Don Pasquale, Fidelio, and Psychiatry

In our scientific endeavors and personal longings to understand human behavior and the meaning of human existence, we seem to be pulled back and forth between biologic, genetic, or constitutional considerations, and various attempts to explore primarily or directly the realms of the “soul.” I'm satisfied that both of these orientations are fully justified; but the attempts to integrate them are hampered by a deeply ingrained, common way of experiencing our world, which has become pervasive especially since the French philosopher, Descartes, separated all that is into “measurable” and “thinking” things. Though his separation eventually made possible wonderful and frightening developments in the natural sciences, we came to assume in psychology that the measurable things (such as our body) and the nonmeasurable things (such as our “soul” or “spirit”) interact in some rather mysterious ways. Only a radically expanded philosophic perspective can offer a way out of this dilemma. The Swiss psychiatrist Medard Boss, based on the German philosopher Heidegger, rightly insists that there is no way whatsoever of explaining how the nonmeasurable “psyche” can be influenced by the measurable neurophysiologic processes, or of how the psyche sitting upon the nerve cells of our brain can force them to send messages to the various measurable functions and structures of our body. Thus Boss emphasizes that we must change our orientation toward human existence at least as radically as did Copernicus when he abandoned the universally accepted assumption that the earth was the center of the universe (Boss, 1985).

Though not completely free of any prejudice pertaining to the dichotomy of body and soul, and without disparaging the enormously interesting findings in genetic, neurophysiologic and neuropharmacologic research, I have chosen—since choose we must—to focus primarily on my patients' subjective role in trying to shape a world that they are no longer comfortable with. I have pursued t