Is it psychiatry or the psychiatrist that is changing? Outcome of the psychiatrist's evolution.

When there is a discussion about changes in psychiatry, it becomes evident at once that the discussion is actually about changes in the role of the psychiatrist. Psychiatry is a discipline related to complex overlapping principles and methodologies deriving from different fields, that sometimes cannot be superimposed, and above all it is a discipline that is mostly operational, classical and connected to operating in the sense of understanding and of intervening. Without this dimension, psychiatry loses much of its meaning and becomes useless. What derives from this is that psychiatry does not exist per se independently of who makes use of it, like mathematics or, albeit with greater limitations, biology, and even neurology. The consequence is that it is not psychiatry that changes, but the psychiatrist, linking his own destiny and the destiny of the discipline he is creating in the cultural, social, economic and artistic contexts that surround him. Throughout this essay, Rossi has used Psychiatrists as a masculine/male and we have left this status as such. We must, therefore, resign ourselves to not possessing a scientific discipline inside an ivory tower, but to be perching on a flexible structure buffeted by every wind. So it is the psychiatrist who changes. In any case, despite all attempts to ennoble psychiatry by giving it a long history, making it originate from mediaeval demonology, from the Malleus Maleficarum, or from Theophrastus, or even more anciently from Athenian tragedy, it does not actually originate from all of this. Man’s tragic awareness originates with Greek tragedy and introspection with Theophrastus, while mediaeval demonology gave rise to the connection between the emotions and what is unknown and obscure. The modern discipline of psychiatry as we intend it nowadays originated in 19th century literature with de Balzac, as noted previously on the Psychopathology of Minkowski. If asked what made me choose de Balzac from the vast range of 19th century literature, there are several reasons why he seems to me the most suitable author to represent this beginning. In any case, despite what is commonly believed, modern psychiatry did not originate in Germany, but in France. Whoever is patient enough to re-read the marvellous descriptions in the 19th century Annales M edico Psychologique, from Magnan to Morel, De Cl erambault and Cotard, will perceive de Balzac’s expertise in these clinical cases, with his painstaking but wide-ranging descriptions of the states of mind or life experiences of the petit bourgeoisie of his day, perhaps of all modern day people. His descriptions are more suitable than those of the Russian novelists, although they were masters in describing unusual, exceptional and grandiose situations. Feodor Karamazov is certainly not the p ere Goriot inside all of us. The descriptions of the French psychiatrists can be read like novellas or novels. McEwan succeeds in constructing an ambiguous narrative by linking his own novel Enduring Love with a clinical description from the D elire des erotomanes by De Cl erambault. If suitably shortened, as at the end of the novel, McEwan’s work could be published in a psychiatric journal. To confirm this, here are two excerpts from de Balzac.