Explanation In Psychiatry Research Articles

Une psychiatrie sans esprit ?

Philosophy of Mind is currently one of the most prolific fields of research in philosophy and has witnessed a progressive hybridization with cognitive science. It focuses on fundamental questions to neuroscience and psychiatry, such as the nature of mental states and cognitive processes, or the relationships between mental states and the world. Anticipating the accumulation of experimental data from neuroscience, it provides a framework for the generation of theories in cognitive science. Philosophy of mind has thus laid the foundations of the conceptual space within which cognitive sciences have spread: a large part of contemporary theories in cognitive science result from a hybridization of conceptions forged by philosophers of mind and data produced by neuroscientists. Yet contemporary psychiatry is still reluctant to feed on the philosophy of mind, other than through the fragments that emerge from neuroscience. In this paper, we describe the evolution of contemporary philosophy of mind, and we detail its contributions around three central themes for psychiatry: naturalization of mind, mental causality, and subjectivity of mental states. We show how philosophy of mind provide the conceptual framework to link different levels of explanation in psychiatry: from biological to functional, from neurophysiology to cognition, from matter to mind.

Diagnosis and causal explanation in psychiatry

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves.

Philosophy of Science Perspectives on Psychiatry for the Person

The WPA Program on Psychiatry for the Person calls for a more comprehensive approach to psychiatry in which conventional elements are combined with a specifically person centred extra ingredient. The World Psychiatric Association’s call to focus efforts on psychiatry for the person also coincides with proposals to revise both DSM and ICD taxonomies which are likely to stress the importance of improving their validity through the epistemic values exemplified in natural science. Thus the Program aims to balance a growing emphasis on the natural scientific underpinnings of psychiatry with an increased focus on the importance and role of the person. This proposal to balance natural science with the role of the person mirrors some of Karl Jaspers’ aims a century ago. At the turn of the century in Germany, psychiatry was dominated by academic neuroscientists working under the assumption, epitomised by the German psychiatrist Wilhelm Griesinger’s famous aphorism, that ‘Mental illnesses are brain illnesses’. Jaspers’ response was to stress the role of understanding in addition to explanation in psychiatry. This reflected the debate, called the Methodenstreit , about the correct methods for psychology in the late nineteenth century. Should the human sciences (the Geisteswissenschaften ) attempt to copy the methods of the natural sciences ( Naturwissenschaften ), or should they follow a distinct method or methods? Setting the development of the Program on Psychiatry for the Person against that background suggests the importance for it also of an understanding of the Methodenstreit .

Explanation in Psychiatry

Philosophy of psychiatry has boomed in the last few years. We are now seeing a growing literature on the nature of psychiatric explanation, including work that makes contact with longstanding disputes in the philosophy of science as well as more specific work on mental disorders. This paper looks at some recent work on both representing and explaining mental illness. An emerging picture sees explanation of mental disorder as first constructing causal-statistical networks that represent disease pathways as they unfold in time, and then choosing strategies for causal explanation. The epistemic problems in psychiatry are huge, and they arise from the extreme variety in the causes and trajectories of mental disorders across patients. Existing concepts of levels of explanation and mechanism may seem like an obvious epistemic armoury, but they may not fit psychiatry very well, and philosophical theories of psychiatric explanation stress different ways of trying to understand robust patterns amid the individual variation.

Psychiatry in the Scientific Imageby Dominic Murphy; Cambridge, Massachusetts, MIT Press, 2006, 422 pages, $35

