Put more simpy, can we learn enough about psychiatric disorders to appropriately treat them by means of empirical studies and experimentation, or might it be more helpful to take a more holistic approach (eg, return to using case studies) to understand complex human clients?

There is no yes or no answer to such question. Exact science is based on reductionism. As long as we are conscious of the fact that we reduce the "reality" (nature ) to an artificial system we are able to explore with our specific methods we'll not be seduced to overinterpret our findings. . It is essential not to forget the insights we get from holistic approaches, and to have a clear undestanding on which explanatory level we are experimenting and interpreting our findings. There are so many investigators who never or only rarely give a thought to the vexing problem of interfaces between various explanatory levels. And this results in the bizarre reductionistic materialism which we are confronted with so often in these days. Much of the pseudophilosophical arguoing of modern brain researchers is rooted in this fundamental epistemiological neglect.

A crucial question considering the current funding skewed towards Random Control Trials. Given the complex nature of mental distress/disorders, a range of methodologies are essential If we take Popper's concept of falsifiability, it is essential to use case studies ( and I would argue participative action research) which can potentially refute the hypotheses of empirical research. Funding should therefore be directed to a wide range of research projects.

I agree with the importance of recognising different explanatory methods and I would also argue that it is crucial to articulating the underpinning beliefs of different paradigms. Mental health and disorders have changed across time and place not only in response to empirical research but also according to the prevailing ideologies and dominant beliefs of the time. Failing to understand the influence of the social construction of concepts such as mental health can contribute to the status quo in which random control trials are privileged over developing knowledge from practice in action research or in exploring the phenomenological experience of mental health and of the biopsychosocial factors , which impact on such experience and of action research

Whilst I acknowledge the importance of RCT's, I am interested in why random control trials remain so dominant in an era when current science (such as epigenetics) contributes to an understanding of the complex interaction of factors that can influence the emergence of illness across the lifespan.

I hope this debate continues. Thank you for the discussion so far.

Susan,

No question that RCTs rule in clinical research design, but your question is a valid one: should they be held in such high esteem? What can we learn from case studies and other qualitative methods that would trump the sheer magnitude of large RCTs? How can we overcome the admittedly inherent bias in case studies? Perhaps multiple case study designs with a team of researchers to control for bias and demand characteristics?

I'm not clear to what degree these thoughts will add to the conversation, but I just spent four years working with cancer patients who have largely given up on the traditional, allopathic, cut/burn/poison model and have looked to alternative methods for addressing various cancerous conditions.  Most of these patients had already further acidified their bodies with radiation and chemotherapy which did not provide the desired results.  Many of these patients continued to communicate with their primary care physicians and oncologists.  Uniformly, when they achieved positive results with CAM (complementary and alternative medicine) procedures and reported these resuts to their medical practitioners, the medical response was often major surprise and some variaiton of "whatever you're doing, just keep doing it."  But the medical people did not want to know what they were doing!  When cancer patients do well with standard medicine, doctors credit the cut/burn/poison methods.  When the results are not positive, they blame the advanced nature of the cancer and starting therapy too late.   Most cancer patients who follow "doctors orders" also make many other changes in their life and lifestyle based on their own independent and  fear-driven research.  There are at least 50 or more activities that cancer patients might undertake in addition to standard procedures.  Doctors RARELY OR NEVER want to know what they are.  They include dietary changes, vegetarianism, electron rich food intake, light therapy, targeted DNA nutritional supplementation, acid/alkaline restructuring, changing body fluids in drastic measures such as flooding with alkaline water, religions and prayer, work changes, relationship changes, increased support of friends, outside financial assistance, resolving family problems, more time with family, quitting work, changing jobs, firing the boss, exercise, various types of yoga, psychotherapy, lymphatic and other massage, gut cleansing, detox, and colonics, rebuilding blood with chlorophyll, oils, water, and minerals, Rife therapies, marriage counseling, vacations, more hobby focus such as music, gardening and outdoor living, making purchases formerly denied onesself, more sleep and rest, multiple additions of nutritional supplements, homeopathic and naturopathic programs, divorce, unloading financial burdens, ...and the list is much longer.  Positive results in the reversal of cancer is oftren related to many lifestyle changes,  but credit is then given by medical practitionrs to cut/burn/poison therapies.  When oncologists tell me about fighting fire with fire, I remind them that firemen use water. 

Patrick, they are not relevant to the concersation, but I am grateful for your contribution all the same, having a 39-year old nephew who is fighting a severe cancer (with chemo and radio presently).