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41 - Psychiatric Discourse: Scientific Reductionism for the Autonomous Person

from Section 14

Published online by Cambridge University Press:  02 April 2020

By
Stephan Heckers
Edited by
Kenneth S. Kendler ,
Josef Parnas  and
Peter Zachar
Kenneth S. Kendler
Affiliation:
Virginia Commonwealth University
Josef Parnas
Affiliation:
University of Copenhagen
Peter Zachar
Affiliation:
Auburn University, Montgomery
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Summary

Scientific reductionism is necessary for progress in psychiatry. The psychiatric clinician reduces complex mental states and behaviors into diagnosis and formulation before considering the need for and the modality of treatment. The psychiatric researcher explains human behavior with mechanistic models of disease progression and outcome. The resulting psychiatric discourse is confusing, with competing explanatory models, terminologies, and treatment philosophies. Here I will develop the idea that hypothesis testing in psychiatry is shaped by two questions: 1) How strongly can we reduce mental states and behavior? and 2) How much does the person seek and require treatment?If answers to these questions are aligned, it facilitates research and preserves autonomy. Misalignment impedes scientific progress and leads to wasteful debates. Psychiatry needs to balance scientific reductionism with respect of agency and self-efficacy.

Keywords

psychopathologypsychiatric interviewpsychiatric diagnosisnosologypsychiatric researchneuroscienceshared decision makingagency
Type
Chapter
Information
Levels of Analysis in Psychopathology
Cross-Disciplinary Perspectives
 , pp. 495 - 509
Publisher: Cambridge University Press
Print publication year: 2020

