But despite that open recognition, there's still competition between different models of the mind that strongly influences treatment choices and makes our eclecticism perhaps more apparent than real. One way is that clinicians artificially divide psychopathology by saying Axis I disorders are biologically hardwired, i.e., not derived from psychic conflict, and therefore not amenable to psychotherapeutic interventions. In contrast, Axis II disorders are seen as resulting from psychic conflict, and therefore amenable to interpretation, implying that psychological treatment and not medication should be the primary treatment modality. It should be recognized that such a division has no empirical basis and serves only to promote misguided competitions in our field. And, of course, such competitions also can harm the patient, who may not get needed medication because of theoretical issues.
Considerations are similar in all disorders, but let's take depression as a specific example.
Over the years, there's been an increasing divergence between psychoanalysts' concept of depression and diagnostic categories of affective disorder used in clinical psychiatry. Underlying the differences in diagnostic approaches are significant differences in theories of etiology. But in clinical settings, we don't need resolution of theoretical conflicts regarding etiology to develop a system to guide medication use in combination with psychoanalysis. Rather, we must focus on phenomenology. Data establishing efficacy of medication in affective syndromes were collected in studies that included patients based on phenomenology of their symptoms, including chronicity, content and intensity, not the presumed etiology or meaning of the depression.