Explanatory Models for Psychiatric Illness

Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, Richmond, VA 23298-0126, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 07/2008; 165(6):695-702. DOI: 10.1176/appi.ajp.2008.07071061
Source: PubMed

ABSTRACT How can we best develop explanatory models for psychiatric disorders? Because causal factors have an impact on psychiatric illness both at micro levels and macro levels, both within and outside of the individual, and involving processes best understood from biological, psychological, and sociocultural perspectives, traditional models of science that strive for single broadly applicable explanatory laws are ill suited for our field. Such models are based on the incorrect assumption that psychiatric illnesses can be understood from a single perspective. A more appropriate scientific model for psychiatry emphasizes the understanding of mechanisms, an approach that fits naturally with a multicausal framework and provides a realistic paradigm for scientific progress, that is, understanding mechanisms through decomposition and reassembly. Simple subunits of complicated mechanisms can be usefully studied in isolation. Reassembling these constituent parts into a functioning whole, which is straightforward for simple additive mechanisms, will be far more challenging in psychiatry where causal networks contain multiple nonlinear interactions and causal loops. Our field has long struggled with the interrelationship between biological and psychological explanatory perspectives. Building from the seminal work of the neuronal modeler and philosopher David Marr, the author suggests that biology will implement but not replace psychology within our explanatory systems. The iterative process of interactions between biology and psychology needed to achieve this implementation will deepen our understanding of both classes of processes.

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    • "I remarked above that combining the perspectives of different levels into coherent explanations of mental illness is a difficult task. Whilst impressive work has been done—particularly by Kenneth Kendler (e.g. 2008, 2012) and by Kendler and John Campbell (e.g. 2009, 2014)—to demonstrate the need for multi-level explanations in psychiatry and to consider how they are best formulated, the question of what makes a good explanation for a given purpose has been ignored. We know, for example, that some cases of depression are best explained primarily in"
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    ABSTRACT: Multilevel explanations abound in psychiatry. However, formulating useful such explanations is difficult or (some argue) impossible. I point to several ways in which Lane et al. successfully use multilevel explanations to advance understanding of psychotherapeutic effectiveness. I argue that the usefulness of an explanation depends largely on one's purpose, and conclude that this point has been inadequately recognised in psychiatry. How to Cite This Article Link to This Abstract Blog This Article Copy and paste this link Highlight all Citation is provided in standard text and BibTeX formats below. Highlight all BibTeX Format @article{BBS:9749968,author = {Roache,Rebecca},title = {How does psychotherapy work? A case study in multilevel explanation},journal = {Behavioral and Brain Sciences},volume = {38},month = {1},year = {2015},issn = {1469-1825},doi = {10.1017/S0140525X14000284},URL = {},} Click here for full citation export options. Blog This Article Copy and paste this code to insert a reference to this article in your blog or online community profile: Highlight all How does psychotherapy work? A case study in multilevel explanation Rebecca Roache (2015). Behavioral and Brain Sciences , Volume 38 , January 2015e23 The code will display like this How does psychotherapy work? A case study in multilevel explanation Rebecca Roache (2015) Behavioral and Brain Sciences, , Volume 38, January 2015e23 Rebecca Roache (2015). How does psychotherapy work? A case study in multilevel explanation. Behavioral and Brain Sciences, 38, e23 doi:10.1017/S0140525X14000284 Metrics Related Content Related Articles
    Behavioral and Brain Sciences 05/2014; Forthcoming. DOI:10.1017/S0140525X14000284 · 20.77 Impact Factor
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    • "But, it is unclear to me that it is “valid” to conceive of mental disorders primarily in terms of simplistic singularly determining etiologies when accumulating empirical evidence indicates that the signs and symptoms of mental disorders develop in a highly contingent manner through complex interactions between biological factors and the environment. As Kendler [43] notes, social and cultural factors and the agency of the person with illness become entwined in their own right as pertinent, but not singular, explanatory factors. "
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    ABSTRACT: In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM--whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
    Philosophy Ethics and Humanities in Medicine 04/2012; 7:8. DOI:10.1186/1747-5341-7-8
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    • "edisch handelen opleidingselementen zijn, wordt impliciet de visie naar voren gebracht dat de inhoud van het kennisonderwijs gekoppeld is aan diagnostische classificatiesystemen (zie hiertoe de bijlagen III t/m VIII). De validiteit en de betrouwbaarheid van de huidige diagnostische en classificatiesystemen worden ernstig bekritiseerd (Ghaemi 2009; Kendler e.a. 2008; Van Praag 2008). Gegeven onze visie op psychiatrie ligt het meer voor de hand om de mechanismen als primaire oriëntatie te gebruiken in het onderwijs. Hoe effectief onderwijs is, is afhankelijk van de participatie van de studenten, de interactie met een peergroep (Naranjo e.a. 1997) en de interactie tussen student en docent (Lathers & "
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    ABSTRACT: The curriculum for the Academic Training Course in Psychiatry in South- Limburg (UOP-ZL) needed to be modernised. There were widely differing views about the purpose and function of psychiatry and about the structure of the curriculum. Trainees failed to attend regularly because of their daily duties. Following discussion about the need for modernisation of the course in Psychiatry (HOOP), the UOP-ZL curriculum was thoroughly revised and updated. Further development of HOOP, a careful study of the teaching material and discussion among members of UOP-ZL and the Mental Health Service in Eindhoven, led to the development of more unified views about psychiatry and produced the ingredients for a revised curriculum for training in psychiatry. In the early stages of their course, trainees are introduced to some basic principles; these include understanding the mechanisms for dimensions of affect, motivation, salience and cognition from a biological, cognitive and ecological perspective, and perceiving the relationship between these factors and normal and abnormal behaviour. The course is a mix of problem based learning and interactive classroom teaching and is delivered by clinical and scientific experts. Every two weeks the trainees in each year-group are given a whole day 'free' (i.e. free of normal duties) when they are required to attend classed and lectures. The two main results of the new curriculum are: diagnosis-related teaching has been replaced by an approach based on explanatory mechanisms for dimensional psychopathology and dysfunction, and the tuition provided is both problem-based and interactive and is given by expert teachers.
    Tijdschrift voor psychiatrie 01/2012; 54(3):267-77.
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