Powers of Ten

1980 was a time of revolutionary change in psychiatry. It was the year the DSM-III was published (Diagnostic and Statistical Manual of Mental Disorders, 3^rd ed.).  It happened to be the year I began my residency training.

In the 1960’s and 70’s psychiatry was under attack.  At that time, academic psychiatry was predominantly psychoanalytical, based upon Freud and his successors.  Psychiatry was criticized for its abstract and unproven theories.  It was criticized for lengthy and expensive therapies of unproven efficacy, that ministered primarily to the worried-well.  At the same time, there was little research and little enlightened treatment for the severely and chronically mentally ill. Psychiatry was harshly criticized for being out of step with the other medical specialties.

The diagnoses in DSM- I (1952) and DSM-II (1968) reflected the dominance of psychoanalytic psychiatry.  DSM-III, however, was a paradigm shift, written by psychiatrists who believed that psychiatry was and should be focused on the biology of mental disorders. DSM-III brought psychiatry back into the mainstream of medicine and DSM-III subsequently became psychiatry's 'bible' for diagnoses.

For me, 1980 was a time when clashing academic perspectives competed for the hearts and minds of we who were in training.  I was taught and supervised by a new generation of biological psychiatrists.  I was also taught and supervised by an old guard of psychoanalytical psychiatrists.  I felt adrift in the middle of a war of ideas. As if I wasn’t already confused, among my teachers there were also a smattering of family system’s therapists, behaviorists and developmental theorists.

It was the illustrations in a book that showed me how to reconcile the seemingly contradictory perspectives of my teachers. During my residency, I found Powers of Ten, by Charles and Ray Eames (1982). It became for me the most influential book I never read.  (I only looked at the pictures.)  It’s based on 42 illustrations.  In the middle of the book the picture is of a man peacefully sleeping on a picnic blanket. If you move back one page you see only his hand.  Move back another page and you see the fine detail of his skin.  Each picture turning backward is magnified from the preceding picture by a power of ten.  Now, if you go back to the middle and turn the pages forward you see that the man on a blanket is in a park. Next, that the park is on the Lake Shore of Chicago, and so on., Each page forward distances by a power of ten. The 42 pictures range from the smallest known subatomic particles up to the furthest known reaches of the cosmos.  My ‘aha’ moment was when I realized that no one picture was more real, or more ‘true’, than another.  Each was only a different lens, a different power of ten.

I understood then that my teachers each viewed psychiatry through a different lens. Each perspective was true in its own way.  People can be seen and understood through a variety of lenses.  They can be understood through the biological lenses of anatomy, physiology and genetics.  They can be understood through psychological lenses or interpersonal lenses, lenses focused on family or lenses focused on society and culture.  Some lenses offer more clarity.  Some lenses offer greater clinical utility.  But what was most important to me at the time was my realization that different perspectives did not have to be mutually exclusive.  Each perspective was just a different lens, a different power of ten.

During the subsequent thirty-eight years of my career, I taught and I practiced knowing that many lenses are needed in order to begin to fathom the complexity of human beings. Though each lens is in some manner true, no one lens encompasses Truth, with a capital “T”.  However, when we can look through a variety of lenses, we learn many small truths, truths that I believe lead us to see ourselves, others and our world with greater clarity and wisdom.