Whose evidence? Lessons from the philosophy of science and the epistemology of medicine

Objective: To demonstrate the inadequacies of empiricism as a scientific foundation for evidence-based approaches to psychiatry. Method: The principles of empiricism are reviewed in the light of developments in the philosophy of science and phenomenology. Case studies are selected from the history of physical sciences, biological science and clinical sciences (pathology, neuroscience, psychosocial science and psychopathology), paying particular attention to the role of observation in theory construction. Results: The principles of empiricism, particularly its view of the nature of observation as the basis of evidence do not reflect the historical reality of scientific theorizing and practice. Science has constructed alternative models of its own activity that do justice to the complexities of its subject matter, including the world of human experience and mental illness. Conclusions: A failure to recognize both the limitations of empiricism in science and the conceptual richness of alternative formulations that accord more closely with the complexity of psychiatry's domain will result in a naive model of science and inadequate understanding of the limitations of 'evidence' that guide the training, clinical practice and research in our profession. The consequences will be the intellectual, clinical and ethical impoverishment of psychiatry.