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References

Allen, P., Modinos, G., Hubl, D., Shields, G., Cachia, A., Jardri, R., … Hoffman, R. (2012) ‘Neuroimaging auditory hallucinations in schizophrenia: From neuroanatomy to neurochemistry and beyond.’ Schizophrenia Bulletin, 38(4), 695–703.Google Scholar
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Publishing.Google Scholar
Andreasen, N. C. (2007) ‘DSM and the death of phenomenology in America: An example of unintended consequences.’ Schizophrenia Bulletin, 33(1), 108–112.CrossRefGoogle ScholarPubMed
Baron-Cohen, S. (2017) ‘Editorial perspective: Neurodiversity – A revolutionary concept for autism and psychiatry.’ Journal of Child Psychology and Psychiatry, 58(6), 744–747.CrossRefGoogle ScholarPubMed
Baxter, L. R. Jr., Phelps, M. E., Mazziotta, J. C., Guze, B. H., Schwartz, J. M., & Selin, C. E. (1987) ‘Local cerebral glucose metabolic rates in obsessive-compulsive disorder. A comparison with rates in unipolar depression and in normal controls [published erratum appears in Arch Gen Psychiatry 1987 Sep;44(9):800] [see comments].’ Archives of General Psychiatry, 44(3), 211–218.CrossRefGoogle Scholar
Binswanger, L. (1957) Der Mensch in der Psychiatrie. Pfullingen: Neske.Google Scholar
Bracken, P., Thomas, P., Timimi, S., Asen, E., Behr, G., Beuster, C., … Yeomans, D. (2012) ‘Psychiatry beyond the current paradigm.’ British Journal of Psychiatry, 201(6), 430–434.CrossRefGoogle ScholarPubMed
Brewer, A. A., & Barton, B. (2016) ‘Maps of the auditory cortex.’ Annual Review of Neuroscience, 39, 385–407.CrossRefGoogle ScholarPubMed
Broome, M. R., Harland, R., Owen, G. S., & Stringaris, A. (Eds.). (2013) The Maudsley reader in phenomenological psychiatry. Cambridge, UK: Cambridge University Press.Google Scholar
Chung, J. Y., & Insel, T. R. (2014) ‘Mind the gap: Neuroscience literacy and the next generation of psychiatrists.’ Academic Psychiatry, 38(2), 121–123.CrossRefGoogle ScholarPubMed
Dierks, T., Linden, D. E., Jandl, M., Formisano, E., Goebel, R., Lanfermann, H., & Singer, W. (1999) ‘Activation of Heschl’s gyrus during auditory hallucinations.’ Neuron, 22(3), 615–621.CrossRefGoogle ScholarPubMed
Engel, G. L. (1980) ‘The clinical application of the biopsychosocial model.’ American Journal of Psychiatry, 137(5), 535–544.Google ScholarPubMed
Engstrom, E. J. (2004) Clinical psychiatry in imperial Germany: A history of psychiatric practice. Ithaca, NY: Cornell University Press.Google Scholar
Foucault, M. (1984) ‘What is enlightenment?’ In Rabinow, P. (Ed.), The Foucault reader (pp. 32–50). New York: Pantheon Books.Google Scholar
Foucault, M. (2006) Psychiatric power. Lectures at the College de France, 1973–1974. New York City: Picador.Google Scholar
Fuchs, T. (2014) ‘Brain mythologies. Jasper’s critique of reductionism from a current perspective.’ In Fuchs, T. (Ed.), Karl Jasper’s philosophy and psychopathology (pp. 75–84). New York: Springer.CrossRefGoogle Scholar
Fusar-Poli, P. (2015) ‘The enduring search for the Koplik spots of psychosis.’ JAMA Psychiatry, 72(9), 863–864.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Hijazi, Z., Stahl, D., & Steyerberg, E. W. (2018) ‘The science of prognosis in psychiatry: A review.’ JAMA Psychiatry, 75(12), 1280–1288.Google Scholar
Ghaemi, S. N. (2003) The concepts of psychiatry: A pluralistic approach to the mind and mental illness. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Havens, L. (2005) Psychiatric movements. From sects to science. New Brunswick: Transaction Publishers.Google Scholar
Heckers, S. (2017) ‘Project for a scientific psychiatry: Neuroscience literacy.’ JAMA Psychiatry, 74(4), 315.Google Scholar
Helmers, S. L., Phillips, V. L., & Esper, G. J. (2010) ‘Translational medicine in neurology: The time is right.’ Archives of Neurology, 67(10), 1263–1266.CrossRefGoogle ScholarPubMed
Honig, L. S. (2012) ‘Translational research in neurology: Dementia.’ Archives of Neurology, 69(8), 969–977.Google Scholar
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … Wang, P. (2010) ‘Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders.’ The American Journal of Psychiatry, 167(7), 748–751.CrossRefGoogle Scholar
Insel, T. R., & Quirion, R. (2005) ‘Psychiatry as a clinical neuroscience discipline.’ JAMA, 294(17), 2221–2224.CrossRefGoogle ScholarPubMed
Jardri, R., Pouchet, A., Pins, D., & Thomas, P. (2011) ‘Cortical activations during auditory verbal hallucinations in schizophrenia: A coordinate-based meta-analysis.’ The American Journal of Psychiatry, 168(1), 73–81.Google Scholar
Jaspers, K. (1913) Allgemeine Psychopathologie (9th ed., 1973). Berlin: Springer-Verlag.Google Scholar
Jones-Davis, D. M., & Macdonald, R. L. (2003) ‘GABA(A) receptor function and pharmacology in epilepsy and status epilepticus.’ Current Opinion in Pharmacology, 3(1), 12–18.Google Scholar
