The metaphysics of mental disorder

Psychiatry is caught in a number of philosophical errors. One is reductionism, as psychiatry tends to look for the underlying biological causes of mental disorders. The other is dualism, as it sees mental disorders as either being caused by our brain or being caused by our mind. Both of these errors are the result of seeing the world as made up of a hierarchy of things. Instead, if psychiatry viewed the world as fundamentally composed of processes, dynamically interacting with each other, a much more nuanced understanding of mental disorders would become available, argues Elly Vintiadis.

Following in the tradition of Democritus and the atomists, mainstream metaphysics in the West saw the world as made up of things which are in turn made up of smaller things – and so on to the end. This, however, is only one possible way of seeing the world. Another is that of Heraclitus who said that everything flows. According to this view, the world is constantly in motion and made up of a hierarchy of intertwined processes that exist on different time scales. For example, a human organism whose properties change throughout its development is a process, but more extensive than the underlying process of cell renewal that our body constantly undergoes.

Obviously there is change and there are processes even in non-process metaphysics, for example, we talk about events, like my ball throwing. In such a context, it is generally understood that the changes which occur during the processes are changes undergone by a durable subject (for example, a person whose properties change). In contrast, in process metaphysics, dynamically interacting processes are the underlying nature of all that we experience as stable. The key to this debate is to oppose a static vision to a dynamic vision of the ultimate constituents of reality. This distinction may help us see how many of the errors of modern psychiatry rest on traditional metaphysics, and thus motivate a shift to process metaphysics for a better understanding of mental disorders.

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There is no underlying biological cause for major depression – it can result from a number of possible causal pathways.

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If we think of the world as a hierarchy of different levels of organization, as is often the case when we think in terms of things, we often think in terms of “lower” levels determining the properties of the “lower” levels. superiors”. This can easily lead to the idea that the lower levels are the (only) truly causal ones. In psychiatry, this reductionist image is reflected in the biomedical model which aims to discover the biological causes of patients’ symptoms, focusing on the brain as the locus of mental disorders. This can lead, in turn, to the essentialism of mental disorders. In other words, it makes us wonder what a mental disorder is really that is, what is its biological “essence”, or what all cases of a particular disorder have in common – the causative agent of their symptoms.

However, we have failed to reduce mental disorders to disorders of the brain, nor to find their “essence”. Most mental disorders are multicausal (caused by many factors) and causally heterogeneous (the same illness can be caused by different combinations of factors) and evidence shows that the onset and post-onset course of many disorders are caused by environmental, social and cultural factors. . For example, there is no underlying biological cause for major depression – it can result from a number of possible causal pathways.

What is true of mental disorders is that they take time to develop and they affect people, not just brains, who have genetic predispositions, but who also have a personal history and construct a narrative of their experiences – that is, they have explanatory patterns through which they use to make sense of their condition and which, in turn, may play an active role in perpetuating mental disorders. So to understand mental disorders, we need to consider these factors and understand patients’ life experiences, values, goals and narratives, and their brains.




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Beyond the problematic search for essences and ultimate levels of reduction, another problem in psychiatry that often goes unnoticed is dualism: we still tend to view psychiatric illnesses as either cerebral or mental. This dualism is also found in our attributions of responsibility and blame; the more a disorder is perceived to have psychological or environmental/social causes, the more the patient is seen as blameworthy and responsible for it. While if the disorder is considered biological, it is the opposite: it is generally considered beyond the control of the person. In addition to this, dualistic thinking underpins the conventional dichotomies of nature versus nurture and biology versus nurture that attempt to establish which of the two in each dichotomy is more fundamental, often giving secondary importance to anything related to the broader social context.

These three problems of essentialism, reductionism and dualism, do not necessarily go hand in hand with a non-processual metaphysics, but they are only possible within such frameworks. By embracing process metaphysics, we can explain why questions such as whether a disorder has biological or social causes or what a disorder is it’s true, are ill-posed while providing a context in which such questions do not arise. Because mental disorders are complex phenomena that manifest in different ways, operate on different time scales, and emerge through various causal pathways, they are best understood as processes, consisting of a set of processes that interact in nonlinear ways. .

At the same time, the metaphysics of the processes can base the criticism of the biomedical and biopsychosocial model of the mental disorders, while allowing us to improve this last. If the world is, indeed, fundamentally made up of processes rather than things, any reductionist model like the biomedical model, and any model that does not approach mental disorders in a multidimensional way, cannot do justice to the complexity of a such world. On the other hand, although the biopsychosocial model integrates biological, psychological and environmental factors when trying to understand mental disorders, in practice it remains static and fragmented, arguably, by virtue of the metaphysical framework in which it is inscribed. Conventional dichotomies between nature and nurture, and biology and nurture are embedded in this model, despite the fact that it attempts to highlight the importance of their interaction.

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The complexity of mental disorders makes the very question of whether their causes are physical, mental or social overly simplistic.
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On the other hand, because the processes do not have rigid boundaries, but interrelate in a multidirectional way and support each other in a dynamic way, we cannot correctly speak of distinct ontological levels, and even less of a hierarchy, of so that the dichotomies that arise in the metaphysics of things are unavailable in a process framework. In such a framework, a person is the product of a continuous process of development, so rather than thinking in terms of different factors belonging to different domains, for example the biological and the social acting on each other, in a process framework, we can see the person as a unified process embedded in an environment. Such a vision can add a more dynamic aspect to the biopsychosocial model, thus helping to improve it.

A mental disorder is never purely biological or purely psychological or purely psychosocial; the complexity of mental disorders makes the very question of whether their causes are physical, mental or social overly simplistic. This means that we cannot choose one process or level as ontologically more fundamental than another and it also means that we cannot exclude a component a priori when trying to understand a disorder. Addiction, for example, cannot be understood without taking into account the person’s character, background, past experiences and social environment, as well as the way the patient himself experiences his addiction. The physiological changes in the brain during addiction are important, but they alone will not explain why a person became addicted or remained addicted. For this, we also need to have an idea of ​​what motivated drug use and what helped to maintain it.


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A view that naturally follows from process metaphysics is that. To understand mental disorders, we need to see them as dynamic and physically, socially and historically situated. That is to say, we have to tackle the specific embodied the person who is in a specific socio-cultural reality related to it in a specific way; not as subject to opposing forces, but as a whole in which all these aspects work together and are shaped over time. Disorders are essentially dynamic and there is no way to pin down a person’s disordered state into one or more stable characteristics. But this is not an accidental characteristic of them – because of the way they arise from events in people’s lives and ongoing interactions, they cannot be understood simply in terms of a succession of states.

Thus, one of the advantages of adopting a processual metaphysics is that it makes it possible to better apprehend the complexity of mental disorders and to draw up a dynamic picture of them, which is not always easy to do in a metaphysical framework. process. Moreover, thinking about mental disorders in a different conceptual framework requires addressing the many levels that interact to cause them, thus a metaphysics of processes requires a pluralistic explanatory approach but also opens the way to better treatment and prevention options.

In terms of explanation, because mental disorders are multilevel phenomena, we need to approach the whole process at different levels of abstraction, different time scales with different methodological tools. This in turn involves a diverse allocation of funds for research – including research into how non-medical services can improve mental health outcomes.. In terms of treatment, process metaphysics leads naturally away from a one-size-fits-all approach and towards pluralistic, flexible, person-centered therapy. Such an approach to therapy may not be a unique feature of process metaphysics, but it is a direct implication of a process-based ontology and, in this sense, it can help to anchor and explain existing points of view.

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