1
|
Stein DJ, Nielsen K, Hartford A, Gagné-Julien AM, Glackin S, Friston K, Maj M, Zachar P, Aftab A. Philosophy of psychiatry: theoretical advances and clinical implications. World Psychiatry 2024; 23:215-232. [PMID: 38727058 PMCID: PMC11083904 DOI: 10.1002/wps.21194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.
Collapse
Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kris Nielsen
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Anna Hartford
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne-Marie Gagné-Julien
- Centre for Research in Ethics, Canada Research Chair in Epistemic Injustice and Agency, Université du Québec à Montréal, Montreal, Canada
| | - Shane Glackin
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Awais Aftab
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
2
|
Ehring T, Limburg K, Kunze AE, Wittekind CE, Werner GG, Wolkenstein L, Guzey M, Cludius B. (When and how) does basic research in clinical psychology lead to more effective psychological treatment for mental disorders? Clin Psychol Rev 2022; 95:102163. [DOI: 10.1016/j.cpr.2022.102163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
|
3
|
Byrne EA. Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:371-379. [PMID: 32170570 PMCID: PMC7426317 DOI: 10.1007/s11019-020-09945-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Miranda Fricker's influential concept of epistemic injustice (Oxford University Press, Oxford, 2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one's predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
Collapse
|
4
|
Boardman J. Commentary on: Social versus biological psychiatry: It's time for integration! Int J Soc Psychiatry 2018; 64:624-625. [PMID: 29638178 DOI: 10.1177/0020764018767203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jed Boardman
- Department of Social Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
5
|
Vanyukov MM, Tarter RE, Conway KP, Kirillova GP, Chandler RK, Daley DC. Risk and resistance perspectives in translation-oriented etiology research. Transl Behav Med 2016; 6:44-54. [PMID: 27012252 DOI: 10.1007/s13142-015-0355-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Risk for a disorder and the mechanisms that determine its elevation, risk factors, are the focus of medical research. Targeting risk factors should serve the goal of prevention and treatment intervention. Risk, however, is but one of the aspects of liability to a disorder, a latent trait that encompasses effects of all factors leading to or from the diagnostic threshold. The coequal but opposite aspect of liability is resistance to a disorder. The factors that increase resistance and thus enable prevention or recovery may differ from those that elevate risk. Accordingly, there are nontrivial differences between research perspectives that focus on risk and on resistance. This article shows how this distinction translates into goals and methods of research and practice, from the choice of potential mechanisms tested to the results sought in intervention. The resistance concept also differs from those of "resilience" and "protective factors," subsuming but not limited to them. The implications of the concept are discussed using substance use disorder as an example and substantiate the need for biomedical research and its translation to shift to the resistance perspective.
Collapse
Affiliation(s)
- Michael M Vanyukov
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA.
| | - Ralph E Tarter
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Galina P Kirillova
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Dennis C Daley
- University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA
| |
Collapse
|
6
|
Prakash S, Sagar R. Psychiatric classification: Current debate and future directions. Asian J Psychiatr 2016; 20:15-21. [PMID: 27025466 DOI: 10.1016/j.ajp.2016.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/20/2016] [Accepted: 01/31/2016] [Indexed: 12/14/2022]
Abstract
Classification of health related conditions can be a complex task. This is particularly so in case of psychiatric disorders. The present paper reviews the fundamentals of psychiatric classification, including its basis, history, methods of evaluation, the journey so far and future directions. The various criticisms of current classificatory systems and possible solutions are discussed. Special reference to the research domain criteria (RDoC) approach has been made and implications discussed.
Collapse
Affiliation(s)
- Sathya Prakash
- Department of Psychiatry, All India Institute of Medical Sciences, 110029 New Delhi, India.
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, 110029 New Delhi, India
| |
Collapse
|
7
|
Abstract
This paper provides a comprehensive review of outcome studies and meta-analyses of effectiveness studies of psychodynamic therapy (PDT) for the major categories of mental disorders. Comparisons with inactive controls (waitlist, treatment as usual and placebo) generally but by no means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is little evidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence or psychosis. The strongest current evidence base supports relatively long-term psychodynamic treatment of some personality disorders, particularly borderline personality disorder. Comparisons with active treatments rarely identify PDT as superior to control interventions and studies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT to alternatives exist, but are small in number and often questionable in design. Reviews of the field appear to be subject to allegiance effects. The present review recommends abandoning the inherently conservative strategy of comparing heterogeneous "families" of therapies for heterogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients.
Collapse
Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
| |
Collapse
|
8
|
Licinio J, Wong ML. Molecular psychiatry: 20 years. Mol Psychiatry 2015; 20:545-7. [PMID: 25778473 DOI: 10.1038/mp.2015.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J Licinio
- South Australian Health and Medical Research Institute and Department of Psychiatry, School of Medicine, Flinders University, Adelaide, Australia
| | - M-L Wong
- South Australian Health and Medical Research Institute and Department of Psychiatry, School of Medicine, Flinders University, Adelaide, Australia
| |
Collapse
|
9
|
Broome MR, He Z, Iftikhar M, Eyden J, Marwaha S. Neurobiological and behavioural studies of affective instability in clinical populations: a systematic review. Neurosci Biobehav Rev 2015; 51:243-54. [PMID: 25662294 DOI: 10.1016/j.neubiorev.2015.01.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/04/2015] [Accepted: 01/26/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the neurobiological, psychophysical and behavioural measures of affective instability in clinical populations. DATA SOURCES A range of medical and psychological science electronic databases were searched (including MEDLINE, EMBASE, and PsycINFO). Hand searching and reference checking are also included. REVIEW METHODS Reviews, systematic reviews, experimental and cross-sectional studies, providing affective instability in neurobiological and behavioural measurements in clinical populations. Studies were selected, data were extracted and quality was appraised. RESULTS Twenty-nine studies were included, 6 of which were review studies (one a meta-analysis) and 23 of which were primary studies, across a wide variety of disorders including ADHD, bipolar affective disorder, schizophrenia, severe mood dysregulation, major depression, and borderline personality disorder. CONCLUSIONS The bulk of the studies converge on the role of the amygdala, particularly in borderline personality disorders, and how it connects with other areas of the brain. Future research needs to extend these findings across diagnoses and development.
Collapse
Affiliation(s)
- Matthew R Broome
- Department of Psychiatry, University of Oxford, Oxford, UK; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Zhimin He
- Department of Psychology, Institute of Psychiatry, King's College of London, London, UK
| | - Mashal Iftikhar
- Oxford University Medical School, University of Oxford, Oxford, UK
| | - Julie Eyden
- Department of Psychology, University of Warwick, Coventry, UK
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Early Intervention Service, Swanswell Point, Coventry and Warwickshire Partnership Trust, Coventry, UK
| |
Collapse
|
10
|
Affiliation(s)
- Giovanni Stanghellini
- Department of Psychological, Humanistic and Territorial Studies, G. d'Annunzio University, Chieti, Italy and Diego Portales University, Santiago, Chile
| | | |
Collapse
|