The Ontological Assumptions of Psychiatry

On the ontological assumptions of the medical model of psychiatry: philosophical considerations and pragmatic tasks

Tejas Patil, James Giordano

Philosophy, Ethics, and Humanities in Medicine 2010, 5:3

Full Text Available here.


Abstract
A common theme in the contemporary medical model of psychiatry is that pathophysiological processes are centrally involved in the explanation, evaluation, and treatment of mental illnesses. Implied in this perspective is that clinical descriptors of these pathophysiological processes are sufficient to distinguish underlying etiologies. Psychiatric classification requires differentiation between what counts as normality (i.e.- order), and what counts as abnormality (i.e.- disorder). The distinction(s) between normality and pathology entail assumptions that are often deeply presupposed, manifesting themselves in statements about what mental disorders are.
In this paper, we explicate that realism, naturalism, reductionism, and essentialism are core ontological assumptions of the medical model of psychiatry. We argue that while naturalism, realism, and reductionism can be reconciled with advances in contemporary neuroscience, essentialism - as defined to date - may be conceptually problematic, and we pose an eidetic construct of bio-psychosocial order and disorder based upon complex systems’ dynamics. However we also caution against the overuse of any theory, and claim that practical distinctions are important to the establishment of clinical thresholds. We opine that as we move ahead toward both a new edition of the Diagnostic and Statistical Manual, and a proposed Decade of the Mind, the task at hand is to re-visit nosologic and ontologic assumptions pursuant to a re-formulation of diagnostic criteria and practice.


This is an interesting paper, especially their treatment of essentialism and the impressive way in which they associate epistemological demands with clinical realities(see the Conclusion). They also present a very good systems theory approach to understanding why psychiatric diagnosis will never have the precision we would like. Below I will address some of their statements but be warned, the paper should be read in full; and carefully. There are some difficult issues here, beware of what seems plausible. As the authors note:

In other words, naturalistic intuitions are not evidence of their content.

The Truth About Stress

Author: Angela Patmore
Publisher: Atlantic Books, London, 2006

About the Author:

Former University of East Anglia research fellow and International Fulbright Scholar. Her book, Sportsmen Under Pressure(1986) was a Times sports book of the year. The Truth About Stress was shortlisted for the MIND Book of the Year Award 2007.





General Thesis

1. Stress is a bad concept. Not defined.
2. The stress response has been pathologised but is vital to our survival.
3. We are medicalising a response to contingencies when we should be managing those responses to contingencies.
4. That most drugs to treat anxiety and stress are next to useless if not dangerous.
5. That the stress industry is largely un-regulated and is costing governments, business, and individuals too much money.
6. That the best approach to managing stress is to introduce people to stress. Inurement. Basically, train people to cope with stressful events.

page 81
"This [steady state hypothesis of physiology -Cannon's] has led to the fight-or-flight mechanism being viewed as a hard-wired, primitive, malfunctioning sort of bodily self-destruct system, that is even referred to in some of the literature as 'the fight-or-flight syndrome', as though the survival mechanism were an illness."