Using a Socratic dialogue to tackle thorny issues of psychiatry

Medical students often experience significant cognitive dissonance as they attempt to understand psychiatry. After the security of lab values and medical tests that characterize much of medical practice, the ambiguity of seemingly subjectively obtained information characteristic of psychiatry often leaves students somewhat uncomfortable with how psychiatric diagnoses are made and understood. This is, at its root, an issue of epistemology: How do we know what we say we know? Psychiatry can seem "fuzzy" to medical students, and it behooves psychiatry educators to explicitly address this discomfort but, at the same time, not apologize for the differences between psychiatry and "the rest of medicine." In this article, the author strives to emphasize that this kind of epistemological challenge is ancient and esteemed, represented to some extent in the writings of Plato (who believed that we measure the world by comparing our experience with our innate sense of what we know is true) and Aristotle (who insisted that what we know is based largely on what we can measurably experience). Using humor, an imagined conversation among these ancient philosophers and a modern psychiatrist-medical educator might help to dispel some of the discomfort that psychiatry education sometimes engenders among future physicians. The author presents an example of such a conversation. After a brief discussion of the epistemological differences characteristic of Platonic and Aristotelian views, students could be shown a script similar to the example script and then asked to discuss and debate the arguments elucidated. Perhaps even better, students could be asked to write their own debates based on how Plato or Aristotle would be expected to behave.