Professor G E Berrios read Psychology, Philosophy and History and Philosophy of Science at Corpus Christi College, Oxford, and then trained as a neurologist and a psychiatrist at the Oxford United Hospitals. At Leeds University, he trained in Medical Statistics under Professor Max Hamilton and in Didactic Analysis with Harry Guntrip. Since 1977, he has taught at Cambridge University, where he is Emeritus Professor of the Epistemology of Psychiatry.
Sitting in the Berrios home-library surrounded by thousands of psychiatric texts in multiple languages – all of which ‘the man’ has read and can readily quote from – it becomes evident that this consultant psychiatrist is no ordinary doctor and that the instruction he will provide on how to think will be life-changing. To boot, this supreme intellect is coupled with inordinate kindness and nurturing – a rare combination of qualities that, despite his denial of ‘uniqueness’, truly makes him, one of a kind.
Dr Seuss says, ‘There is no one alive who is Youer than You’. What makes You you? I have no idea, really. This is not the sort of question that I ask of myself. One possible reason for this lack of curiosity may be that the Western view that to achieve realization man has to be different and singular alarms me somewhat. I am aware of the fact that this postulate of singularity is required by the concept of moral responsibility central to Christianity and by the firming up of the notion of property that culminates in Lockean individualism. Neither of these developments make ‘singularity’ essential to the concept of man. The sad thing is that, throughout its short history, psychiatry has been forced to adopt most of its cultural proxies (self, person, personality, ego, subjectivity, executive functions, etc.).
The irony of it all is that there is a lack of consonance between this overemphasis on uniqueness and the rather generic and mechanistic explanations for the origin, development and functioning of man offered by current neuroscience, genetics and evolutionary theory. In psychiatry, we need to consider the possibility that mankind can be better defined in terms of a syncytial, self-less and groupal model. In summary, it may be the case that there is nothing that actually makes me singular and different from the rest. This conclusion would not make me unhappy.
What is your favourite idea in psychiatry, and why? It has changed over the years. In my youth, I suppose, it was the possibility of ‘explaining’ madness by linking it to the brain and curing it by manipulating the diseased bits. Now, I believe that such reductionisms are not only fanciful but also dangerous and unethical. Instead, I feel that the only idea worth bothering about in psychiatry is that of ‘psychogenesis’, that is, the possibility that madness may be generated in the common semantic space in which we all live and which is regulated by sets of cultural configurators that tell us how to interpret neural signals and the like. In other words, whether it is possible (a) for culture to configure brain activity to the point that the functional specificity of neural networks can be modified, and hence (b) that the stereotyped presentation of ‘psychiatric complaints’ (which looks natural and eternal) may be due less to neural hard-wiring than to the activity of cultural configurators themselves subject to periodic replacement and change (Berrios and Marková, 2015).
Peter Medawar wrote a book The Art of the Soluble. What is one really important but soluble question in psychiatry? With due respect to Sir Peter, I am not sure that I fully agree with the philosophy of science that he developed out of his brilliant immunological research. Great scientists rarely make great philosophers of science. I am saying this because the very meaning of what constitutes a ‘soluble’ question in psychiatry does depend upon how we want to define solubility and upon the epistemological and historical context. How does one ‘determine’ that a problem has actually been ‘solved’? ‘Soluble’ is less an empirical notion than a social, political, economic and aesthetic one. While in Physics or Chemistry one can get away with an operational definition, a measure of prediction and a statistical model and argue that solubility is purely empirical and enduring, when it comes to psychiatry this methodology no longer works. Psychiatry straddles the natural and social sciences, and this hybrid nature renders its objects fuzzy and changeable. Within psychiatry, solubility gains new meanings. For example, is ‘understanding’ a form of solving a problem? Or does solving a problem mean gaining the capacity for actually changing it? In summary, solubility, whether within the traditional sciences or the modern hybrid disciplines, is an elusive and chameleonic notion. During the psychoanalytical period of American psychiatry, some issues were considered as solved; I am pretty sure that the current sponsors of Research Domain Criteria might not be altogether happy with those solutions.
What’s the best career advice you ever received, and has it served you well? Autobiographical accounts force one to organize facts and feelings chronologically, thereby establishing many contrived causal links (Berrios, 2000). The result is no more than a just-so story whose value resides less in its ‘truth’ than in becoming a sort of morality tale: the ‘rags-to-riches’ story (whether academic or monetary) is a typical example of what I am talking about. Now, accepting that what I am going to say is just a reconstruction, I would say that the most crucial piece of advice I received was when at the end of my Oxford period I was offered jobs both in the Philosophy of Science and in Psychiatry – and in the enthusiasm of the moment I was very keen to abandon medicine for philosophy. My tutor, Charles Webster, the great historian of science, told me in no uncertain terms that it would be a silly decision, that I should remain in medicine.
What is the future of psychiatry? I have no idea. Once again, I suspect it does depend upon how one defines psychiatry. If it is defined as the ‘brain science of mental disorders’, then one can wax lyrical about it having a secured and brilliant future. If one defines it as a collection of narratives about madness, then the future looks less secure. One should not forget that the alliance between medicine and madness only took place during the early 19th century. The alliance itself can be interpreted as the ‘result of scientific progress’ or as a temporary solution to the social disruption caused by the mad during that historical period.
Still, my advice to any young psychiatrist that may be reading these lines is that we psychiatrists ought to fight our corner and defend the medical narrative. It has, so far, been successful in the understanding and management of mental disorders and with a bit of tweaking may be even better in the future.