Jutel, A. (2009) ‘Sociology of diagnosis: A preliminary review.’ Sociology of Health and Illness, 31(2), 278–299.CrossRefGoogle ScholarPubMed
Kant, I. (1784) ‘Beantwortung der Frage: Was ist Aufklärung?’ Berlinische Monatsschrift, 12, 481–494.Google Scholar
Kendler, K. S. (1990) ‘Toward a scientific psychiatric nosology. Strengths and limitations.’ Archives of General Psychiatry, 47(10), 969–973.Google Scholar
Kraemer, H. C. (2013) ‘Validity and psychiatric diagnoses.’ JAMA Psychiatry, 70(2), 138–139.Google Scholar
Kraepelin, E. (1913) Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Achte, vollständig umgearbeitete Auflage. 3. Band. Klinische Psychiatrie. 2. Teil. Leipzig: Verlag von Johann Ambrosius Barth.Google Scholar
Linscott, R. J., & van Os, J. (2013) ‘An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders.’ Psychological Medicine, 43(6), 1133–1149.Google Scholar
Luhrmann, T. M. (2001) Of two minds: The growing disorder in American psychiatry. New York: Knopf.Google Scholar
Makari, G. J. (2008) Revolution in mind: The creation of psychoanalysis. New York: Harper Collins.Google Scholar
McGrath, J. J., Saha, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., … Kessler, R. C. (2015) ‘Psychotic experiences in the general population: A cross-national analysis based on 31,261 respondents from 18 countries.’ JAMA Psychiatry, 72(7), 697–705.Google Scholar
McHugh, P. R., & Slavney, P. R. (1998) The perspectives of psychiatry. Baltimore, MD: Johns Hopkins University Press.CrossRefGoogle Scholar
Obeso, J. A., Stamelou, M., Goetz, C. G., Poewe, W., Lang, A. E., Weintraub, D., … Stoessl, A. J. (2017) ‘Past, present, and future of Parkinson’s disease: A special essay on the 200th anniversary of the shaking palsy.’ Movement Disorders, 32(9), 1264–1310.CrossRefGoogle ScholarPubMed
Parnas, J., Sass, L. A., & Zahavi, D. (2013) ‘Rediscovering psychopathology: The epistemology and phenomenology of the psychiatric object.’ Schizophrenia Bulletin, 39(2), 270–277.Google Scholar
Parsons, T. (1951) The social system. New York: Free Press.Google Scholar
Reynolds, C. F., 3rd, Lewis, D. A., Detre, T., Schatzberg, A. F., & Kupfer, D. J. (2009) ‘The future of psychiatry as clinical neuroscience.’ Academic Medicine, 84(4), 446–450.Google Scholar
Rosenberg, C. E. (2006) ‘Contested boundaries: Psychiatry, disease, and diagnosis.’ Perspectives in Biology and Medicine, 49(3), 407–424.CrossRefGoogle ScholarPubMed
Sass, L. A. (2007) ‘‘Schizophrenic person’ or ‘person with schizophrenia’?’ Theory & Psychology, 17(3), 395–420.CrossRefGoogle Scholar
Schmitt, W. (1983) ‘Das Modell der Naturwissenschaft in der Psychiatrie im Übergang vom 19. zum 20. Jahrhundert.’ Berichte der Wissenschaftsgeschichte, 8, 89–101.CrossRefGoogle Scholar
Schneider, K. (1919) ‘Reine Psychiatrie, symptomatische Psychiatrie und Neurologie.’ Zeitschrift für die gesamte Neurologie und Psychiatrie, 49, 159–166.CrossRefGoogle Scholar
Schneider, K. (1959) Clinical psychopathology. New York: Grune & Stratton.Google Scholar
Slade, M. (2017) ‘Implementing shared decision making in routine mental health care.’ World Psychiatry, 16(2), 146–153.Google Scholar
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … Whitley, R. (2014) ‘Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems.’ World Psychiatry, 13(1), 12–20.CrossRefGoogle ScholarPubMed
Solomon, M. (2015) Making medical knowledge. Oxford: Oxford University Press.Google Scholar
Strik, W., & Dierks, T. (2011) Biologische Psychopathologie. Stuttgart: Verlag W. Kohlhammer.Google Scholar
Szasz, T. S. (1961) The myth of mental illness: Foundations of a theory of personal conduct. New York: Dell.Google Scholar
Trull, T. J., & Durrett, C. A. (2005) ‘Categorical and dimensional models of personality disorder.’ Annual Review of Clinical Psychology, 1, 355–380.Google Scholar
Waters, F., Allen, P., Aleman, A., Fernyhough, C., Woodward, T. S., Badcock, J. C., … Laroi, F. (2012) ‘Auditory hallucinations in schizophrenia and nonschizophrenia populations: A review and integrated model of cognitive mechanisms.’ Schizophrenia Bulletin, 38(4), 683–692.Google Scholar
Wernicke, C. (1880) Über den wissenschaftlichen Standpunkt in der Psychiatrie. Kassel: Fischer.Google Scholar
Wernicke, C. (2000) Grundriss der Psychiatrie. Nijmegen: Arts & Boeve Verlag.Google Scholar
World Health Organization. (1992) ICD-10 classifications of mental and behavioural disorders. Geneva: World Health Organization.Google Scholar
Zolnierek, C. D. (2011) ‘Exploring lived experiences of persons with severe mental illness: A review of the literature.’ Issues in Mental Health Nursing, 32(1), 46–72.CrossRefGoogle ScholarPubMed

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