EVIDENCE-BASED MEDICINE IN CONTEXT: A Pragmatist Approach To Psychiatric Practice

The debate concerning evidence-based medicine (EBM) is often articulated in dichotomous terms. For example, it has been claimed that EBM is linked epistemologically to the theory of foundationalism and that important critics of EBM emerge from anti-foundationalist epistemologies. This may leave us stuck in an overly general and fruitless debate concerning how different kinds of knowledge should be ranked. By contrast, when framed in less dichotomous terms, opposing positions of EBM might be brought to agree that the different perspectives they represent are both relevant and important for psychiatric practice. Disagreement would then focus on how the perspectives should be related and weighted. In this paper, I use contemporary pragmatism's conception of a vocabulary to bypass the realism-relativism dichotomy and to make a rethinking of EBM's role in psychiatry. According to this approach, scientific evidence as well as narrative perspectives should always be evaluated in specific contexts, according to how well they serve our concrete, particular ends. Although the role of scientific evidence in the formation of psychiatric practice is indisputably important, that role is not to provide a basis, in any meaningful, nonambiguous sense, for psychiatry as such. This point is illustrated by a pragmatist approach to Straus et al.'s operationalized version of EBM.