Back to table of contents Previous article Next article Book ReviewFull AccessPsychiatry in the Scientific ImageJeffrey S. Barkin M.D.Jeffrey S. Barkin M.D.Search for more papers by this authorPublished Online:1 Mar 2008https://doi.org/10.1176/ps.2008.59.3.336AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Dominic Murphy is assistant professor of psychiatry in the Department of Philosophy, California Institute of Technology. His Psychiatry in the Scientific Image is a scholarly and rigorous volume that straddles clinical psychiatry and the boundaries of scientific theory. What emerges is a thorough discussion of psychiatric disorders at a deep theoretic level. Murphy attempts, largely successfully, to understand and classify mental disorders. He tackles theoretic underpinnings in the cognitive neurosciences to foster a deeper philosophic description of what constitutes a mental illness. He takes us on a rigorous journey suggesting that categorical descriptions detract from allowing a deep understanding of mental phenomena. He posits that understanding psychiatric diagnosis must instead be rigorously defined by the scientific method and incorporate explanation from the cognitive neurosciences. We are shortchanged by atheoretic systems, such as the DSM , he argues, as we fail to adequately describe and understand what a mental disorder even is. Murphy starts the book by defining what constitutes a mental disorder. At what point are certain unusual behaviors considered to be psychiatric disorders? Though persons with Tourette's syndrome demonstrate behavioral symptoms they are not psychotic. Motoric behaviors are not a departure from the reality that defines a psychotic state. Indeed, the categorical taxonomic description detracts from permitting an understanding of etiologic causality.Murphy then draws upon the work of Guze and Kandel to define the medical model of explanation in psychiatry. Indeed, his description of Kandel's framework of biologic psychiatry is one of the excellent sections in this volume, and he chooses the work of Kandel as a model of scientific reductionism. Murphy then describes the work of Nancy Andreasen to define cognitive neuroscience as a series of convergences from numerous disparate models. He then makes a transition to define the very boundaries of mechanistic explanation of psychosis, addiction, and psychopathy. This section of the book is derived more from philosophy than psychiatry and is more difficult to grasp.Murphy then segues into a theory of explanatory power that is more intellectually rigorous than simple construct validity. Indeed, in this section his central idea is realized: we must strive to understand psychiatric conditions based upon a group of symptoms that derive from understanding the causal features of normal mental functioning. Rather than a simple categorical description, we will be on firmer ground if we instead view mental disorders based upon underlying etiologies.This volume is provocative in its intellectual indictment of conventional methods of classifying mental disorders. Murphy strives to understand psychiatric illness from the lens of normal mind- and brain-based behavior. This volume is not readily accessible to the clinically focused reader but will instead be of interest to students of cognitive neuroscience and hypothesis testing related to diagnostic classification.Dr. Barkin is in private practice in Portland, Maine. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 3 March, 2008Pages 336-336PSYCHIATRIC SERVICES March 2008 Volume 59 Number 3 Metrics History Published online 1 March 2008 Published in print 1 March 2008

Diagnostic understanding and diagnostic explanation in psychiatry

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Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry

Conceptual dichotomies between mind and brain, psychology and neuroscience, meaning and causation, and fact and value confound thinking in philosophy of mind, clinical psychiatry, and psychiatric ethics. Paul Churchland's theory of eliminative materialism highlights these dichotomies, stating that advances in neuroscience have restricted, and eventually will eliminate, any need for psychology. The core principles of this theory are questionable, because psychiatrists still need psychology and perhaps always will. The main argument in this essay is that even in cases of well-defined brain pathology (where eliminative materialism seems most plausible), psychological concepts remain critical. Thus, philosophers and psychiatrists should generate conceptual models that lead not to eliminativism but to explanatory pluralism, which is the pragmatic integration of diverse concepts toward the end of better handling clinical challenges. The contributions of Karl Jaspers in opposition to eliminative materialism and in support of pluralism are discussed. Jaspers delineated the role of meaningful psychological explanation in a psychiatry rooted in neuroscientific explanation. However, his notion that meaningful states do not have causal power is disputable and has come under fire in recent philosophy of mind and cognitive neuroscience, which highlight the possibility that meaningful psychological states can be causally significant. This idea has implications for psychiatric ethics and the fact/value debate.

Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry

Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry

Causal explanations in psychiatry: a critique of some current concepts.

The rules known as Koch's postulates have served as invaluable guides to the discovery of the specific causes of various infectious diseases. It may safely be assumed that their influence has also been great on the methods of study in the field of non-infectious diseases. For example, with slight modification Koch's postulates may be applied to the study of diseases caused by poisons. But can they be modified and applied with profit in psychiatric research? This is an important problem, and it cannot be discussed without reference, explicit or implicit, to philosophical assumptions. In this paper some consequences of the philosophy of science of Sir Karl Popper will be tentatively explored.