model of mind, because
classical physics presumes that once all the initial
coordinates of a system are known, final coordinates
can be determined.

19. Psychgenic Causality
∗Concept of psychogenic causality is very complex,
∗Meaning could be assigned to internal experiences
long after such experiences took place (for example
delusional memories in a psychotic state).

20. Quantum Paradigm
∗ It has been shown that there is a delay between the
stimulus and the time the brain takes to evoke a
conscious event (Libet, 1992).
∗ In this delay of about half a second it seems that brain
can affect the past in a sort of “Backward Causality”.
This apparently bizarre idea makes some sense
intuitively with the psychiatrists working with the
patients

21. Quantum Paradigm
∗ Long range quantum coherent phenomena in brain
(for example in psychoskletal microtubules and in
nerve junction) can be a possible explanation
(Penrose,1994).

22. Quantum Paradigm and
Psychotherapy
∗ Process od Psychotherapy remains mysterious
∗ Often it is hard to pinpoint the psychic events that
lead to clinical improvement. It may be that the
difficulty is in part due to methodological issues.
Nevertheless, it may also be true that something in
this paradigm is inherently incalculable

23. Quantum Paradigm and
Psychotherapy
∗ A therapeutic paradigm based on quantum mechanics
can go a long away in relieving the feelings of anxiety,
helplessness and dependence on part of the patient.
∗ This “existential anxiety" as described by Yalom
reflects the deterministic consensus of early 20th
century (Yalom, 2005).

24. Statistics and Psychiatry
∗ Psychiatry has developed a dogmatic reliance of
inferential statistics in psychiatry.
∗ The critics have argued that the statistical inference
now aims to replace judgment in the name of
objectivity (Gigerenzer, 1989).

25. Statistics and Psychiatry
∗ Quantum physics reminds us that we can only predict
the nature of the course based on statistical inference
but never quite determine it. The overly reliant use of
statistics should be thought over again.

26. Quantum Insights Used By
Psychiatrists?
Psychiatrists (N = 382) at universities around the United
States were asked to answer a questionnaire that
contained clinical scenarios reflecting mental,
interpersonal, or therapeutic processes corresponding
to quantum or classical physical principles. Respondents
(N = 191) were significantly more likely to rate scenarios
reflecting quantum principles as being consistent with
their experience than they were those reflecting
classical principles (p < .0005). ( Lee 1999)

27. New Paradigm in Psychiatry
Consciousness is not a product of the physical body, and
it plays a role in all illness.
Illness and healing have a spiritual dimension to them
which strongly influences the underlying physical
processes
We should look beyond the narrow biomedical model
and to quantum physics for inspiration