- Full Text
- Scholarly Journal
Symptoms are not the solution but the problem: Why psychiatric research should focus on processes rather than symptoms
Full text preview
Historically, biomedical research has oscillated between two principle scientific paradigms: mapping of phenomena to remote causes versus rejecting the intelligibility of such remote causes and pursuing a taxonomy on the level of the phenomenon (Zachar & Kendler 2017). Most medical fields have settled successfully on the former paradigm, but in psychiatry, the pendulum continues to swing. The rejection of a biological reduction of psychiatric phenomena and the retreat to discretional mapping of symptoms, as follows from Borsboom et al.’s argumentation in the target article, is in line with the currently observed swing-back of the pendulum to the latter paradigm. This motion is motivated by the valid negative critique of the limited therapeutic success that biological research in psychiatry has had and is conceptually grounded in non-reductive materialism. Specifically, the authors argue: “Currently, there is no compelling evidence for the viability of reducing mental disorders to unique biological abnormalities” (target article, sect. 1, para. 4). They conclude that this reasons against distinct biological causes for mental disorders. Although we agree with the premise, both from an empirical and a theoretical perspective, we do not agree that the conclusion is justified. Both historical evidence from biological reduction in other fields of medicine (Kotchen 2011) and the principle of minimal assumptions (Ockham's razor) favor the alternate conclusion that it is not the assumption of biological causes, but the artificial and arbitrary labeling of mental disorders that is problematic. Artificial, ever-changing definitions are unlikely to lead to a biologically coherent cause – or biological correlate (Katahira & Yamashita 2017). We agree with Borsboom et al. that a research paradigm that tries to unravel the causes of such artificial entities is flawed by essentialism; however, shifting the focus from disorders (i.e., symptom-aggregates) to symptoms inherits the problem of essentialism: For what is a symptom? A symptom...